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和对象大吵一架为何导致拉肚子？新研究发现了身体里的“多米诺”｜科学60秒

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紧张和压力如何让炎症性肠病复发

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熊熊吵架 @Unsplash
与日常的肠胃不适不同，炎症性肠病（inflammatory bowel disease，IBD）常伴有疼痛、出血、体重下降和腹泻等症状，甚至有时须要进行手术治疗。这是一种非常常见的疾病，在美国，约有300万名成年人患有这种疾病。
损伤小肠的克罗恩病（Crohn's disease）和影响大肠的溃疡性结肠炎（ulcerative colitis）也属于炎症性肠病，炎症是导致这两种疾病的原因。炎症性肠病通常与过度活跃的免疫系统有关，人体自身的免疫细胞会攻击消化道，而这可能与遗传因素有关。
医生一般会使用免疫抑制剂来治疗炎症性肠病，比如类固醇或舒缓炎症的药物，但即使是已经控制住的病情也可能在未来周期性复发。近期的一项研究发现，作为炎症性肠病的主要诱因之一，心理压力会通过特定路径传递信号，如同多米诺骨牌一样影响肠道功能和炎症反应。
美国宾夕法尼亚大学（University of Pennsylvania）佩雷尔曼医学院（Perelman School of Medicine）的助理教授克里斯托夫·泰伊斯（Christoph Thaiss）表示：“压力本身并不会导致炎症性肠病，但它会大大增加其严重程度。”
泰伊斯是这项研究的核心人物之一。他们发现，炎症性肠病患者倒下的第一块多米诺骨牌是某种压力巨大的经历：与伴侣分手、失业、家庭成员去世或发生其他重大事件时，数周后他们往往就会病发。
泰伊斯团队首先观察了压力对患有类似肠道疾病小鼠的影响路径，然后在人类患者身上进行了验证，发现同样的模式在三组不同炎症性肠病患者身上都发生了。
例如，当你与对象大吵一架后，大脑因感到威胁而……[查看全文]

How Stress Messes With Your Gut

Josh Fischman: Hey, remember the other day when we were comparing belly aches?
Tanya Lewis: Yeah, I do remember that. I was feeling a bit off, but drinking ginger ale really helped settle my stomach. Did your antacid tablets end up helping?
Fischman: Yeah they did. But neither of us was really sick. I mean, we both showed up at work, after all. 
Lewis: Yeah, I mean, speak for yourself—I wasn't feeling great. But I definitely wasn't extremely ill. 
Fischman: There is another kind of gastrointestinal illness, though, that's in a whole different league. It's inflammatory bowel disease, or IBD. That's bouts of disabling pain, bleeding, weight loss, diarrhea and hospitalizations that sometimes require surgery. 
Lewis: That really doesn't sound like fun. I actually know some people with IBD. Is it a super common illness?
Fischman: Unfortunately, it is. About 3 million adults in the U.S. have it. 
Lewis: I've heard of Crohn's disease, which can be pretty disabling. Isn't that a type of IBD? 
Fischman: Yeah, it is. The other type is called ulcerative colitiis. 
Lewis: Oh, I've heard of that one too. I think it mainly affects the large intestine.
Fischman: And Crohn's often damages the small intestine, although it can hurt other parts of the GI tract as well. 
What makes them both IBD is inflammation. IBD is often linked to an overactive immune system, where the body's own immune cells attack the digestive tract. And it may have a genetic component. 
Lewis: Yeah, I've heard that Crohn's is more common among people with a family history of it. But are there any effective treatments?
Fischman: That's usually some variety of immune suppressant such as a steroid drug or a medication that soothes inflammation. But even these controlled cases have periodic flare-ups.
The causes of these flares have been a real mystery. But I've been reading that the reason—or at least one of the main reasons—can be psychological stress.
Lewis: That does make sense. But it seems a little bit obvious that stress triggers a lot of diseases. So what's the new thing here?
Fischman: It's the precise connections. Starting in the brain, researchers traced two different pathways, made up of molecules and cells that kind of bang into one another. And the paths led all the way down to the intestines. 
Lewis: So is that kind of like a series of falling dominoes, each one knocking the next one over? 
Fischman: Yeah that's a good way of thinking of it.
Lewis: But I just want to be clear: you're not saying that IBD is all in your head, right?
Fischman: No, no. Really no. It's a biological disease tied to those hyperactive immune cells. But...
Christoph Thaiss: Psychological stress will greatly exacerbate the severity of the disease. So stress by itself is not causing the disease, but it's greatly increasing the magnitude of the disease.
Fischman: That's Christoph Thaiss.
Thaiss: I'm an assistant professor of microbiology here at the Perelman School of Medicine at the University of Pennsylvania.
Fischman: Thaiss was one of the scientists who traced out the rows of dominoes, as you put it. And his team found that the first domino to fall with IBD patients was some kind of stressful experience.
Thaiss: If they had broken up with their partner or lost their jobs or lost someone in the family or any other major event in the lives of these patients ... if someone goes through a very stressful period in their lives, it feels like their disease flaring up, but the physician doesn't see microscopic signs of inflammation yet. But then very often what will happen is a few weeks down the road, then there will be a flare. So there is definitely a very strong component of how the brain or the psychological state of the patient can control inflammatory diseases. 
Lewis: That is really validating, and I can say from personal experience that that intense stress can affect the body. But it sounds kind of anecdotal. I'm guessing Thaiss did some more scientific studies?
Fischman: Hey, I don't blame you for a little skepticism. There's a lot of loose talk about how stress affects the body, and you're right: Thaiss and his team did go after this more scientifically. First they looked at mice with IBD-like conditions in order to identify the rows of molecular dominoes.
Then they verified that these same dominoes fell down in people. The pattern held true in three different groups of IBD patients. They even went so far as to do colonoscopy exams on some of these people, and saw these molecular signs of inflammation after stressful events.
Lewis: So what's the next domino after someone has a fight with their spouse...[full transcript]

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论文信息

Schneider, K.M. et al. (2023) ‘The enteric nervous system relays psychological stress to intestinal inflammation’, Cell, 186(13). 

DOI: 10.1016/j.cell.2023.05.001

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