IBS不同亚型患者内脏高敏感与Hp感染的关联性差异及其对治疗反应的影响

Differences in the Association of Visceral Hypersensitivity with Hp Infection in Patients with Different Subtypes of IBS and Its Impact on Treatment Response

摘要: 目的：深入探究幽门螺杆菌(Hp)感染与肠易激综合征(IBS)患者内脏高敏感的相关性，明确不同亚型IBS在Hp感染方面存在的差异，以及各亚型对Hp根除治疗的响应情况。方法：263例IBS患者根据Rome IV标准分为便秘型IBS (IBS-C)组(n = 79例)、腹泻型IBS (IBS-D)组(n = 89例)、混合型IBS (IBS-M)组(n = 51例)、未定型IBS (IBS-U)组(n = 44例)，同期选择门诊健康体检者作为对照组(n = 80例)。检测IBS各亚组及对照组的HP感染阳性率；Hp阳性IBS患者均给予Hp根除治疗，比较各亚组疗效；比较Hp阳性IBS各亚组患者根除治疗前后症状积分、血清及结肠黏膜5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)表达水平、直肠肛管压力、直肠容量和感觉阈值检测结果，同时分析其与HP感染阳性率的相关性。结果：IBS-D组HP感染阳性率明显高于其他亚组及对照组(P < 0.05)，IBS-C组、IBS-M组、IBS-U组HP感染阳性率明显高于对照组(P < 0.05)；IBS-D组Hp阳性患者根除治疗的治疗总有效率明显高于其他亚组(P < 0.05)；根除治疗前，IBS-C组腹泻症状积分明显低于其他亚组(P < 0.05)，而腹胀症状积分明显高于其他亚组(P < 0.05)，IBS-D组腹泻症状积分和症状积分总分明显高于其他亚组(P < 0.05)，而腹胀症状积分明显低于IBS-M组和IBS-U组(P < 0.05)，各亚组血清5-HT表达水平均明显高于对照组(P < 0.05)，IBS-D组血清及结肠黏膜5-HT、CGRP表达水平均明显高于其他亚组(P < 0.05)，IBS-D组最大缩窄压、排便阈值均明显低于其他亚组(P < 0.05)，IBS-C组排便阈值均明显高于IBS-M组和IBS-U组，而IBS-C组松弛压、感知阈值、最大耐受量均明显高于其他亚组(P < 0.05)；根除治疗后，各亚组患者腹泻、腹痛、腹胀症状积分及症状积分总分均明显降低(P < 0.05；各亚组患者血清及结肠黏膜5-HT、CGRP表达水平均明显降低(P < 0.05)，IBS-D组最大缩窄压、排便阈值均明显升高(P < 0.05)，而IBS-C组松弛压、感知阈值、最大耐受量均明显降低(P < 0.05)。结论：Hp感染与IBS患者内脏高敏感显著相关，各亚型在Hp感染阳性率、症状及相关指标上差异明显，Hp根除治疗对IBS患者有效且IBS-D组疗效更佳，治疗后各亚型症状及相关指标均改善。

Abstract: Objective: To deeply explore the correlation between Helicobacter pylori (Hp) infection and visceral hypersensitivity in patients with irritable bowel syndrome (IBS), clarify the differences in Hp infection among different subtypes of IBS, and investigate the response of each subtype to Hp eradication therapy. Method: 263 IBS patients were divided into IBS-C group (n = 79 cases), IBS-D group (n = 89 cases), IBS-M group (n = 51 cases) and IBS-U group (n = 44 cases) according to the Rome IV criteria. At the same time, the outpatient healthy examinees were selected as the control group (n = 80 cases). The positive rate of Hp infection in each subgroup of IBS and the control group was detected. Hp positive IBS patients were all treated with Hp eradication therapy, and the efficacy of each subgroup was compared. The symptom scores, expression levels of serum and colonic mucosal 5-HT and CGRP, rectal anal pressure, rectal volume, and sensory threshold test results of Hp positive IBS patients in different subgroups before and after eradication treatment were compared. Their correlation with the positive rate of HP infection were analyzed. Results: The positive rate of Hp infection in the IBS-D group was significantly higher than that in other subgroups and the control group (P < 0.05). The positive rate of Hp infection in the IBS-C group, IBS-M group, and IBS-U group was significantly higher than that in the control group (P < 0.05). The total effective rate of eradication treatment for Hp positive patients in the IBS-D group was significantly higher than that of other subgroups (P < 0.05).Before eradication treatment, the diarrhea symptom score of IBS-C group was significantly lower than that of other subgroups(P < 0.05), while the abdominal distension symptom score was significantly higher than that of other subgroups (P < 0.05). The diarrhea symptom score and total symptom score of IBS-D group were significantly higher than that of other subgroups (P < 0.05), while the abdominal distension symptom score was significantly lower than those of IBS-M group and IBS-U group (P < 0.05). The serum 5-HT expression levels in each subgroup were significantly higher than those of the control group (P < 0.05), and the serum and colon mucosal 5-HT and CGRP expression levels in IBS-D group were significantly higher than those of other subgroups (P < 0.05). The maximum constriction pressure and defecation threshold of IBS-D group were significantly lower than those of other subgroups (P < 0.05). The defecation threshold of the IBS-C group was significantly higher than that of the IBS-M and IBS-U groups (P < 0.05), while the relaxation pressure, perception threshold, and maximum tolerance of the IBS-C group were significantly higher than those of other subgroups (P < 0.05). After eradication treatment, the symptom scores of diarrhea, abdominal pain, and bloating in each subgroup of patients were significantly reduced (P < 0.05). The expression levels of 5-HT and CGRP in serum and colon mucosa in each subgroup of patients were significantly reduced (P < 0.05). The maximum constriction pressure and defecation threshold in the IBS-D group were significantly increased (P < 0.05), while the relaxation pressure, perception threshold and maximum tolerance in the IBS-C group were significantly reduced (P < 0.05). Conclusion: Hp infection is significantly associated with visceral hypersensitivity in patients with IBS. There are obvious differences among various subtypes in terms of Hp infection positive rate, symptoms, and related indicators. Hp eradication therapy is effective for IBS patients, and the curative effect is better in the IBS-D group. After treatment, the symptoms and related indicators of all subtypes are improved.