2022年医学专题—肠易激综合征的新概念(1).pptVIP免费

肠易激综合征的新概念肠易激综合征的新概念(gàiniàn)(gàiniàn)NewestconceptsinNewestconceptsinirritablebowelirritablebowelsyndromesyndromeIBSIBS张虎张虎华西华西(Huáxī)(Huáxī)医院消化科医院消化科第一页，共五十三页。旧概念(gàiniàn)：过敏性结肠炎易激结肠或黏液性结肠炎第二页，共五十三页。新概念：一种(yīzhǒnɡ)以腹痛或腹部不适伴排便习惯改变为特征的功能性肠病…agroupoffunctionalboweldisordersinwhichdiscomfortorpainisassociatedwithdefecationorachangeinbowelhabit,andwithfeaturesofdisordereddefecation.第三页，共五十三页。该病缺乏可解释(jiěshì)症状的形态学改变和生化异常第四页，共五十三页。•Psychologicdisturbancerelatestopatientswhoseephysicians•PsychosocialfactorsinfluencehealthcareseekingIBSNon-patientsnormalnormalIBSpatientsPsychologicdisturbanceIBS-Psychosocial第五页，共五十三页。流行病学(liúxínɡbìnɡxué)研究西方国家患病率5---24%美国人群10-20%就诊(jiùzhěn)率30％$80亿国内北京潘国宗7.26％广州陈旻湖5.6％就诊率22.4％第六页，共五十三页。WhatcausesIBS?第七页，共五十三页。DevelopmentofIBSpathophysiology｛inflammation5-HTmediatedhypersensitivityandgutmotilityBrain-gutinteractionVisceralhypersensitivityAbnormalmotorfunction195019601970198019902000AbnormalnetworkregulationAbnormalnetworkregulationOfnerve-immune-Ofnerve-immune-endocrineendocrineIBSmolecularbiologyIBSmolecularbiology…………..第八页，共五十三页。IBS发病(fābìng)机制的认识临床症状腹痛(fùtònɡ)、不适大便异常，流行病学等第一阶段第九页，共五十三页。IBS发病(fābìng)机制的认识临床症状运动异常感觉异常社会心理致病腹痛、不适(bùshì)压力、电活动大便异常，敏感性、5-HT流行病学等炎症、脑肠交流第一阶段第二阶段第十页，共五十三页。VisceralHypersensitivityhyperalgesiaallodyniaEndogenousEndogenousModulationModulation.cortex.cortex.Brainstem.BrainstemEndorgansensitivity.silentnociceptorsSpinalSpinalHyperexcitabilityHyperexcitability.Nitricoxide.NitricoxideActivationActivationLong-termLong-termHyperalgesiaHyperalgesia..toniccorticalregulationtoniccorticalregulatio...