便秘型肠易激综合征患者肛门直肠感觉及动力学变化的临床研究
|
摘要
目的探讨便秘型肠易激综合征(IBS-C)患者的肛门动力学及肛门直肠感觉功能变化及其盆底肌电压情况。方法选择2014年12月1日至2017年12月1日期间中国人民解放军联勤保障部队942医院消化内科收治的IBS-C患者36例(IBS-C组)及健康自愿者28例(对照组),分别采用ZJ-D3型肛肠压力检测仪和生物刺激反馈仪检测2组受试者的直肠肛管压力(肛管静息压、直肠静息压、肛管直肠压差、肛管高压带长度、直肠感觉阈值及直肠顺应性)和盆底肌电压变化并进行比较。结果 IBS-C组的直肠静息压和肛管静息压分别与对照组比较差异均无统计学意义(P>0.05),但IBS-C组的肛管直肠压差明显高于对照组(t=4.371,P=0.017),IBS-C组的肛管高压带长度明显长于对照组(t=6.180,P=0.042)。IBS-C组盆底肌的最大肌电压、最小肌电压及电压频率均明显高于对照组(t=3.386,P=0.031;t=5.763,P=0.042;t=8.410,P<0.001)。结论肛门直肠动力学和直肠感觉功能异常可能是IBS-C的重要病因之一,IBS-C可能存在异常的盆底肌肌电压变化。
Objective To investigate changes in anal dynamics and anorectal sensory function in patients with irritable bowel syndrome with constipation(IBS-C) and detect its status of basin's myoelectric pressure. Methods Thirty-six patients with IBS-C(IBS-C group) and 28 healthy volunteers(control group) were collected. The rectal-anal canal pressure and the change of the basin's myoelectric status were detected by the ZJ-D3 gastrointestinal motility tester and bio-stimulus feedback instrument, respectively. The anal canal resting pressure, rectal resting pressure, anorectal pressure difference, length of anal canal high pressure area, rectal sensation threshold, rectal compliance, and basin's myoelectric voltage were compared between these two groups. Results There were no significant differences in the rectal resting pressure and anal canal resting pressure between the IBS-C group and the control group(t=–2.312, P=0.851;t=–5.464, P=0.283), but the difference value of anorectal pressure of the IBS-C group was significantly higher than that of the control group(t=4.371, P=0.017), and the length of the anal canal hypertension area in the IBS-C group was significantly longer than that of the control group(t=6.180, P=0.042). The maximal and minimum basin's myoelectric voltage and frequency of the basin's myoelectric voltage in the IBS-C group were significantly higher than those in the control group(t=3.386, P=0.031; t=5.763, P=0.042; t=8.410, P<0.001). Conclusion Anorectal dynamics and rectal sensory dysfunction are one of important causes of IBS-C, it might be existed abnormal changes in basin's myoelectric voltage.
Objective To investigate changes in anal dynamics and anorectal sensory function in patients with irritable bowel syndrome with constipation(IBS-C) and detect its status of basin's myoelectric pressure. Methods Thirty-six patients with IBS-C(IBS-C group) and 28 healthy volunteers(control group) were collected. The rectal-anal canal pressure and the change of the basin's myoelectric status were detected by the ZJ-D3 gastrointestinal motility tester and bio-stimulus feedback instrument, respectively. The anal canal resting pressure, rectal resting pressure, anorectal pressure difference, length of anal canal high pressure area, rectal sensation threshold, rectal compliance, and basin's myoelectric voltage were compared between these two groups. Results There were no significant differences in the rectal resting pressure and anal canal resting pressure between the IBS-C group and the control group(t=–2.312, P=0.851;t=–5.464, P=0.283), but the difference value of anorectal pressure of the IBS-C group was significantly higher than that of the control group(t=4.371, P=0.017), and the length of the anal canal hypertension area in the IBS-C group was significantly longer than that of the control group(t=6.180, P=0.042). The maximal and minimum basin's myoelectric voltage and frequency of the basin's myoelectric voltage in the IBS-C group were significantly higher than those in the control group(t=3.386, P=0.031; t=5.763, P=0.042; t=8.410, P<0.001). Conclusion Anorectal dynamics and rectal sensory dysfunction are one of important causes of IBS-C, it might be existed abnormal changes in basin's myoelectric voltage.
引文
1Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology, 2016 Feb 18. pii:S0016-5085(16)00222-5.
2Lacy BE. Review article:an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2018, 48(8):817-8304.
3Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome:a clinical review. JAMA, 2015, 313(9):949-958.
4杜海涛,陈峥,万军.肠易激综合征的病理机制研究进展.解放军医学院学报, 2017, 38(1):85-88.
5Ek WE, Reznichenko A, Ripke S, et al. Exploring the genetics of irritable bowel syndrome:a GWA study in the general population and replication in multinational case-control cohorts. Gut, 2015,64(11):1774-1782.
6Gupta A. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med, 2013, 368(6):578.
7Fukudo S, Kaneko H, Akiho H, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome. J Gastroenterol,2015, 50(1):11-30.
8罗哲,崔立红,贺星.肠道菌群失调与肠易激综合征关系的研究进展.解放军医学院学报, 2015, 36(10):1011-1013.
9弓三东,崔立红.粪菌移植在肠易激综合征中的研究进展.解放军医学院学报, 2015, 36(10):1006-1010.
10李超,迟雁,王化虹,等.腹泻型肠易激综合征患者肛管直肠动力及感觉功能与外周血肥大细胞类胰蛋白酶的相关性研究.中国全科医学, 2017, 20(11):1320-1325.
11Drossman DA. The functional gastrointestinal disorders and the RomeⅡprocess. Gut, 1999, 45(Suppl 2):I1-I5.
12叶彬,陈春晓.老年住院慢性便秘患者的焦虑抑郁状态和睡眠状况.中国老年学杂志, 2016, 36(8):1996-1998.
13窦迎春,曲海霞,许倩倩,等.焦虑及抑郁评分与慢性便秘患者临床不同伴随症状关系研究.胃肠病学和肝病学杂志, 2018,27(8):896-899.
14罗敏,李峨,李国栋,等.肛管直肠压力测定在肛门功能评估中的价值及临床应用.现代中西医结合杂志, 2012, 21(18):1946-1947.
15段建华,赵洪川.便秘型肠易激综合征患者结、直肠肛门动力学的临床研究.胃肠病学和肝病学杂志, 2006, 15(2):191-193.
16颜文娟,李蜀豫.便秘型肠易激综合征患者直肠肛管压力的改变与焦虑/抑郁情绪测定评分的临床意义.临床消化病杂志,2014, 26(4):230-232.
17王晓玉,罗新.盆底功能障碍的生物反馈治疗和电刺激治疗.中国实用妇科与产科杂志, 2009, 22(7):559-560.
18刘玲玲,冯珍.肌电生物反馈的临床研究及应用进展.中国康复医学杂志, 2012, 27(3):289-292.
19王梦欣,宋冬玲,简佳.肌电生物反馈对难治性肠易激综合征内脏痛觉敏感的影响.中华物理医学与康复杂志, 2009, 31(1):26-29.
20季新涛,丁义江.生物反馈治疗便秘的现状.结直肠肛门外科,2008, 14(6):385-387.
21Kosako M, Akiho H, Miwa H, et al. Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation(IBS-C):a large population-based internet survey.Biopsychosoc Med, 2018, 12:12.
22张璐,段丽萍,刘懿萱,等.中国人群肠易激综合征患病率和相关危险因素的Meta分析.中华内科杂志, 2014, 53(12):969-975.
23Adeyemo MA, Spiegel BM, Chang L. Meta-analysis:do irritable bowel syndrome symptoms vary between men and women.Aliment Pharmacol Ther, 2010, 32(6):738-755.
24Simrén M, Barbara G, Flint HJ, et al. Intestinal microbiota in functional bowel disorders:a Rome foundation report. Gut, 2013,62(1):159-176.
25Dupont HL. Review article:evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Aliment Pharmacol Ther, 2014, 39(10):1033-1042.
26罗勰林.生物刺激反馈仪结合盆底肌训练疗法对产后盆底肌功能康复效果观察.中国医疗器械信息, 2017, 23(14):84-85.
27李晓霞,夏泳,郑琳.生物反馈电刺激结合盆底肌训练疗法对产后盆底肌功能康复效果观察.中国实用妇科与产科杂志, 2012,28(6):442-444.
2Lacy BE. Review article:an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2018, 48(8):817-8304.
3Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome:a clinical review. JAMA, 2015, 313(9):949-958.
4杜海涛,陈峥,万军.肠易激综合征的病理机制研究进展.解放军医学院学报, 2017, 38(1):85-88.
5Ek WE, Reznichenko A, Ripke S, et al. Exploring the genetics of irritable bowel syndrome:a GWA study in the general population and replication in multinational case-control cohorts. Gut, 2015,64(11):1774-1782.
6Gupta A. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med, 2013, 368(6):578.
7Fukudo S, Kaneko H, Akiho H, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome. J Gastroenterol,2015, 50(1):11-30.
8罗哲,崔立红,贺星.肠道菌群失调与肠易激综合征关系的研究进展.解放军医学院学报, 2015, 36(10):1011-1013.
9弓三东,崔立红.粪菌移植在肠易激综合征中的研究进展.解放军医学院学报, 2015, 36(10):1006-1010.
10李超,迟雁,王化虹,等.腹泻型肠易激综合征患者肛管直肠动力及感觉功能与外周血肥大细胞类胰蛋白酶的相关性研究.中国全科医学, 2017, 20(11):1320-1325.
11Drossman DA. The functional gastrointestinal disorders and the RomeⅡprocess. Gut, 1999, 45(Suppl 2):I1-I5.
12叶彬,陈春晓.老年住院慢性便秘患者的焦虑抑郁状态和睡眠状况.中国老年学杂志, 2016, 36(8):1996-1998.
13窦迎春,曲海霞,许倩倩,等.焦虑及抑郁评分与慢性便秘患者临床不同伴随症状关系研究.胃肠病学和肝病学杂志, 2018,27(8):896-899.
14罗敏,李峨,李国栋,等.肛管直肠压力测定在肛门功能评估中的价值及临床应用.现代中西医结合杂志, 2012, 21(18):1946-1947.
15段建华,赵洪川.便秘型肠易激综合征患者结、直肠肛门动力学的临床研究.胃肠病学和肝病学杂志, 2006, 15(2):191-193.
16颜文娟,李蜀豫.便秘型肠易激综合征患者直肠肛管压力的改变与焦虑/抑郁情绪测定评分的临床意义.临床消化病杂志,2014, 26(4):230-232.
17王晓玉,罗新.盆底功能障碍的生物反馈治疗和电刺激治疗.中国实用妇科与产科杂志, 2009, 22(7):559-560.
18刘玲玲,冯珍.肌电生物反馈的临床研究及应用进展.中国康复医学杂志, 2012, 27(3):289-292.
19王梦欣,宋冬玲,简佳.肌电生物反馈对难治性肠易激综合征内脏痛觉敏感的影响.中华物理医学与康复杂志, 2009, 31(1):26-29.
20季新涛,丁义江.生物反馈治疗便秘的现状.结直肠肛门外科,2008, 14(6):385-387.
21Kosako M, Akiho H, Miwa H, et al. Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation(IBS-C):a large population-based internet survey.Biopsychosoc Med, 2018, 12:12.
22张璐,段丽萍,刘懿萱,等.中国人群肠易激综合征患病率和相关危险因素的Meta分析.中华内科杂志, 2014, 53(12):969-975.
23Adeyemo MA, Spiegel BM, Chang L. Meta-analysis:do irritable bowel syndrome symptoms vary between men and women.Aliment Pharmacol Ther, 2010, 32(6):738-755.
24Simrén M, Barbara G, Flint HJ, et al. Intestinal microbiota in functional bowel disorders:a Rome foundation report. Gut, 2013,62(1):159-176.
25Dupont HL. Review article:evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Aliment Pharmacol Ther, 2014, 39(10):1033-1042.
26罗勰林.生物刺激反馈仪结合盆底肌训练疗法对产后盆底肌功能康复效果观察.中国医疗器械信息, 2017, 23(14):84-85.
27李晓霞,夏泳,郑琳.生物反馈电刺激结合盆底肌训练疗法对产后盆底肌功能康复效果观察.中国实用妇科与产科杂志, 2012,28(6):442-444.