肠易激综合征与性别相关性激素水平及免疫调节因素的关系
|
摘要
目前临床观察发现肠易激综合征(irritable bowel syndrome,IBS)存在性别差异,且经流行病学调查结果证实IBS男女发病比例约为1∶2.而目前对于I B S机制的相关研究并未针对性别开展有针对性的研究,故我们通过查阅相关文献对可能影响该病性别差异的几种因素如性激素及其受体、促肾上腺皮质激素释放因子和免疫因素等进行整理分析,以期为阐释IBS发病的性别差异提供依据,以帮助明确IBS病因和发病机制,最终为临床靶向治疗提供更精准的策略.
Clinically,it has been found that there exist sex differences in irritable bowel syndrome(IBS).Epidemiological evidence confirms that the ratio of males to females with IBS is about1:2.Previous research on the mechanism of IBS rarely focused on such sex differences.In order to provide a basis for explaining the sex differences in IBS,the authors analyzed the relevant literature and found that several factors such as sex hormones and their receptors,corticotropin releasing factor and immune factors may cause such sex differences.The identification of these factors may help clarify the etiology and pathogenesis of IBS and provide a more accurate strategy for clinical targeted therapy.
Clinically,it has been found that there exist sex differences in irritable bowel syndrome(IBS).Epidemiological evidence confirms that the ratio of males to females with IBS is about1:2.Previous research on the mechanism of IBS rarely focused on such sex differences.In order to provide a basis for explaining the sex differences in IBS,the authors analyzed the relevant literature and found that several factors such as sex hormones and their receptors,corticotropin releasing factor and immune factors may cause such sex differences.The identification of these factors may help clarify the etiology and pathogenesis of IBS and provide a more accurate strategy for clinical targeted therapy.
引文
1 Chey WD,Kurlander J,Eswaran S.Irritable bowel syndrome:a clinical review.JAMA 2015;313:949-958[PMID:25734736 DOI:10.1001/jama.2015.0954]
2 Wang W,Wang F,Fan F,Sedas AC,Wang J.Mind-Body Interventions for Irritable Bowel Syndrome Patients in the Chinese Population:a Systematic Review and Meta-Analysis.Int J Behav Med 2016 Sep 19.[Epub ahead of print][PMID:27646279 DOI:10.1007/s12529-016-9589-0]
3李晓青,常敏,许东,方秀才.中国肠易激综合征流行病学调査现状分析.胃肠病学和肝病学杂志2013;22:734-739
4 Herman J,Pokkunuri V,Braham L,Pimentel M.Gender distribution in irritable bowel syndrome is proportional to the severity of constipation relative to diarrhea.Gend Med2010;7:240-246[PMID:20638629 DOI:10.1016/j.genm.2010.06.007]
5 Vaiopoulou A,Karamanolis G,Psaltopoulou T,Karatzias G,Gazouli M.Molecular basis of the irritable bowel syndrome.World J Gastroenterol2014;20:376-383[PMID:24574707 DOI:10.3748/wjg.v20.i2.376]
6熊理守,陈旻湖,陈惠新,许岸高,王伟岸,胡品津.广东省社区人群肠易激综合征的流行病学研究.中华医学杂志2004;84:18-21
7姚欣,杨云生,赵卡冰,孙刚,刘英圣,王巍峰.罗马Ⅲ标准研究肠易激综合征临床特点及亚型.世界华人消化杂志2008;16:563-566
8李佩武,张耿坤,汤汉心,陈少铭.汕头市高三学生肠易激综合征流行病学的调査分析.现代消化及介入诊疗2011;16:165-167
9谢汝欢,林振威.广东阳江地区肠易激综合征患者临床特征的评估.中国实用医药2012;7:38-40
10杨竞,蔡顺天,崔丽红,彭丽华,杨云生.海军某部官兵肠易激综合征流行病学调査及影响因素分析.解放军医学杂志2013;38:453-456
11何侠垠,桑怡,摇豪谧,邓燕勇,丛衍群.高校教师肠易激综合征的流行病学调査及其与心理因素的关系.浙江中西医结合杂志2013;12:1038-1040
12刘春斌,梁谷,郑琴芳,梁惠萍,梁列新,李致忠,蒋莉萍,谢晓铿,蔡篮,熊章龙,龙淑珍,薛丽平.广西南宁市社区居民肠易激综合征流行病学现状.世界华人消化杂志2014;22:5365-5370
13付玉军,李莲花.平顶山市居民肠易激综合征及功能性便秘的流行病学调査.临床消化病杂志2005;17:132-134
14崔楠,吴保平,吴赛珠.性激素及其受体与肠易激综合征发病机制的试验研究.胃肠病学和肝病学杂志2007;16:223-225
15韩炜,陈建,李君曼,郭成浩,袁孟彪,李延青.肥大细胞及其雌激素受体在肠易激综合征发病机制中的作用,中华消化内镜杂志2003;20:100-103
16韩炜,郭成浩,陈建,李延青,李君曼,李文通.肥大细胞及其上高亲和力雌激素受体在肠易激综合征发病机制中的作用研究,胃肠病学2003;8:24
17陈瑜,林春,唐影,黄子杰.雌激素对肠易激综合征模型雌鼠内脏痛觉敏感性的影响.中国疼痛医学杂志2009;15:35-38
18 Meier R,Beglinger C,Dederding JP,MeyerWyss B,Fumagalli M,Rowedder A,Turberg Y,Brignoli R.Influence of age,gender,hormonal status and smoking habits on colonic transit time.Neurogastroenterol Motil 1995;7:235-238[PMID:8574912 DOI:10.1111/j.1365-2982.1995.tb00231.x]
19 Teff KL,Alavi A,Chen J,Pourdehnad M,Townsend RR.Muscarinic blockade inhibits gastric emptying of mixed-nutrient meal:effects of weight and gender.Am J Physiol 1999;276:R707-R714[PMID:10070130]
20 Mulak A,Tache Y,Larauche M.Sex hormones in the modulation of irritable bowel syndrome.World J Gastroenterol 2014;20:2433-2448[PMID:24627581 DOI:10.3748/wjg.v20.i10.2433]
21张青,梁列新,钱伟,侯晓华.性别及动情周期对大鼠内脏感觉影响的研究.中华消化杂志2005;25:49-50
22 Cho T,Chaban VV.Expression of P2X3 and TRPV1receptors in primary sensory neurons from estrogen receptors-αand estrogen receptor-βknockout mice.Neuroreport 2012;23:530-534[PMID:22581043 DOI:10.1097/WNR.0b013e328353fabc]
23陶景德.雌激素在新生期结直肠炎症诱导的成年大鼠慢性内脏痛过敏中的作用及其机制的研究.苏州:苏州大学,2013:5
24刘红霞,潘虹,施真,王华.雌孕激素通过调节一氧化氮影响束缚应激小鼠结肠动力.现代生物医学进展2013;13:854-857
25 Hogan AM,Kennelly R,Collins D,Baird AW,Winter DC.Oestrogen inhibits human colonic motility by a non-genomic cell membrane receptor-dependent mechanism.Br J Surg 2009;96:817-822[PMID:19405165 DOI:10.1002/bjs.6612]
26 Li TJ,Yu BP,Dong WG,Luo HS,Xu L,Li MQ.Ovarian hormone modulates 5-hydroxytryptamine3 receptors mRNA expression in rat colon with restraint stress-induced bowel dysfunction.World J Gastroenterol 2004;10:2723-2726[PMID:15309727DOI:10.3748/wjg.v10.i18.2723]
27陈跃华,陈兴奎,尹小君,施茵.电针对腹泻型肠易激综合征患者结肠黏膜5-HT、5-HT3R表达的影响.中华中医药学刊2012;30:1242-1245
28张喜梅,张振玉.焦虑、抑郁和消化道症状与肠易激综合征的相关性研究.医药论坛杂志2011;22:1-25
29 Buckley MM,O'Mahony SM,O'Malley D.Convergence of neuro-endocrine-immune pathways in the pathophysiology of irritable bowel syndrome.World J Gastroenterol 2014;20:8846-8858[PMID:25083058 DOI:10.3748/wjg.v20.i27.8846]
30郭尧嘉.腹泻型肠易激综合征中医证型与患者抑郁、焦虑心理特征的相关性研究.南京:南京中医药大学,2013:12
31 Hauser G,Pletikosic S,Tkalcic M.Cognitive behavioral approach to understanding irritable bowel syndrome.World J Gastroenterol 2014;20:6744-6758[PMID:24944466 DOI:10.3748/wjg.v20.i22.6744]
32常敏,方秀才.促肾上腺皮质激素释放因子与肠易激综合征.基础医学与临床2011;12:1396-1399
33 Tanaka Y,Kanazawa M,Kano M,Morishita J,Hamaguchi T,Van Oudenhove L,Ly HG,Dupont P,Tack J,Yamaguchi T,Yanai K,Tashiro M,Fukudo S.Differential Activation in Amygdala and Plasma Noradrenaline during Colorectal Distention by Administration of CorticotropinReleasing Hormone between Healthy Individuals and Patients with Irritable Bowel Syndrome.PLoS One 2016;11:e0157347[PMID:27448273 DOI:10.1371/journal.pone.0157347]
34 Bravo JA,Dinan TG,Cryan JF.Alterations in the central CRF system of two different rat models of comorbid depression and functional gastrointestinal disorders.Int J Neuropsychopharmacol 2011;14:666-683[PMID:20860876 DOI:10.1017/S1461145710000994]
35张璐,周鸿,吕宾,鉬莉,李蒙,CRF在大鼠5-HT信号通路和内脏高敏感中的作用.胃肠病学2011;16:534-538
36刘晓丽,阎芳,王琳,刘兆霞,韩慧蓉,张广学,石剑飞,曲梅花.CRF、UCN1和CRFR1在肠易激综合征大鼠结肠中变化的研究.时珍国医国药2012;23:1542-1545
37 Tache Y,Martinez V,Million M,Rivier J.Corticotropin-releasing factor and the brain-gut motor response to stress.Can J Gastroenterol 1999;13 Suppl A:18A-25A[PMID:10202204]
38 Sasaki A,Sato N,Suzuki N,Kano M,Tanaka Y,Kanazawa M,Aoki M,Fukudo S.Associations between Single-Nucleotide Polymorphisms in Corticotropin-Releasing Hormone-Related Genes and Irritable Bowel Syndrome.PLoS One 2016;11:e0149322[PMID:26882083 DOI:10.1371/journal.pone.0149322]
39 Videlock EJ,Shih W,Adeyemo M,MahurkarJoshi S,Presson AP,Polytarchou C,Alberto M,Iliopoulos D,Mayer EA,Chang L.The effect of sex and irritable bowel syndrome on HPA axis response and peripheral glucocorticoid receptor expression.Psychoneuroendocrinology2016;69:67-76[PMID:27038676 DOI:10.1016/j.psyneuen.2016.03.016]
40秦丽娟,汪丽佳,刘丹,刘任,周岐新.大鼠抑郁行为的性差异与下丘脑-垂体-肾上腺轴功能及脑源性神经营养因子表达的相关性.中国生物制品学杂志2014;27:524-528
41蒋建新,成为荣,徐西,杨涌.CUMS所致大鼠抑郁行为的性别差异与HPA轴功能及BDNF表达相关性研究.现代中西医结合杂志2015;12:1276-1278,1282
42刘修波,卫红军,张巍巍,王青.IL-6、IL-23在肠易激综合征患者肠黏膜的表达及意义.现代生物医学进展2011;11:1250-1252 1288
43唐巧珍,刘玉兰.溃疡性结肠炎和肠易激综合征结肠黏膜HBD-2、NF-κB,IL-6和IL-23的表达,中国现代医生2013;22:42-44
44 Scully P,McKernan DP,Keohane J,Groeger D,Shanahan F,Dinan TG,Quigley EM.Plasma cytokine profiles in females with irritable bowel syndrome and extra-intestinal co-morbidity.Am J Gastroenterol 2010;105:2235-2243[PMID:20407431 DOI:10.1038/ajg.2010.159]
45李帅,李志婷.腹泻型肠易激综合征患者肠黏膜中IL-4、IL-6的表达及意义.医学信息2015;24:63-63
46郑(?),吴盛迪,沈锡中.肠道微生态在肠易激综合征及其相关精神心理障碍中的作用与研究进展.中华消化杂志2016;36:214-216
47陈飞,周雪莲.氟哌噻吨美利曲辛和匹维溴铵联合治疗肠易激综合征的疗效.中国生化药物杂志2016;36:86-88
48胡景岚.抗抑郁剂在肠易激综合征治疗中的作用.中国实用医刊2016;43:127-128
49王丽杰,王杨,付晓丽,吴志颖.肠易激综合征患者焦虑调査及人格特征分析.实用医药杂志2015;32:631-632
50薛晓培.肠易激综合征与焦虑抑郁情绪的相关性调査及分析.医学信息2014;27;100
51崔婷婷,卢艳如,陈玉龙.肠易激综合征伴抑郁的治疗机制研究.中国实用医刊2011;38:26-28
52李延青,杨云生,陈建.肠易激综合征.第1版.北京:中国医药科技出版社,2005:128-136
53董文珠,李兆申,许国铭,邹多武,龚燕芳,孙振兴.肠易激综合征肥大细胞与P物质免疫反应阳性神经纤维的实验研究.中华消化杂志2002;11:15-18
54吴晓亮,孙建华.肠易激综合征国内实验研究现状的调査.世界华人消化杂志2010;18:3818-3823
2 Wang W,Wang F,Fan F,Sedas AC,Wang J.Mind-Body Interventions for Irritable Bowel Syndrome Patients in the Chinese Population:a Systematic Review and Meta-Analysis.Int J Behav Med 2016 Sep 19.[Epub ahead of print][PMID:27646279 DOI:10.1007/s12529-016-9589-0]
3李晓青,常敏,许东,方秀才.中国肠易激综合征流行病学调査现状分析.胃肠病学和肝病学杂志2013;22:734-739
4 Herman J,Pokkunuri V,Braham L,Pimentel M.Gender distribution in irritable bowel syndrome is proportional to the severity of constipation relative to diarrhea.Gend Med2010;7:240-246[PMID:20638629 DOI:10.1016/j.genm.2010.06.007]
5 Vaiopoulou A,Karamanolis G,Psaltopoulou T,Karatzias G,Gazouli M.Molecular basis of the irritable bowel syndrome.World J Gastroenterol2014;20:376-383[PMID:24574707 DOI:10.3748/wjg.v20.i2.376]
6熊理守,陈旻湖,陈惠新,许岸高,王伟岸,胡品津.广东省社区人群肠易激综合征的流行病学研究.中华医学杂志2004;84:18-21
7姚欣,杨云生,赵卡冰,孙刚,刘英圣,王巍峰.罗马Ⅲ标准研究肠易激综合征临床特点及亚型.世界华人消化杂志2008;16:563-566
8李佩武,张耿坤,汤汉心,陈少铭.汕头市高三学生肠易激综合征流行病学的调査分析.现代消化及介入诊疗2011;16:165-167
9谢汝欢,林振威.广东阳江地区肠易激综合征患者临床特征的评估.中国实用医药2012;7:38-40
10杨竞,蔡顺天,崔丽红,彭丽华,杨云生.海军某部官兵肠易激综合征流行病学调査及影响因素分析.解放军医学杂志2013;38:453-456
11何侠垠,桑怡,摇豪谧,邓燕勇,丛衍群.高校教师肠易激综合征的流行病学调査及其与心理因素的关系.浙江中西医结合杂志2013;12:1038-1040
12刘春斌,梁谷,郑琴芳,梁惠萍,梁列新,李致忠,蒋莉萍,谢晓铿,蔡篮,熊章龙,龙淑珍,薛丽平.广西南宁市社区居民肠易激综合征流行病学现状.世界华人消化杂志2014;22:5365-5370
13付玉军,李莲花.平顶山市居民肠易激综合征及功能性便秘的流行病学调査.临床消化病杂志2005;17:132-134
14崔楠,吴保平,吴赛珠.性激素及其受体与肠易激综合征发病机制的试验研究.胃肠病学和肝病学杂志2007;16:223-225
15韩炜,陈建,李君曼,郭成浩,袁孟彪,李延青.肥大细胞及其雌激素受体在肠易激综合征发病机制中的作用,中华消化内镜杂志2003;20:100-103
16韩炜,郭成浩,陈建,李延青,李君曼,李文通.肥大细胞及其上高亲和力雌激素受体在肠易激综合征发病机制中的作用研究,胃肠病学2003;8:24
17陈瑜,林春,唐影,黄子杰.雌激素对肠易激综合征模型雌鼠内脏痛觉敏感性的影响.中国疼痛医学杂志2009;15:35-38
18 Meier R,Beglinger C,Dederding JP,MeyerWyss B,Fumagalli M,Rowedder A,Turberg Y,Brignoli R.Influence of age,gender,hormonal status and smoking habits on colonic transit time.Neurogastroenterol Motil 1995;7:235-238[PMID:8574912 DOI:10.1111/j.1365-2982.1995.tb00231.x]
19 Teff KL,Alavi A,Chen J,Pourdehnad M,Townsend RR.Muscarinic blockade inhibits gastric emptying of mixed-nutrient meal:effects of weight and gender.Am J Physiol 1999;276:R707-R714[PMID:10070130]
20 Mulak A,Tache Y,Larauche M.Sex hormones in the modulation of irritable bowel syndrome.World J Gastroenterol 2014;20:2433-2448[PMID:24627581 DOI:10.3748/wjg.v20.i10.2433]
21张青,梁列新,钱伟,侯晓华.性别及动情周期对大鼠内脏感觉影响的研究.中华消化杂志2005;25:49-50
22 Cho T,Chaban VV.Expression of P2X3 and TRPV1receptors in primary sensory neurons from estrogen receptors-αand estrogen receptor-βknockout mice.Neuroreport 2012;23:530-534[PMID:22581043 DOI:10.1097/WNR.0b013e328353fabc]
23陶景德.雌激素在新生期结直肠炎症诱导的成年大鼠慢性内脏痛过敏中的作用及其机制的研究.苏州:苏州大学,2013:5
24刘红霞,潘虹,施真,王华.雌孕激素通过调节一氧化氮影响束缚应激小鼠结肠动力.现代生物医学进展2013;13:854-857
25 Hogan AM,Kennelly R,Collins D,Baird AW,Winter DC.Oestrogen inhibits human colonic motility by a non-genomic cell membrane receptor-dependent mechanism.Br J Surg 2009;96:817-822[PMID:19405165 DOI:10.1002/bjs.6612]
26 Li TJ,Yu BP,Dong WG,Luo HS,Xu L,Li MQ.Ovarian hormone modulates 5-hydroxytryptamine3 receptors mRNA expression in rat colon with restraint stress-induced bowel dysfunction.World J Gastroenterol 2004;10:2723-2726[PMID:15309727DOI:10.3748/wjg.v10.i18.2723]
27陈跃华,陈兴奎,尹小君,施茵.电针对腹泻型肠易激综合征患者结肠黏膜5-HT、5-HT3R表达的影响.中华中医药学刊2012;30:1242-1245
28张喜梅,张振玉.焦虑、抑郁和消化道症状与肠易激综合征的相关性研究.医药论坛杂志2011;22:1-25
29 Buckley MM,O'Mahony SM,O'Malley D.Convergence of neuro-endocrine-immune pathways in the pathophysiology of irritable bowel syndrome.World J Gastroenterol 2014;20:8846-8858[PMID:25083058 DOI:10.3748/wjg.v20.i27.8846]
30郭尧嘉.腹泻型肠易激综合征中医证型与患者抑郁、焦虑心理特征的相关性研究.南京:南京中医药大学,2013:12
31 Hauser G,Pletikosic S,Tkalcic M.Cognitive behavioral approach to understanding irritable bowel syndrome.World J Gastroenterol 2014;20:6744-6758[PMID:24944466 DOI:10.3748/wjg.v20.i22.6744]
32常敏,方秀才.促肾上腺皮质激素释放因子与肠易激综合征.基础医学与临床2011;12:1396-1399
33 Tanaka Y,Kanazawa M,Kano M,Morishita J,Hamaguchi T,Van Oudenhove L,Ly HG,Dupont P,Tack J,Yamaguchi T,Yanai K,Tashiro M,Fukudo S.Differential Activation in Amygdala and Plasma Noradrenaline during Colorectal Distention by Administration of CorticotropinReleasing Hormone between Healthy Individuals and Patients with Irritable Bowel Syndrome.PLoS One 2016;11:e0157347[PMID:27448273 DOI:10.1371/journal.pone.0157347]
34 Bravo JA,Dinan TG,Cryan JF.Alterations in the central CRF system of two different rat models of comorbid depression and functional gastrointestinal disorders.Int J Neuropsychopharmacol 2011;14:666-683[PMID:20860876 DOI:10.1017/S1461145710000994]
35张璐,周鸿,吕宾,鉬莉,李蒙,CRF在大鼠5-HT信号通路和内脏高敏感中的作用.胃肠病学2011;16:534-538
36刘晓丽,阎芳,王琳,刘兆霞,韩慧蓉,张广学,石剑飞,曲梅花.CRF、UCN1和CRFR1在肠易激综合征大鼠结肠中变化的研究.时珍国医国药2012;23:1542-1545
37 Tache Y,Martinez V,Million M,Rivier J.Corticotropin-releasing factor and the brain-gut motor response to stress.Can J Gastroenterol 1999;13 Suppl A:18A-25A[PMID:10202204]
38 Sasaki A,Sato N,Suzuki N,Kano M,Tanaka Y,Kanazawa M,Aoki M,Fukudo S.Associations between Single-Nucleotide Polymorphisms in Corticotropin-Releasing Hormone-Related Genes and Irritable Bowel Syndrome.PLoS One 2016;11:e0149322[PMID:26882083 DOI:10.1371/journal.pone.0149322]
39 Videlock EJ,Shih W,Adeyemo M,MahurkarJoshi S,Presson AP,Polytarchou C,Alberto M,Iliopoulos D,Mayer EA,Chang L.The effect of sex and irritable bowel syndrome on HPA axis response and peripheral glucocorticoid receptor expression.Psychoneuroendocrinology2016;69:67-76[PMID:27038676 DOI:10.1016/j.psyneuen.2016.03.016]
40秦丽娟,汪丽佳,刘丹,刘任,周岐新.大鼠抑郁行为的性差异与下丘脑-垂体-肾上腺轴功能及脑源性神经营养因子表达的相关性.中国生物制品学杂志2014;27:524-528
41蒋建新,成为荣,徐西,杨涌.CUMS所致大鼠抑郁行为的性别差异与HPA轴功能及BDNF表达相关性研究.现代中西医结合杂志2015;12:1276-1278,1282
42刘修波,卫红军,张巍巍,王青.IL-6、IL-23在肠易激综合征患者肠黏膜的表达及意义.现代生物医学进展2011;11:1250-1252 1288
43唐巧珍,刘玉兰.溃疡性结肠炎和肠易激综合征结肠黏膜HBD-2、NF-κB,IL-6和IL-23的表达,中国现代医生2013;22:42-44
44 Scully P,McKernan DP,Keohane J,Groeger D,Shanahan F,Dinan TG,Quigley EM.Plasma cytokine profiles in females with irritable bowel syndrome and extra-intestinal co-morbidity.Am J Gastroenterol 2010;105:2235-2243[PMID:20407431 DOI:10.1038/ajg.2010.159]
45李帅,李志婷.腹泻型肠易激综合征患者肠黏膜中IL-4、IL-6的表达及意义.医学信息2015;24:63-63
46郑(?),吴盛迪,沈锡中.肠道微生态在肠易激综合征及其相关精神心理障碍中的作用与研究进展.中华消化杂志2016;36:214-216
47陈飞,周雪莲.氟哌噻吨美利曲辛和匹维溴铵联合治疗肠易激综合征的疗效.中国生化药物杂志2016;36:86-88
48胡景岚.抗抑郁剂在肠易激综合征治疗中的作用.中国实用医刊2016;43:127-128
49王丽杰,王杨,付晓丽,吴志颖.肠易激综合征患者焦虑调査及人格特征分析.实用医药杂志2015;32:631-632
50薛晓培.肠易激综合征与焦虑抑郁情绪的相关性调査及分析.医学信息2014;27;100
51崔婷婷,卢艳如,陈玉龙.肠易激综合征伴抑郁的治疗机制研究.中国实用医刊2011;38:26-28
52李延青,杨云生,陈建.肠易激综合征.第1版.北京:中国医药科技出版社,2005:128-136
53董文珠,李兆申,许国铭,邹多武,龚燕芳,孙振兴.肠易激综合征肥大细胞与P物质免疫反应阳性神经纤维的实验研究.中华消化杂志2002;11:15-18
54吴晓亮,孙建华.肠易激综合征国内实验研究现状的调査.世界华人消化杂志2010;18:3818-3823