运脾和胃法治疗餐后不适综合征的疗效观察及机制探索
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摘要
目的观察运脾和胃法治疗功能性消化不良餐后不适综合征的临床疗效,并通过动物实验探讨运脾和胃法治疗功能性消化不良餐后不适综合征的作用机理。
方法临床研究：采用随机对照研究方法,将60例确诊的功能性消化不良餐后不适综合征脾虚气滞证患者分为两组,治疗组30例予以运脾和胃汤口服治疗,对照组30例予以口服多潘立酮治疗,疗程为4周,1个疗程结束后,观察治疗前后两组主要临床症状改善情况,进行疗效评价。实验研究：采用碘乙酰胺灌胃制备功能性消化不良模型,SD大鼠随机分为4组：正常组、模型组、运脾和胃汤组及多潘立酮组,各组连续给药3周后,观察各组大鼠胃窦黏膜组织病理的情况,运用酚红排空实验测定各组大鼠胃排空率,免疫组化法测定胃窦组织中DOG-1表达水平。
结果临床研究：两组患者在餐后饱胀、早饱、嗳气、上腹胀、餐后恶心等症状改善方面,治疗组优于对照组,差异有统计学意义。治疗组总有效率为93%,对照组总有效率为70%,差异有统计学意义(P<0.05)。实验研究：各组大鼠胃窦黏膜未见明显损伤。与模型组相比,运脾和胃汤组和多潘立酮组大鼠胃排空率及胃窦组织中DOG-1表达均有升高,差异有统计学意义(P<0.05)。运脾和胃汤组与多潘立酮组相比,胃排空率和胃窦组织中DOG-1表达升高,差异有统计学意义(P<0.05)。
结论运脾和胃法治疗餐后不适综合征有较好的临床疗效,说明运脾和胃法是治疗功能性消化不良餐后不适综合征脾虚气滞证的有效方法。运脾和胃法治疗功能性消化不良的作用机制可能与促进胃排空,提高胃窦组织中DOG-1表达有关。
Objective The goal of the present study were to observe the clinical curative effect of the Method of invigorating spleen and harmonize the function of the stomach treating Postprandial Distress Syndrome and to explore the possible action mechanism by zoopery.
Method Clinical part:Patients with postprandial distress syndrme were randomly divided into two groups,assigned 30 patients in controlled group to receive domperidone tablets,another 30 patients in treated group was taken a Chinese herbal formula called Yupi Hewei Decoction. After 4 weeks of treatment, the clinical curative effect was analyzed. Experimental part:The male SD rats were receive 0.1% iodoacetamide to make the model of functional dyspepsia,then divided randomly into 4 groups——Yupi Hewei Decoction,domperidone tablets,model and normal groups.Rats in normal group were not given any intervention measures.The gastric emptying changes of rats were assayed and distributions of the expressions of DOG-1 were detected.
Result The treated group showed a higher efficiency rate (93%) in compared to the controlled group (70%).The treated group showed a significant difference of statistical probability level of (P<0.05)PDS. Yupi Hewei Decoction could increase the gastric emptying and the level of DOG-1 in rat model of functional dyspepsia. There was no significant gastric mucosa damage in rats in each group.
Conclude The Method of invigorating spleen and harmonize the function of the stomach has a significant effect on treating Postprandial distress syndrme. Yupi Hewei Decoction could increase the gastric emptying and the level of DOG-1 in rat model of functional dyspepsia. The action mechanism maybe related to increasing the level of the DOG-1.
方法临床研究：采用随机对照研究方法,将60例确诊的功能性消化不良餐后不适综合征脾虚气滞证患者分为两组,治疗组30例予以运脾和胃汤口服治疗,对照组30例予以口服多潘立酮治疗,疗程为4周,1个疗程结束后,观察治疗前后两组主要临床症状改善情况,进行疗效评价。实验研究：采用碘乙酰胺灌胃制备功能性消化不良模型,SD大鼠随机分为4组：正常组、模型组、运脾和胃汤组及多潘立酮组,各组连续给药3周后,观察各组大鼠胃窦黏膜组织病理的情况,运用酚红排空实验测定各组大鼠胃排空率,免疫组化法测定胃窦组织中DOG-1表达水平。
结果临床研究：两组患者在餐后饱胀、早饱、嗳气、上腹胀、餐后恶心等症状改善方面,治疗组优于对照组,差异有统计学意义。治疗组总有效率为93%,对照组总有效率为70%,差异有统计学意义(P<0.05)。实验研究：各组大鼠胃窦黏膜未见明显损伤。与模型组相比,运脾和胃汤组和多潘立酮组大鼠胃排空率及胃窦组织中DOG-1表达均有升高,差异有统计学意义(P<0.05)。运脾和胃汤组与多潘立酮组相比,胃排空率和胃窦组织中DOG-1表达升高,差异有统计学意义(P<0.05)。
结论运脾和胃法治疗餐后不适综合征有较好的临床疗效,说明运脾和胃法是治疗功能性消化不良餐后不适综合征脾虚气滞证的有效方法。运脾和胃法治疗功能性消化不良的作用机制可能与促进胃排空,提高胃窦组织中DOG-1表达有关。
Objective The goal of the present study were to observe the clinical curative effect of the Method of invigorating spleen and harmonize the function of the stomach treating Postprandial Distress Syndrome and to explore the possible action mechanism by zoopery.
Method Clinical part:Patients with postprandial distress syndrme were randomly divided into two groups,assigned 30 patients in controlled group to receive domperidone tablets,another 30 patients in treated group was taken a Chinese herbal formula called Yupi Hewei Decoction. After 4 weeks of treatment, the clinical curative effect was analyzed. Experimental part:The male SD rats were receive 0.1% iodoacetamide to make the model of functional dyspepsia,then divided randomly into 4 groups——Yupi Hewei Decoction,domperidone tablets,model and normal groups.Rats in normal group were not given any intervention measures.The gastric emptying changes of rats were assayed and distributions of the expressions of DOG-1 were detected.
Result The treated group showed a higher efficiency rate (93%) in compared to the controlled group (70%).The treated group showed a significant difference of statistical probability level of (P<0.05)PDS. Yupi Hewei Decoction could increase the gastric emptying and the level of DOG-1 in rat model of functional dyspepsia. There was no significant gastric mucosa damage in rats in each group.
Conclude The Method of invigorating spleen and harmonize the function of the stomach has a significant effect on treating Postprandial distress syndrme. Yupi Hewei Decoction could increase the gastric emptying and the level of DOG-1 in rat model of functional dyspepsia. The action mechanism maybe related to increasing the level of the DOG-1.
引文
[1]尚云.和胃健运汤治疗非溃疡性消化不良的临床观察[J].中医杂志,1998,39(3)：168-169
[2]周斌,段鲜红.运动障碍型消化不良的中医学病机特点[J].中国中西医结合脾胃杂志,1998,6(3)：170-171
[3]李军祥,吴凯等.综述古代中医药治疗痞满的历史概述,1996,4(2)：636
[4]陆维宏等.辨证治疗功能性消化不良618例疗效观察[J].中国医药学报,1994,9(4)：31
[5]刘沈林.对痞满辨证论治的几点认识[J].南京中医学院学报,1994,10(5)：24-25
[6]冯少华.功能性消化不良的治疗体会[J].光明中医,2006,(11).
[7]赵菊琴,戴祖汀,肖汉玺等.浅谈“痞满”证候与治疗[J].《中国农材医学》,1995,3(7)：61-62
[8]金群,王爱民,张旭初等.分型辨治功能性消化不良364例临床观察[J].江苏中医,1999,20(7)：17
[9]李乾构.功能性消化不良的辨证论治探析[J].中国中西医结合脾胃杂志1990,4(2)：115
[10]麦燕芳.中医辨证分型治疗功能性消化不良56例疗效观察[J].国医论坛,1999,14(3)：30-31
[11]单兆伟,周学文,李乾构.实用中医消化病学.北京：人民卫生出版社,2001,321-322
[12]孙淑君,张小萍.功能性消化不良病机的中西医研究进展[J].贵阳中医学院学报2007,5(3)：29
[13]Quartero AO, de Wit NJ, Lodder AC, et al. Disturbed solid-phase gastric emptying in functional dyspepsia:a meta-analysis. Digestive Diseases & Sciences 1998;43 (9):2028-33.
[14]Haag S, Talley NJ, Holtmann G. Symptom pattern in functional dyspepsia and irritable bowel syndrome:relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters.Gut 2004 Oct;53 (10):1145-51.
[15]Sarnelli G,Caenepeel P, Geypens B, et al. Symptoms associated with impaired gastric emptying. Am J Gastroenterol 1998;93:2082-2088.
[16]Talley NJ, Verlinden M, Jones M. Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?Am J Gastroenterol 2001:96:1442-8.
[17]Stanghellini V,Tosetti C, Patermico A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996:110:1036-1042.
[18]Perri F, Clemente R, Festa V, et al. Patterns of symptoms in functional dyspepsia:Role of Helicobacter pylori infection and delayed gastric emptying. Am J Gastroenterol 1998:93:2082-2088.
[19]Ahluwalia NK, Thompson DG, Mamtora H, et al. Evaluation of gastric antral motor performance in patients with dysmotility-like dyspepsia using real-time high-resolution ultrasound.Neurogastroenterology & Motility 1996;8(4):333-8.
[20]Greydanus MP,Malagelada JR,Kao PC,et al. Neurohormonal factors in functionaldyspepsia:insight on pathophysiological mechanisms. Gastroenterology 1991:100:1311-1318.
[21]Camilleri M.Malagelada JR.Kao PC, et al. Gastric and autonomic responses to stress in functiongal dyspepsia. Digestive Disease & Sciences 1986b;31(11):1169-77.
[22]Bortolotti M, Cucchiara S, Sarti P, et al. Interdigestive gastroduodenal motility in patients with ulcer-like dyspepsia:effect of ranitidine. Hepatogastroenterology, 1992,39(1):31-3.
[23]Wilmer A, Van Cutsem E, Andrioli A, et al. Ambulatory gastrojejunal manometry in severe motility-like dyspepsia:lack of correlation between dysmotility, symptoms, and gastric emptying. Gut,1998,42(2):235-42.
[24]Moayyedi P, Soo S, Deeks J, et al. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev,2004,(4):CD001960.
[25]李叶,罗云坚,黄穗平.功能性消化不良与胃肠动力和胃肠激素关系的研究进展[J].新中医,2003,35(2)：74
[26]Thumshirn M, Camilleri M, Saslow SB, et al. Gastric accommodation in non-ulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function. Gut,1999,44(1):55-64.
[27]Marzio L, Falcucci M, Grossi L, et al. Proximal and distal gastric distension in normal subjects and H. pylori-positive and-negative dyspeptic patients and correlation with symptoms. Dig Dis Sci,1998,43(12):2757-63.
[28]Klatt S, Pieramico 0, Guethner C, et al. Gastric hypersensitivity in non-ulcer dyspepsia: an inconsistent finding. Dig Dis Sci,1997,42(4):720-3.
[29]Jebbink HJ, Van Berge-Henegouwen GP, Bruijs PP, et al. Gastric myoelectrical activity and gastrointestinal motility in patients with functional dyspepsia. Eur J Clin Invest, 1995,25 (6):429-37.
[30]Pfaffenbach B, Adamek RJ, Bartholomaus C, et al. Gastric dysrhythmias and delayed gastric emptying in patients with functional dyspepsia. Dig Dis Sci,1997,42(10):2094-9.
[31]Lin X, Levanon D, Chen JD. Impaired postprandial gastric slow waves in patients with functional dyspepsia. Dig Dis Sci,1998,43(8):1678-84.
[32]Lin Z, Eaker EY, Sarosiek I, et al. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastroenterol,1999,94(9):2384-9.
[33]Koch KL, Hong SP, Xu L. Reproducibility of gastric myoelectrical activity and the water load test in patients with dysmotility-like dyspepsia symptoms and in control subjects. J Clin Gastroenterol,2000,31(2):125-9.
[34]Mearin F, Cucala M, Azpiroz F, et al. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology,1991,101(4):999-1006.
[35]Holtmann G, Gschossmann J, Neufang-Huber J, et al. Differences in gastric mechanosensory function after repeated ramp distensions in non-consulters with dyspepsia and healthy controls. Gut,2000,47 (3):332-6.
[36]Tack J, Caenepeel P, Fischler B, et al. Symptoms associated with hypersensitivity to gastric distention in functional dyspepsia. Gastroenterology,2001,121(3):526-35.
[37]Klatt S, Pieramico 0, Guethner C, et al. Gastric hypersensitivity in nonulcer dyspepsia: an inconsistent finding. Dig Dis Sci,1997,42(4):720-3.
[38]Caldarella MP, Azpiroz F, Malagelada JR. Antro-fundic dysfunctions in functional dyspepsia. Gastroenterology,2003,124(5):1220-9.
[39]Ladabaum U, Minoshima S, Hasler WL, et al. Gastric distention correlates with activation of multiple cortical and subcortical regions. Gastroenterology,2001,120(2):369-76.
[40]Vandenbergh J, Dupont P, Fischler B, et al. Regional brain activation during proximal stomach distention in humans:A positron emission tomography study. Gastroenterology, 2005,128(3):564-73.
[41]Holtmann G, Goebell H, Jockenhoevel F, et al. Altered vagal and intestinal mechanosensory function in chronic unexplained dyspepsia. Gut,1998,42(4):501-6.
[42]Holtmann G, Gschossmann J, Buenger L, et al. Do changes in visceral sensory function determine the development of dyspepsia during treatment with aspirin. Gastroenterology, 2002,123(5):1451-8.
[43]Holtmann G, Goebell H, Jockenhoevel F, et al. Altered vagal and intestinal mechanosensory function in chronic unexplained dyspepsia. Gut,1998,42(4):501-6.
[44]Greydanus MP, Vassallo M, Camilleri M, et al. Neurohormonal factors in functional dyspepsia:insights on pathophysiological mechanisms. Gastroenterology,1991,100(5 Pt 1):1311-8.
[45]Simren M, Vos R, Janssens J, et al. Acid infusion enhances duodenal mechanosensitivity in healthy subjects. Am J Physiol Gastrointest Liver Physiol,2003,285(2):G309-15.
[46]Lee KJ, Vos R, Janssens J, et al. Influence of duodenal acidification on the sensorimotor function of the proximal stomach in humans. Am J Physiol Gastrointest Liver Physiol, 2004,286(2):G278-84.
[47]Samsom M, Verhagen MA, vanBerge HGP, et al. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology, 1999,116(3):515-20.
[48]Lee KJ, Demarchi B, Demedts I, et al. A pilot study on duodenal acid exposure and its relationship to symptoms in functional dyspepsia with prominent nausea. Am J Gastroenterol, 2004,99 (9):1765-73.
[49]Schwartz MP, Samsom M, Van Berge Henegouwen GP, et al. Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia. Aliment Pharmacol Ther,2001,15(12):1921-8.
[50]朱良如,谢小平.肥大细胞在胃感觉过敏患者胃黏膜中的改变[J].中华消化杂志,2003,3(2)：76
[51]Chiloiro M, Russo F, Riezzo G, et al. Effect of Helicobacter pylori infection on gastric emptying and gastrointestinal hormones in dyspeptic and healthy subjects. Dig Dis Sci, 2001,46(1):46-53.
[52]Riezzo G, Chiloiro M, Russo F, et al. Gastric electrical activity and gastrointestinal hormones in dyspeptic patients. Digestion,2001,63(1):20-9.
[53]Holtmann G, Siffert W, Haag S, et al. G-protein beta 3 subunit 825 CC genotype is associated with unexplained (functional) dyspepsia. Gastroenterology,2004,126(4):971-9.
[54]Watson RG, Shaw C, Buchanan KD, et al. Circulating gastrointestinal hormones in patients with flatulent dyspepsia, with and without gallbladder disease. Digestion,1986,35(4):211-6.
[55]Kaneko H, Mitsuma T, Fujii S, et al. Immunoreactive-somatostatin concentrations of the human stomach and mood state in patients with functional dyspepsia:a preliminary case-control study. J Gastroenterol Hepatol,1993,8(4):322-7.
[56]Moss SF, Legon S, Bishop AE, et al. Effect of Helicobacter pylori on gastric somatostatin in duodenal ulcer disease. Lancet,1992,340(8825):930-2.
[57]Monnikes H, der Voort IR v, Wollenberg B, et al. Gastric perception thresholds are low and sensory neuropeptide levels high in helicobacter pylori-positive functional dyspepsia. Digestion,2005,71(2):111-23.
[58]Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology,2004,127(4):1239-55.
[59]Talley NJ, Boyce P, Jones M. Dyspepsia and health care seeking in a community:How important are psychological factors. Dig Dis Sci,1998,43(5):1016-22.
[60]Koloski NA, Talley NJ, Boyce PM. Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia:a critical review of the literature on symptom and psychosocial factors. Am J Gastroenterol,2001,96(5):1340-9.
[61]Wilhelmsen I, Haug TT, Ursin H, et al. Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer. Significance of somatization. Dig Dis Sci,1995,40(5):1105-11.
[62]Cheng C. Seeking medical consultation:perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia. Psychosom Med, 2000,62(6):844-52.
[63]Fischler B, Vandenberghe J.Persoons P,et al. Evidence-based subtypes in functional dyspepsia with confirmatory factor analysis:Psychosocial and physiopathological correlates. Gastroenterology 2003;124:903-10
[64]冯英,赵永锋.功能性消化不良患者的抑郁和焦虑调查分析[J].中华临床医学杂志,2005, 6(5)：23-24
[65]宋志强,柯美云,王智凤等.有和无重叠症状的功能性消化不良患者中消化不良症状学和发病机制的比较研究.胃肠病学,2006,11：458-461
[66]胡品津.幽门螺杆菌与功能性消化不良[J].中华内科杂志,2000,139(2)：81-82
[67]KindtS, CaenepeelP, ArtsJ, etal. Characteristicand determinants of longterm outcome in acute onset functional dyspepsia patients. astroenterology,2006,130:A134
[68]DrossmanDA.The functional gastrointestinaldisorders and the RomeⅢ process. Gastroenterology,2006,130:1377-1390
[69]Liebregts T, Adam B, Bredack C, et al.The link betweenmealrelated sympotoms and cytokine release in patients with func-tional dyspepsia. Gastroenterology,2006,130:A625
[70]Tally NJ, Lock GR, Lahr BD, et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut,2006,55:933-39.
[71]Holtmann G, Talley NJ, Liebregts T, et al. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med,2006,354(8):832-40.
[72]Talley NJ, Haque M, Wyeth JW, et al. Development of a new dyspepsia impact scale:the Nepean Dyspepsia Index. Aliment Pharmacol Ther,1999,13(2):225-35.
[73]Talley NJ, Verlinden M, Jones M. Validity of a new quality of life scale for functional dyspepsia:a United States multicenter trial of the Nepean Dyspepsia Index. Am J Gastroenterol, 1999,94(9):2390-7.
[74]刘松林,赵映前,万晓刚.功能性消化不良的中医临床辨证规律研究.中国医药学报,2004,(08)：499-501.
[1]Gomez-Pinilla PJ, Gibbons SJ, Bardsley MR, et al. Anol is a selective marker of interstitial cells of Cajal in the human and mouse gastrointestinal tract. Am J Physiol Gastrointest Liver Physiol.2009.296(6):G1370-81.
[2]Liu LS, Winston JH, Shenoy MM, Song GQ, Chen JD, Pasricha PJ. A rat model of chronic gastric sensorimotor dysfunction resulting from transient neonatal gastric irritation. Gastroenterology.2008.134(7): 2070-9.
[3]杨国红,林中军,刘卫红.胃胀舒合剂对功能性消化不良大鼠胃排空及血浆胃肠激素水平的影响.中国中西医结合消化杂志.2008.(06)：381-383.
[4]陈丽萍,吴山力,Erzsebet, Karoly A,迟宝荣.碘乙酰胺诱导的大鼠胃炎中神经肽免疫阳性神经’纤维的变化.吉林大学学报(医学版).2007.(01)：75-77.
[5]Larauche M, Anton PM, Garcia-Villar R, et al. Protective effect of dietary nitrate on experimental gastritis in rats. Br J Nutr.2003.89(6):777-86.
[6]Faussone-Pellegrini MS, Pantalone D, Cortesini C. An ultrastructural study of the interstitial cells of Cajal of the human stomach. J Submicrosc Cytol Pathol.1989.21(3):439-60.
[7]Rumessen JJ, Mikkelsen HB, Thuneberg L. Ultrastructure of interstitial cells of Cajal associated with deep muscular plexus of human small intestine. Gastroenterology.1992.102(1):56-68.
[8]Komuro T. Structure and organization of interstitial cells of Cajal in the gastrointestinal tract. J Physiol. 2006.576(Pt 3):653-8.
[9]周吕,袁勃.促胰液素通过大鼠Cajal间质细胞促进胃平滑肌舒张.基础医学与临床.2003.(06)：612-615.
[10]周吕,袁勃.胃动素对Cajal间质细胞引起的大鼠胃平滑肌收缩的作用.中华医学杂志.2003.(16)： 50-55.
[11]Ward SM, Beckett EA, Wang X, Baker F, Khoyi M, Sanders KM. Interstitial cells of Cajal mediate cholinergic neurotransmission from enteric motor neurons. J Neurosci.2000.20(4):1393-403.
[12]Wang XY, Paterson C, Huizinga JD. Cholinergic and nitrergic innervation of ICC-DMP and ICC-IM in the human small intestine. Neurogastroenterol Motil.2003.15(5):531-43.
[13]Epperson A, Hatton WJ, Callaghan B, et al. Molecular markers expressed in cultured and freshly isolated interstitial cells of Cajal. Am J Physiol Cell Physiol.2000.279(2):C529-39.
[14]Zhu MH, Kim TW, Ro S, et al. A Ca(2+)-activated Cl(-) conductance in interstitial cells of Cajal linked to slow wave currents and pacemaker activity. J Physiol.2009.587(Pt 20):4905-18.
[15]Sanders KM, Ordog T, Koh SD, Ward SM. A Novel Pacemaker Mechanism Drives Gastrointestinal Rhythmicity. News Physiol Sci.2000.15:291-298.
[16]Nemeth L, Puri P. Three-dimensional morphology of c-Kit-positive cellular network and nitrergic innervation in the human gut. Arch Pathol Lab Med.2001.125(7):899-904.
[17]Nemeth L, Maddur S, Puri P. Immunolocalization of the gap junction protein Connexin43 in the interstitial cells of Cajal in the normal and Hirschsprung's disease bowel. J Pediatr Surg.2000.35(6):823-8.
[18]Faussone-Pellegrini MS. Relationships between neurokinin receptor-expressing interstitial cells of Cajal and tachykininergic nerves in the gut. J Cell Mol Med.2006.10(1):20-32.
[19]Salmhofer H, Neuhuber WL, Ruth P, Huber A, Russwurm M, Allescher HD. Pivotal role of the interstitial cells of Cajal in the nitric oxide signaling pathway of rat small intestine. Morphological evidence. Cell Tissue Res.2001.305(3):331-40.
[20]Zhu MH, Kim TW, Ro S, et al. A Ca(2+)-activated Cl(-) conductance in interstitial cells of Cajal linked to slow wave currents and pacemaker activity. J Physiol.2009.587(Pt 20):4905-18.
[21]Hwang SJ, Blair PJ, Britton FC, et al. Expression of anoctamin 1/TMEM16A by interstitial cells of Cajal is fundamental for slow wave activity in gastrointestinal muscles. J Physiol.2009.587(Pt 20):4887-904.
[2]周斌,段鲜红.运动障碍型消化不良的中医学病机特点[J].中国中西医结合脾胃杂志,1998,6(3)：170-171
[3]李军祥,吴凯等.综述古代中医药治疗痞满的历史概述,1996,4(2)：636
[4]陆维宏等.辨证治疗功能性消化不良618例疗效观察[J].中国医药学报,1994,9(4)：31
[5]刘沈林.对痞满辨证论治的几点认识[J].南京中医学院学报,1994,10(5)：24-25
[6]冯少华.功能性消化不良的治疗体会[J].光明中医,2006,(11).
[7]赵菊琴,戴祖汀,肖汉玺等.浅谈“痞满”证候与治疗[J].《中国农材医学》,1995,3(7)：61-62
[8]金群,王爱民,张旭初等.分型辨治功能性消化不良364例临床观察[J].江苏中医,1999,20(7)：17
[9]李乾构.功能性消化不良的辨证论治探析[J].中国中西医结合脾胃杂志1990,4(2)：115
[10]麦燕芳.中医辨证分型治疗功能性消化不良56例疗效观察[J].国医论坛,1999,14(3)：30-31
[11]单兆伟,周学文,李乾构.实用中医消化病学.北京：人民卫生出版社,2001,321-322
[12]孙淑君,张小萍.功能性消化不良病机的中西医研究进展[J].贵阳中医学院学报2007,5(3)：29
[13]Quartero AO, de Wit NJ, Lodder AC, et al. Disturbed solid-phase gastric emptying in functional dyspepsia:a meta-analysis. Digestive Diseases & Sciences 1998;43 (9):2028-33.
[14]Haag S, Talley NJ, Holtmann G. Symptom pattern in functional dyspepsia and irritable bowel syndrome:relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters.Gut 2004 Oct;53 (10):1145-51.
[15]Sarnelli G,Caenepeel P, Geypens B, et al. Symptoms associated with impaired gastric emptying. Am J Gastroenterol 1998;93:2082-2088.
[16]Talley NJ, Verlinden M, Jones M. Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?Am J Gastroenterol 2001:96:1442-8.
[17]Stanghellini V,Tosetti C, Patermico A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996:110:1036-1042.
[18]Perri F, Clemente R, Festa V, et al. Patterns of symptoms in functional dyspepsia:Role of Helicobacter pylori infection and delayed gastric emptying. Am J Gastroenterol 1998:93:2082-2088.
[19]Ahluwalia NK, Thompson DG, Mamtora H, et al. Evaluation of gastric antral motor performance in patients with dysmotility-like dyspepsia using real-time high-resolution ultrasound.Neurogastroenterology & Motility 1996;8(4):333-8.
[20]Greydanus MP,Malagelada JR,Kao PC,et al. Neurohormonal factors in functionaldyspepsia:insight on pathophysiological mechanisms. Gastroenterology 1991:100:1311-1318.
[21]Camilleri M.Malagelada JR.Kao PC, et al. Gastric and autonomic responses to stress in functiongal dyspepsia. Digestive Disease & Sciences 1986b;31(11):1169-77.
[22]Bortolotti M, Cucchiara S, Sarti P, et al. Interdigestive gastroduodenal motility in patients with ulcer-like dyspepsia:effect of ranitidine. Hepatogastroenterology, 1992,39(1):31-3.
[23]Wilmer A, Van Cutsem E, Andrioli A, et al. Ambulatory gastrojejunal manometry in severe motility-like dyspepsia:lack of correlation between dysmotility, symptoms, and gastric emptying. Gut,1998,42(2):235-42.
[24]Moayyedi P, Soo S, Deeks J, et al. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev,2004,(4):CD001960.
[25]李叶,罗云坚,黄穗平.功能性消化不良与胃肠动力和胃肠激素关系的研究进展[J].新中医,2003,35(2)：74
[26]Thumshirn M, Camilleri M, Saslow SB, et al. Gastric accommodation in non-ulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function. Gut,1999,44(1):55-64.
[27]Marzio L, Falcucci M, Grossi L, et al. Proximal and distal gastric distension in normal subjects and H. pylori-positive and-negative dyspeptic patients and correlation with symptoms. Dig Dis Sci,1998,43(12):2757-63.
[28]Klatt S, Pieramico 0, Guethner C, et al. Gastric hypersensitivity in non-ulcer dyspepsia: an inconsistent finding. Dig Dis Sci,1997,42(4):720-3.
[29]Jebbink HJ, Van Berge-Henegouwen GP, Bruijs PP, et al. Gastric myoelectrical activity and gastrointestinal motility in patients with functional dyspepsia. Eur J Clin Invest, 1995,25 (6):429-37.
[30]Pfaffenbach B, Adamek RJ, Bartholomaus C, et al. Gastric dysrhythmias and delayed gastric emptying in patients with functional dyspepsia. Dig Dis Sci,1997,42(10):2094-9.
[31]Lin X, Levanon D, Chen JD. Impaired postprandial gastric slow waves in patients with functional dyspepsia. Dig Dis Sci,1998,43(8):1678-84.
[32]Lin Z, Eaker EY, Sarosiek I, et al. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastroenterol,1999,94(9):2384-9.
[33]Koch KL, Hong SP, Xu L. Reproducibility of gastric myoelectrical activity and the water load test in patients with dysmotility-like dyspepsia symptoms and in control subjects. J Clin Gastroenterol,2000,31(2):125-9.
[34]Mearin F, Cucala M, Azpiroz F, et al. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology,1991,101(4):999-1006.
[35]Holtmann G, Gschossmann J, Neufang-Huber J, et al. Differences in gastric mechanosensory function after repeated ramp distensions in non-consulters with dyspepsia and healthy controls. Gut,2000,47 (3):332-6.
[36]Tack J, Caenepeel P, Fischler B, et al. Symptoms associated with hypersensitivity to gastric distention in functional dyspepsia. Gastroenterology,2001,121(3):526-35.
[37]Klatt S, Pieramico 0, Guethner C, et al. Gastric hypersensitivity in nonulcer dyspepsia: an inconsistent finding. Dig Dis Sci,1997,42(4):720-3.
[38]Caldarella MP, Azpiroz F, Malagelada JR. Antro-fundic dysfunctions in functional dyspepsia. Gastroenterology,2003,124(5):1220-9.
[39]Ladabaum U, Minoshima S, Hasler WL, et al. Gastric distention correlates with activation of multiple cortical and subcortical regions. Gastroenterology,2001,120(2):369-76.
[40]Vandenbergh J, Dupont P, Fischler B, et al. Regional brain activation during proximal stomach distention in humans:A positron emission tomography study. Gastroenterology, 2005,128(3):564-73.
[41]Holtmann G, Goebell H, Jockenhoevel F, et al. Altered vagal and intestinal mechanosensory function in chronic unexplained dyspepsia. Gut,1998,42(4):501-6.
[42]Holtmann G, Gschossmann J, Buenger L, et al. Do changes in visceral sensory function determine the development of dyspepsia during treatment with aspirin. Gastroenterology, 2002,123(5):1451-8.
[43]Holtmann G, Goebell H, Jockenhoevel F, et al. Altered vagal and intestinal mechanosensory function in chronic unexplained dyspepsia. Gut,1998,42(4):501-6.
[44]Greydanus MP, Vassallo M, Camilleri M, et al. Neurohormonal factors in functional dyspepsia:insights on pathophysiological mechanisms. Gastroenterology,1991,100(5 Pt 1):1311-8.
[45]Simren M, Vos R, Janssens J, et al. Acid infusion enhances duodenal mechanosensitivity in healthy subjects. Am J Physiol Gastrointest Liver Physiol,2003,285(2):G309-15.
[46]Lee KJ, Vos R, Janssens J, et al. Influence of duodenal acidification on the sensorimotor function of the proximal stomach in humans. Am J Physiol Gastrointest Liver Physiol, 2004,286(2):G278-84.
[47]Samsom M, Verhagen MA, vanBerge HGP, et al. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology, 1999,116(3):515-20.
[48]Lee KJ, Demarchi B, Demedts I, et al. A pilot study on duodenal acid exposure and its relationship to symptoms in functional dyspepsia with prominent nausea. Am J Gastroenterol, 2004,99 (9):1765-73.
[49]Schwartz MP, Samsom M, Van Berge Henegouwen GP, et al. Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia. Aliment Pharmacol Ther,2001,15(12):1921-8.
[50]朱良如,谢小平.肥大细胞在胃感觉过敏患者胃黏膜中的改变[J].中华消化杂志,2003,3(2)：76
[51]Chiloiro M, Russo F, Riezzo G, et al. Effect of Helicobacter pylori infection on gastric emptying and gastrointestinal hormones in dyspeptic and healthy subjects. Dig Dis Sci, 2001,46(1):46-53.
[52]Riezzo G, Chiloiro M, Russo F, et al. Gastric electrical activity and gastrointestinal hormones in dyspeptic patients. Digestion,2001,63(1):20-9.
[53]Holtmann G, Siffert W, Haag S, et al. G-protein beta 3 subunit 825 CC genotype is associated with unexplained (functional) dyspepsia. Gastroenterology,2004,126(4):971-9.
[54]Watson RG, Shaw C, Buchanan KD, et al. Circulating gastrointestinal hormones in patients with flatulent dyspepsia, with and without gallbladder disease. Digestion,1986,35(4):211-6.
[55]Kaneko H, Mitsuma T, Fujii S, et al. Immunoreactive-somatostatin concentrations of the human stomach and mood state in patients with functional dyspepsia:a preliminary case-control study. J Gastroenterol Hepatol,1993,8(4):322-7.
[56]Moss SF, Legon S, Bishop AE, et al. Effect of Helicobacter pylori on gastric somatostatin in duodenal ulcer disease. Lancet,1992,340(8825):930-2.
[57]Monnikes H, der Voort IR v, Wollenberg B, et al. Gastric perception thresholds are low and sensory neuropeptide levels high in helicobacter pylori-positive functional dyspepsia. Digestion,2005,71(2):111-23.
[58]Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology,2004,127(4):1239-55.
[59]Talley NJ, Boyce P, Jones M. Dyspepsia and health care seeking in a community:How important are psychological factors. Dig Dis Sci,1998,43(5):1016-22.
[60]Koloski NA, Talley NJ, Boyce PM. Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia:a critical review of the literature on symptom and psychosocial factors. Am J Gastroenterol,2001,96(5):1340-9.
[61]Wilhelmsen I, Haug TT, Ursin H, et al. Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer. Significance of somatization. Dig Dis Sci,1995,40(5):1105-11.
[62]Cheng C. Seeking medical consultation:perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia. Psychosom Med, 2000,62(6):844-52.
[63]Fischler B, Vandenberghe J.Persoons P,et al. Evidence-based subtypes in functional dyspepsia with confirmatory factor analysis:Psychosocial and physiopathological correlates. Gastroenterology 2003;124:903-10
[64]冯英,赵永锋.功能性消化不良患者的抑郁和焦虑调查分析[J].中华临床医学杂志,2005, 6(5)：23-24
[65]宋志强,柯美云,王智凤等.有和无重叠症状的功能性消化不良患者中消化不良症状学和发病机制的比较研究.胃肠病学,2006,11：458-461
[66]胡品津.幽门螺杆菌与功能性消化不良[J].中华内科杂志,2000,139(2)：81-82
[67]KindtS, CaenepeelP, ArtsJ, etal. Characteristicand determinants of longterm outcome in acute onset functional dyspepsia patients. astroenterology,2006,130:A134
[68]DrossmanDA.The functional gastrointestinaldisorders and the RomeⅢ process. Gastroenterology,2006,130:1377-1390
[69]Liebregts T, Adam B, Bredack C, et al.The link betweenmealrelated sympotoms and cytokine release in patients with func-tional dyspepsia. Gastroenterology,2006,130:A625
[70]Tally NJ, Lock GR, Lahr BD, et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut,2006,55:933-39.
[71]Holtmann G, Talley NJ, Liebregts T, et al. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med,2006,354(8):832-40.
[72]Talley NJ, Haque M, Wyeth JW, et al. Development of a new dyspepsia impact scale:the Nepean Dyspepsia Index. Aliment Pharmacol Ther,1999,13(2):225-35.
[73]Talley NJ, Verlinden M, Jones M. Validity of a new quality of life scale for functional dyspepsia:a United States multicenter trial of the Nepean Dyspepsia Index. Am J Gastroenterol, 1999,94(9):2390-7.
[74]刘松林,赵映前,万晓刚.功能性消化不良的中医临床辨证规律研究.中国医药学报,2004,(08)：499-501.
[1]Gomez-Pinilla PJ, Gibbons SJ, Bardsley MR, et al. Anol is a selective marker of interstitial cells of Cajal in the human and mouse gastrointestinal tract. Am J Physiol Gastrointest Liver Physiol.2009.296(6):G1370-81.
[2]Liu LS, Winston JH, Shenoy MM, Song GQ, Chen JD, Pasricha PJ. A rat model of chronic gastric sensorimotor dysfunction resulting from transient neonatal gastric irritation. Gastroenterology.2008.134(7): 2070-9.
[3]杨国红,林中军,刘卫红.胃胀舒合剂对功能性消化不良大鼠胃排空及血浆胃肠激素水平的影响.中国中西医结合消化杂志.2008.(06)：381-383.
[4]陈丽萍,吴山力,Erzsebet, Karoly A,迟宝荣.碘乙酰胺诱导的大鼠胃炎中神经肽免疫阳性神经’纤维的变化.吉林大学学报(医学版).2007.(01)：75-77.
[5]Larauche M, Anton PM, Garcia-Villar R, et al. Protective effect of dietary nitrate on experimental gastritis in rats. Br J Nutr.2003.89(6):777-86.
[6]Faussone-Pellegrini MS, Pantalone D, Cortesini C. An ultrastructural study of the interstitial cells of Cajal of the human stomach. J Submicrosc Cytol Pathol.1989.21(3):439-60.
[7]Rumessen JJ, Mikkelsen HB, Thuneberg L. Ultrastructure of interstitial cells of Cajal associated with deep muscular plexus of human small intestine. Gastroenterology.1992.102(1):56-68.
[8]Komuro T. Structure and organization of interstitial cells of Cajal in the gastrointestinal tract. J Physiol. 2006.576(Pt 3):653-8.
[9]周吕,袁勃.促胰液素通过大鼠Cajal间质细胞促进胃平滑肌舒张.基础医学与临床.2003.(06)：612-615.
[10]周吕,袁勃.胃动素对Cajal间质细胞引起的大鼠胃平滑肌收缩的作用.中华医学杂志.2003.(16)： 50-55.
[11]Ward SM, Beckett EA, Wang X, Baker F, Khoyi M, Sanders KM. Interstitial cells of Cajal mediate cholinergic neurotransmission from enteric motor neurons. J Neurosci.2000.20(4):1393-403.
[12]Wang XY, Paterson C, Huizinga JD. Cholinergic and nitrergic innervation of ICC-DMP and ICC-IM in the human small intestine. Neurogastroenterol Motil.2003.15(5):531-43.
[13]Epperson A, Hatton WJ, Callaghan B, et al. Molecular markers expressed in cultured and freshly isolated interstitial cells of Cajal. Am J Physiol Cell Physiol.2000.279(2):C529-39.
[14]Zhu MH, Kim TW, Ro S, et al. A Ca(2+)-activated Cl(-) conductance in interstitial cells of Cajal linked to slow wave currents and pacemaker activity. J Physiol.2009.587(Pt 20):4905-18.
[15]Sanders KM, Ordog T, Koh SD, Ward SM. A Novel Pacemaker Mechanism Drives Gastrointestinal Rhythmicity. News Physiol Sci.2000.15:291-298.
[16]Nemeth L, Puri P. Three-dimensional morphology of c-Kit-positive cellular network and nitrergic innervation in the human gut. Arch Pathol Lab Med.2001.125(7):899-904.
[17]Nemeth L, Maddur S, Puri P. Immunolocalization of the gap junction protein Connexin43 in the interstitial cells of Cajal in the normal and Hirschsprung's disease bowel. J Pediatr Surg.2000.35(6):823-8.
[18]Faussone-Pellegrini MS. Relationships between neurokinin receptor-expressing interstitial cells of Cajal and tachykininergic nerves in the gut. J Cell Mol Med.2006.10(1):20-32.
[19]Salmhofer H, Neuhuber WL, Ruth P, Huber A, Russwurm M, Allescher HD. Pivotal role of the interstitial cells of Cajal in the nitric oxide signaling pathway of rat small intestine. Morphological evidence. Cell Tissue Res.2001.305(3):331-40.
[20]Zhu MH, Kim TW, Ro S, et al. A Ca(2+)-activated Cl(-) conductance in interstitial cells of Cajal linked to slow wave currents and pacemaker activity. J Physiol.2009.587(Pt 20):4905-18.
[21]Hwang SJ, Blair PJ, Britton FC, et al. Expression of anoctamin 1/TMEM16A by interstitial cells of Cajal is fundamental for slow wave activity in gastrointestinal muscles. J Physiol.2009.587(Pt 20):4887-904.