Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation
Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation
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DOI：
10.1080/00365520802321212
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发表时间：
2008-01-01
影响因子：
1.9
通讯作者：
Gillberg, Per-Goran
中科院分区：
文献类型：
--
作者：
Abrahamsson, Hasse;Ostlund-Lindqvist, Ann-Margret;Gillberg, Per-Goran
目标。胆汁酸来源于胆固醇，是一种有效的生理性泻药。本研究的目的是调查便秘时胆汁酸的合成是否发生改变。材料和方法。对女性便秘患者(23例IBS-C，4例功能性便秘(FC))与非便秘患者(16例IBS-D，20例健康女性)进行比较。测定体重指数(BMI)、血脂、羊毛甾醇、谷甾醇、结肠通过时间(口-肛门通过时间，参考4.3d)和大便次数。测定0800h和1300h反映胆汁酸合成的C4(7-羟基-4-胆固酮-3-酮)水平。当比较所有便秘和非便秘受试者时，发现只有大便频率和大便潜伏期在两组之间有差异(P<0.001)。当便秘患者按OATT分类时，82%的延迟OATT患者午餐时没有正常的C4升高，而正常OATT患者的这一比例为17%(p 0.001)。症状严重程度在不同组之间没有差异。部分OATT严重延迟的患者C4水平显著升高。结论。IBS-C和FC患者的胆汁酸合成与结肠运输有关。当午餐时间没有补体高峰期时，慢传输结肠的昼夜节律发生改变。胆汁酸代谢的改变可能与便秘的病理生理学有关。
Objective. Bile acids are derived from cholesterol and are potent physiological laxatives. The aim of this study was to investigate whether bile acid synthesis is altered in constipation. Material and methods. Female patients with constipation (23 IBS-C, 4 functional constipation (FC)) were studied and compared with non-constipated subjects (16 IBS-D, 20 healthy women). Body mass index (BMI), blood lipids, lanosterol, sitosterol, colonic transit (oro-anal transit time (OATT), reference=4.3 days) and stool frequency were measured. C4 (7--hydroxy-4-cholesten-3-one) levels reflecting bile acid synthesis were measured at 0800 h and 1300 h. Results. When all the groups of constipated and non-constipated subjects were compared, it was found that only stool frequency and OATT differed between groups (p 0.001). When constipated patients were categorized according to OATT, absence of the usual C4 increase at lunchtime was noted in 82% of patients with delayed OATT compared with 17% in subjects with normal OATT (p 0.001). Symptom severity did not differ between groups. A subset of the patients with severely delayed OATT had markedly elevated C4 levels. Conclusions. Patients with IBS-C and FC have marked changes in bile acid synthesis in relation to colonic transit. The diurnal rhythm is altered in the slow transit colon when there is no C4 peak at lunchtime. Alterations in bile acid metabolism may be implicated in the pathophysiology of constipation.