Irritable bowel syndrome - An inflammatory disease involving mast cells.
Irritable bowel syndrome - An inflammatory disease involving mast cells.
复制标题
肠易激综合征 - 一种涉及肥大细胞的炎性疾病。
DOI：
10.5415/apallergy.2011.1.1.36
复制
发表时间：
2011-04
影响因子：
1.7
通讯作者：
Thien F
中科院分区：
文献类型：
--
作者：
Philpott H;Gibson P;Thien F
肠易激综合症 (IBS) 传统上被定义为一种功能性疾病，即在没有明显病理异常的情况下出现症状。近年来，一些 IBS 患者的小肠和大肠中都有低度炎症浸润，通常富含肥大细胞，加上低度炎症的血清学标志物，引起了人们对 IBS 作为一种炎症性疾病的关注。肥大细胞通常与肠道神经元密切相关，体外和体内动物研究表明肥大细胞介质可能影响肠道运动，这为 IBS 提供了生物学上合理的因果机制。使用肥大细胞稳定剂色甘酸钠对 IBS 患者进行的试点研究（“概念验证”）令人鼓舞。基本问题仍然是为什么肥大细胞会浸润 IBS 患者的肠道。 “脑肠轴”紊乱是目前流行的假设，即童年压力或精神共病通过神经免疫机制发挥作用，调节低度炎症。另一种假设是食物过敏可能是造成这种情况的原因。 IBS 患者的血清特异性 IgE 和皮肤点刺试验并未升高，表明 1 型 IgE 介导的食物过敏不是原因。然而，基于问卷调查的研究表明，IBS 患者患特应性疾病的比例较高，并且支气管对乙酰甲胆碱的反应性增加。在这篇综述中，我们强调了肥大细胞在 IBS 中的潜在作用，以及当前和未来对这一有趣疾病的研究方向。
Irritable bowel syndrome (IBS) is traditionally defined as a functional disorder - that is the presence of symptoms in the absence of demonstrable pathological abnormalities. In recent times, low grade inflammatory infiltrates in both the small and large bowel of some patients with IBS - often rich in mast cells, along with serological markers of low grade inflammation have focussed attention on IBS as an inflammatory disease. The observation that mast cells often lie in close association to enteric neurons, and in-vitro and in-vivo animal studies demonstrating that mast cell mediators may influence enteric motility provides a biologically plausible causal mechanism in IBS. Pilot studies on patients with IBS using the mast cell stabiliser sodium cromoglycate ('proof of concept') have been encouraging. The essential question remains why mast cells infiltrate the bowel of IBS patients. A disturbance of the 'brain-gut axis' is the current favoured hypothesis, whereby childhood stress or psychiatric comorbidity act via neuro-immune mechanisms to modulate low grade inflammation. An alternative hypothesis is that food allergy may be responsible. Serum specific IgE, and skin prick tests are not elevated in IBS patients, suggesting type 1 IgE mediated food allergy is not the cause. However questionnaire based studies indicate IBS patients have higher rates of atopic disease, and increased bronchial reactivity to methacholine has been demonstrated. In this review, we highlight the potential role of mast cells in IBS, and current and future research directions into this intriguing condition.