The relationship between preoperative T helper cytokines in the ileal mucosa and the pathogenesis of pouchitis
The relationship between preoperative T helper cytokines in the ileal mucosa and the pathogenesis of pouchitis
复制标题
术前回肠黏膜辅助T细胞因子与储袋炎发病的关系
DOI：
10.1186/s12876-020-01421-w
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发表时间：
2020-08-18
影响因子：
2.4
通讯作者：
Kusunoki, Masato
中科院分区：
文献类型：
--
作者：
Kitajima, Takahito;Okita, Yoshiki;Kusunoki, Masato
背景：虽然小囊炎的病因尚不清楚，但炎性细胞因子与小囊炎的发病机制密切相关。表征炎症性肠病（IBD）的细胞因子反应是该疾病的关键致病成分。虽然已经在实验性结肠炎模型或IBD患者中研究了结肠黏膜的细胞因子谱，但结肠切除术后回肠黏膜的细胞因子谱很少被评估。目的：探讨结肠切除及造袋时回肠黏膜中辅助性T细胞因子与小囊炎的关系。方法：回顾性分析2004年1月至2011年5月行回肠袋-肛门吻合术治疗溃疡性结肠炎的68例患者。在全结肠切除术或次全结肠切除术时，从切除标本的回肠末端获得样本。检测Th细胞因子（ifn - γ、IL-23A、IL-5、IL-13、IL-17A） mRNA表达水平。结果：68例患者中40例（58.8%）发生了袋炎。IL-23A表达水平与包囊炎发病率无相关性（p = 0.301）。与ifn - γ水平较低的患者相比，ifn - γ水平升高的患者的袋炎发病率明显更高（p = 0.043）。单因素分析显示，结肠切除术前给予强的松龙总剂量bbb7000mg （p = 0.04）和高ifn - γ表达（p = 0.02）是发生袋炎的重要危险因素。在多变量分析中，ifn - γ信使RNA (m)水平升高与袋炎发病显著相关（p = 0.03）。结论：结肠切除术时正常回肠黏膜中ifn - γ的表达可能是影响袋炎病理生理的重要因素。
Background: Although the etiology of pouchitis remains unknown, inflammatory cytokines are significantly associated with the pathogenesis of pouchitis. The cytokine responses that characterize inflammatory bowel diseases (IBD) are key pathogenic components of the disease. Although cytokine profiles in the colonic mucosa have been investigated in experimental colitis models or IBD patients, cytokine profiles in the ileal mucosa at colectomy have been rarely assessed.Aim: To assess the relationship between pouchitis and T helper (Th) cytokines in the ileal mucosa collected at the time of colectomy and pouch construction.Methods: This retrospective study involved 68 consecutive patients from January 2004 to May 2011 who underwent ileal pouch-anal anastomosis for ulcerative colitis. Samples were obtained from the terminal ileum of resected specimens at time of total colectomy or subtotal colectomy. mRNA expression levels of Th cytokines (IFN-gamma, IL-23A, IL-5, IL-13 and IL-17A) were determined.Results: Forty of 68 patients (58.8%) developed pouchitis. There was no association between IL-23A expression levels and incidence of pouchitis (p = 0.301). Patients with elevated IFN-gamma had a significantly higher incidence of pouchitis compared with low IFN-gamma patients (p = 0.043). Univariate analysis demonstrated a total dose of prednisolone > 7000 mg administered before colectomy (p = 0.04) and high IFN-gamma expression (p = 0.02) were significant risk factors for pouchitis onset. In multivariate analysis, elevated IFN-gamma messenger(m)RNA levels were significantly associated with pouchitis onset (p = 0.03).Conclusion: IFN-gamma expression in the normal ileal mucosa at the time of colectomy may be an important factor in the pathophysiology of pouchitis.