功能性胃肠道疾病和炎症性肠病患者核磁共振神经影像学的研究进展

doi:10.13481/j.1671-587X.20250230

摘要/Abstract

摘要：

功能性胃肠道疾病（FGID）和炎症性肠病（IBD）是临床上常见的2种胃肠道疾病。FGID是一组非结构性改变的胃肠功能障碍，以肠易激综合征（IBS）和功能性消化不良（FD）较为常见；IBD是一组具有明确病理学特征的慢性炎症性肠道疾病，主要包括克罗恩病（CD）和溃疡性结肠炎（UC）2种亚型。近年来，FGID和IBD发病率均呈逐年上升趋势，且具有较高复发率，治疗效果不佳，严重影响患者身心健康。进一步研究发现精神和心理状态异常等神经系统异常在FGID及IBD的发生发展中具有重要作用。胃肠与精神疾病的共病现象来自共同的病理生理基础，即肠道和中枢神经系统之间的双向沟通存在异常，脑-肠轴学说成为该领域研究热点。若采用可量化的评估手段筛查和识别与FGID和IBD密切相关的关键脑区，并基于脑-肠轴学说对患者进行消化系统-神经系统联合用药，可获得更好的治疗效果。目前，神经影像学研究已为医生理解FGID和IBD神经系统变化提供了初步成果，但尚缺乏基于脑-肠轴神经影像学研究在胃肠道疾病中应用的系统性评价。本文就FGID和IBD患者的脑结构与脑功能改变和基于神经影像学分析脑-肠轴学说在FGID及IBD发生发展以及预后作用等方面进行综述，从而为未来基于脑-肠轴推动FGID和IBD个体化精准医疗提供理论依据。

关键词: 功能性胃肠道疾病, 炎症性肠病, 脑-肠轴, 核磁共振成像, 神经影像学

Abstract:

Functional gastrointestinal disease （FGID） and inflammatory bowel disease （IBD） are two common gastrointestinal diseases in clinical practice. FGID refers to non-structural changes in gastrointestinal function， with irritable bowel syndrome （IBS） and functional dyspepsia （FD） being the common types. On the other hand， IBD is a group of chronic inflammatory bowel diseases with well-defined pathological features， mainly including Crohn’s disease （CD） and ulcerative colitis （UC）. Over the past decades， the incidence rates of both FGID and IBD have increased with years， accompanied by high recurrence rates， and the clinical outcomes remain unsatisfactory， which seriously affect the physical and mental health of patients. Further research has revealed that neuropsychiatric abnormalities， including mental and psychological disorders， play important roles in the occurrence and development of FGID and IBD. The comorbidity of gastrointestinal and psychiatric diseases shares a common pathophysiological basis， that is， the abnormalities in the bidirectional communication between the gut and the central nervous system， and the theory of brain-gut axis has emerged as a research hotspot in this field. Better therapeutic outcomes can be achieved by screening and identifying key brain regions closely related to FGID and IBD through quantifiable assessments， and implementing combined pharmacotherapy on both the digestive system and the nervous system based on the theory of brain-gut axis. Current neuroimaging studies have provided the preliminary results for understanding the changes in the nervous system in FGID and IBD patients， but there is still a lack of systematic evaluation of the application of neuroimaging studies based on the brain-gut axis in gastrointestinal diseases. This paper reviewed the changes in brain structure and function associated with FGID and IBD， and the neuroimaging-based analysis of the brain-gut axis theory in the occurrence and development of these diseases， in order to provide theoretical basis for future personalized precision medicine of FGID and IBD based on the brain-gut axis.

Key words: Functional gastrointestinal diseases, Inflammatory bowel disease, Brain-gut axis, Magnetic resonance imaging, Neuroimaging

中图分类号:

R445.2

孙凡珺,潘星辰,佟丹. 功能性胃肠道疾病和炎症性肠病患者核磁共振神经影像学的研究进展[J]. 吉林大学学报(医学版), 2025, 51(2): 541-548.

Fanjun SUN,Xingchen PAN,Dan TONG. Research progress in MRI neuroimaging for patients with functional gastrointestinal diseases and inflammatory bowel disease[J]. Journal of Jilin University(Medicine Edition), 2025, 51(2): 541-548.

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