背景:小肠通透性(s-IP)的改变可能在腹泻为主的IBS(D-IBS)和乳糜泻(CD)患者中起重要作用。我们的目的是分析D-IBS患者的症状概况以及尿蔗糖(Su)水平,乳果糖(La),甘露醇(Ma),和循环生物标志物(zonulin,肠脂肪酸结合蛋白-I-FABP,和二胺氧化酶-DAO)的胃肠(GI)屏障功能。促炎性白介素6和8(IL-6和IL-8),脂多糖(LPS)的血浆值,还研究了Toll样受体4(TLR-4)。此外,将这些生物标志物与CD和健康对照(HC)中的生物标志物进行比较.最后,根据正常或改变的La/Ma比值,对有[D-IBS(+)]和无[D-IBS(-)]s-IP升高的D-IBS患者进行了比较.
方法:本研究纳入39例D-IBS患者,32例CD患者,20HC通过高效液相色谱法测定尿液中的Su和La/Ma比率来测定GI渗透性。ELISA试剂盒测定了zonulin的循环浓度,I-FABP,DAO,IL-6,IL-8,LPS,和TLR-4。使用Mann-Whitney或Kruskal-Wallis和Dunn的后检验来评估组间的差异。
结果:至于La/Ma比率,%Su,和I-FABP水平,D-IBS患者与CD有显著差异,但不是HC。CD中IL-6水平显著高于HC,而IL-8水平在D-IBS和CD患者中显著高于HC。相反,LPS,和TLR-4浓度在各组间无显著差异.当D-IBS患者根据正常或改变的s-IP进行分类时,D-IBS(+)患者有%La,%Su,I-FABP,和DAO水平显著高于D-IBS(-)水平。细菌易位的炎症参数和标志物(即,IL-6和LPS)在D-IBS(+)患者中明显高于D-IBS(-)患者。
结论:本研究提示可以鉴定出两种不同的D-IBS亚型。对可能的s-IP改变的调查(即,考虑La/Ma比率)可能有助于更好地评估和分类这种异质D-IBS人群。
背景:NCT01574209。2012年3月注册第一次招聘始于2012年4月。
BACKGROUND: Alterations of the small-intestinal permeability (s-IP) might play an essential role in both diarrhoea-predominant IBS (D-IBS) and celiac disease (CD) patients. Our aims were to analyse in D-IBS patients the symptom profile along with the levels of urinary sucrose (Su), lactulose (La), mannitol (Ma), and circulating biomarkers (zonulin, intestinal fatty acid binding protein - I-FABP, and diamine oxidase - DAO) of the gastrointestinal (GI) barrier function. The pro-inflammatory interleukins 6 and 8 (IL-6 and IL-8), the plasma values of lipopolysaccharide (LPS), and Toll-like receptor 4 (TLR-4) were also investigated. Besides, these biomarkers were compared with those in CD and healthy controls (HC). Finally, comparisons were performed between D-IBS patients with [D-IBS(+)] and without [D-IBS(-)] increased s-IP according to normal or altered La/Ma ratio.
METHODS: The study included 39 D-IBS patients, 32 CD patients, and 20 HC. GI permeability was assayed by high-performance liquid chromatography determination in the urine of Su and La/Ma ratio. ELISA kits assayed circulating concentrations of zonulin, I-FABP, DAO, IL-6, IL-8, LPS, and TLR-4. The Mann-Whitney or the Kruskal-Wallis with Dunn\'s post-test was used to assess differences among the groups.
RESULTS: As for the La/Ma ratio, %Su, and I-FABP levels, D-IBS patients were significantly different from CD, but not HC. IL-6 levels were significantly higher in CD than HC, whereas IL-8 levels were significantly higher in both D-IBS and CD patients than HC. By opposite, LPS, and TLR-4 concentrations did not differ significantly among the groups. When D-IBS patients were categorised according to normal or altered s-IP, D-IBS(+) patients had %La, %Su, I-FABP, and DAO levels significantly higher than D-IBS(-) ones. The inflammatory parameters and markers of bacterial translocation (namely, IL-6 and LPS) were significantly higher in D-IBS(+) patients than D-IBS(-) ones.
CONCLUSIONS: The present study suggests that two distinct D-IBS subtypes could be identified. The investigation of possible s-IP alterations (i.e., considering the La/Ma ratio) might be useful to assess better and categorise this heterogeneous D-IBS population.
BACKGROUND: NCT01574209 . Registered March 2012. First recruitment started in April 2012.