功能性胃肠病中的免疫活化(综述)
创作:Erin 审核:mildbreeze 2018年12月21日
  • 分析51篇文献,功能性胃肠病(FGID)中存在淋巴细胞群变化;
  • 功能性消化不良(FD)中粘膜嗜酸性粒细胞增加,肠易激综合征(IBS)中结肠肥大细胞增加,但Th2免疫应答驱动这些变化的证据有限;
  • 循环的肠归巢T细胞增加,提示FGID或与粘膜内稳态的丧失有关;
  • IBS中活化B细胞的比例增加,表明IBS症状与抗原驱动的免疫应答有关;
  • 间接证据显示,Th17应答可能参与FGID;
  • 缺少基于疾病亚型的免疫参数分析,患者免疫中的细微变化可能被忽略。
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mildbreeze
American Journal of Gastroenterology发表的一篇系统综述,分析了功能性胃肠病(包括功能性消化不良和肠易激综合征)中的免疫活化情况,对揭示这些疾病相关的免疫机制有一定参考意义。
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Evidence for Local and Systemic Immune Activation in Functional Dyspepsia and the Irritable Bowel Syndrome: A Systematic Review

功能性消化不良和肠易激综合征中局部和全身免疫激活的证据:系统综述

10.1038/s41395-018-0377-0

2018-11-14, Review

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BACKGROUND: Subtle histopathologic features such as eosinophilia and increased mast cells have been observed in functional gastrointestinal disorders (FGIDs), including functional dyspepsia (FD) and the irritable bowel syndrome (IBS). The mechanisms that drive recruitment of these cells to the gastrointestinal tract remain unexplained, largely due to the heterogeneity in phenotypes among patients diagnosed with such conditions. We aimed to systematically review the literature and collate the evidence for immune activation in FD and IBS, and where possible, detail the nature of activation.
METHODS: Seven literature databases were searched using the keywords: 'functional gastrointestinal disorder', FGID, 'functional dyspepsia', 'non-ulcer dyspepsia', 'idiopathic dyspepsia', 'irritable bowel syndrome', IBS and 'immun*'.
RESULTS: Fifty-one papers reporting discordant immune features met the selection criteria for this review. Changes in lymphocyte populations, including B and T lymphocyte numbers and activation status were reported in IBS and FD, in conjunction with duodenal eosinophilia in FD and increased colonic mast cells in IBS. Increases in circulating α4β7 gut-homing T cells appear to be linked to the pathophysiology of both FD and IBS. Studies in the area are complicated by poor phenotyping of patients into subgroups and the subtle nature of the immune activity involved in FD and IBS.
CONCLUSIONS: Alterations in proportions of gut-homing T lymphocytes in both FD and IBS indicate that a loss of mucosal homeostasis may drive the symptoms of FD and IBS. There is indirect evidence that Th17 responses may play a role in FGIDs, however the evidence for a Th2 immune phenotype in FD and IBS is limited. Although immune involvement is evident, large, well-characterised patient cohorts are required to elucidate the immune mechanisms driving the development of FGIDs.

First Authors:
Grace Burns

Correspondence Authors:
Simon Keely

All Authors:
Grace Burns,Georgia Carroll,Andrea Mathe,Jay Horvat,Paul Foster,Marjorie M Walker,Nicholas J Talley,Simon Keely

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