伊托必利对餐后不适综合征患者胃电图、胃排空率及胃动素浓度的影响
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摘要
目的:探讨伊托必利对餐后不适综合征患者胃电图、胃排空率、胃动素浓度的影响
方法:以符合纳入标准的餐后不适综合征患者为观察对象,从依次连续就诊的本院门诊及住院患者中随机观察196例,每个病人均用14C呼气试验检测Hp,将Hp阳性患者112例随机均分成四组:第一组26例接受铝碳酸镁片(1.0 Tid)药物治疗4周;第二组30例接受盐酸伊托必利片(50mg Tid)及铝碳酸镁片(1.0 Tid)治疗,疗程均为4周;第三组26例接受铝碳酸镁片(1.0 Tid)四周和抗Hp治疗一周,抗Hp采用三联疗法,具体为枸橼酸铋钾片(0.6 Bid)、替硝唑片(0.5 Bid)、阿莫西林胶囊(1.0 Bid);第四组30例除接受第二组治疗方案外,同时抗Hp治疗1周,其中抗Hp方案同第三组。阴性患者84例分别随机分为两组:第五组40例接受铝碳酸镁片(1.0 Tid)药物治疗4周;另一组为第六组44例,接受盐酸伊托必利片(50mg Tid)、铝碳酸镁片(1.0 Tid)治疗4周[1]。各组患者接受治疗前及治疗4周后均抽取空腹血2ml离心处理,标本置于-40℃冰柜冷藏,统一进行胃动素检测;胃电图记录仪测记接受治疗前后的餐前、餐后胃电,记录餐后/餐前功率比、反应面积、胃电节律紊乱百分比;不透X线标志物检测治疗前后的胃排空率。
结果:Hp阳性的四组中:(1)餐后/餐前功率比、反应面积、胃排空率、胃动素浓度四指标治疗前后比较,第二、四组有统计学意义,而第一、三组无统计学意义;(2)胃电节律紊乱百分比治疗前后比较,只有第二组有统计学意义,其余三组均无统计学意义。
Hp阴性的两组中:(1)餐后/餐前功率比、反应面积、胃排空率、胃动素浓度四指标治疗前后比较,第六组有统计学意义,而第五无统计学意义;(2)胃电节律紊乱百分比治疗前后比较,两组均无统计学意义。
相关性分析结果:(1)餐后/餐前功率比、反应面积、胃排空率、胃动素浓度四指标治疗前后的差值与伊托必利的使用有显著的相关性,而胃电节律紊乱百分比治疗前后的差值与伊托必利的使用无显著相关; (2)Hp感染与5个指标治疗前后的差值均无显著相关性;(3)抗Hp治疗与5个指标治疗前后的差值均无显著相关性。
结论:(1)伊托必利能显著提高餐后不适综合征患者的餐后/餐前功率比、反应面积、胃排空率及胃动素浓度,从而有效促进胃动力;(2)Hp感染、抗Hp治疗与餐后不适综合征患者胃动力改善无显著相关性。
Objective: To investigate the impact of Itopride on EGG, gastric emptying rate, the concentration of motilin of patients with postprandial distress syndrome.
Methods: Subjects were these patients with postprandial distress syndrome who fit on inclusion criteria, 196 cases were selected randomly from consecutive successive hospital outpatients and inpatients to be observed, each patient was tested HP with a 14C breath test, 112 Hp-positive patients were randomly divided into four groups: patients in the first group were received the treatment of hydrotalcite tablet (1.0 Tid) for 4 weeks; Patients in the second group were received treatments of itopride hydrochloride tablet(50mg Tid) and aluminum magnesium carbonate tablet (1.0 Tid) for 4 weeks; Patients in the third group were received the treatment of aluminum magnesium carbonate tablet (1.0 Tid) for 4 weeks, also received the anti-Hp therapy as anti-Hp triple therapy: using bismuth potassium citrate tablet (0.6 Bid), tinidazole tablet (0.5 Bid), amoxicillin capsule (1.0 Bid) for 1 week; Patients in the fourth group were received treatments of these patients in the second group and anti-Hp treatment for a week, as the anti-Hp program was used in the third group. 84 HP-negative patients were randomly divided into two groups: patients in the fifth group were received the treatment of aluminum magnesium carbonate tablet (1.0 Tid) for 4 weeks; Patients in the other group as the sixth group were received treatments of itopride hydrochloride tablets (50mg Tid) and aluminum carbonate magnesium tablets (1.0 Tid) for 4 weeks.
Patients in each group were collected fasting blood 2ml centrifuged before and after treatment, samples were stored in -40℃refrigerator; Their motilin were tested; fasting and postprandial EGG was recorded by EGG recorder measurements and Gastric emptying rate were tested by using X ray opaque markers before and after treatment.
Results:In four Hp-positive groups: (1) compared with the postprandial / fasting power ratio, reaction area, gastric emptying rate and motilin concentration before and after treatment; The detective results of the second and four groups were statistically significant, but the detective results of the first and the three groups was not statistically significant; (2) Compared with the percentage of gastric dysrhythmia before and after treatment, the detective results of the second group was statistically significant only, and the remaining three groups were not statistically significant.
In the two Hp-negative: (1) Compared with the postprandial / fasting power ratio, the reaction area, the rate of gastric emptying and motilin concentration before and after treatment; the detective results of the sixth groups were statistically significant, but the fifth group was not statistically significant. (2)Compared with the percentage of gastric dysrhythmia before and after treatment, the detective results of the two group were not statistically significant.
Correlation analysis: (1) difference of four indicators motilin (postprandial / fasting power ratio, the reaction area, gastric emptying rate and the concentration of motilin) before and after treatment had significant correlation with the use of itopride, while the stomach dysrhythmia percentage had no significant correlation with the use of itopride before and after treatment; (2) HP infection and the difference of five indicators before and after treatment had no significant correlation; (3) anti-Hp therapy had no significantly correlated with the difference of the five indicators before and after treatment.
Conclusion:(1) Itopride significantly increased postprandial / fasting power ratio, the reaction area, gastric emptying rate, the concentration of motilin of patients with postprandial distress syndrome, and promoted gastric motility effectively; (2) Hp infection and anti-Hp therapy had no significant correlation with gastric dynamics of patients with postprandial distress syndrome.
方法:以符合纳入标准的餐后不适综合征患者为观察对象,从依次连续就诊的本院门诊及住院患者中随机观察196例,每个病人均用14C呼气试验检测Hp,将Hp阳性患者112例随机均分成四组:第一组26例接受铝碳酸镁片(1.0 Tid)药物治疗4周;第二组30例接受盐酸伊托必利片(50mg Tid)及铝碳酸镁片(1.0 Tid)治疗,疗程均为4周;第三组26例接受铝碳酸镁片(1.0 Tid)四周和抗Hp治疗一周,抗Hp采用三联疗法,具体为枸橼酸铋钾片(0.6 Bid)、替硝唑片(0.5 Bid)、阿莫西林胶囊(1.0 Bid);第四组30例除接受第二组治疗方案外,同时抗Hp治疗1周,其中抗Hp方案同第三组。阴性患者84例分别随机分为两组:第五组40例接受铝碳酸镁片(1.0 Tid)药物治疗4周;另一组为第六组44例,接受盐酸伊托必利片(50mg Tid)、铝碳酸镁片(1.0 Tid)治疗4周[1]。各组患者接受治疗前及治疗4周后均抽取空腹血2ml离心处理,标本置于-40℃冰柜冷藏,统一进行胃动素检测;胃电图记录仪测记接受治疗前后的餐前、餐后胃电,记录餐后/餐前功率比、反应面积、胃电节律紊乱百分比;不透X线标志物检测治疗前后的胃排空率。
结果:Hp阳性的四组中:(1)餐后/餐前功率比、反应面积、胃排空率、胃动素浓度四指标治疗前后比较,第二、四组有统计学意义,而第一、三组无统计学意义;(2)胃电节律紊乱百分比治疗前后比较,只有第二组有统计学意义,其余三组均无统计学意义。
Hp阴性的两组中:(1)餐后/餐前功率比、反应面积、胃排空率、胃动素浓度四指标治疗前后比较,第六组有统计学意义,而第五无统计学意义;(2)胃电节律紊乱百分比治疗前后比较,两组均无统计学意义。
相关性分析结果:(1)餐后/餐前功率比、反应面积、胃排空率、胃动素浓度四指标治疗前后的差值与伊托必利的使用有显著的相关性,而胃电节律紊乱百分比治疗前后的差值与伊托必利的使用无显著相关; (2)Hp感染与5个指标治疗前后的差值均无显著相关性;(3)抗Hp治疗与5个指标治疗前后的差值均无显著相关性。
结论:(1)伊托必利能显著提高餐后不适综合征患者的餐后/餐前功率比、反应面积、胃排空率及胃动素浓度,从而有效促进胃动力;(2)Hp感染、抗Hp治疗与餐后不适综合征患者胃动力改善无显著相关性。
Objective: To investigate the impact of Itopride on EGG, gastric emptying rate, the concentration of motilin of patients with postprandial distress syndrome.
Methods: Subjects were these patients with postprandial distress syndrome who fit on inclusion criteria, 196 cases were selected randomly from consecutive successive hospital outpatients and inpatients to be observed, each patient was tested HP with a 14C breath test, 112 Hp-positive patients were randomly divided into four groups: patients in the first group were received the treatment of hydrotalcite tablet (1.0 Tid) for 4 weeks; Patients in the second group were received treatments of itopride hydrochloride tablet(50mg Tid) and aluminum magnesium carbonate tablet (1.0 Tid) for 4 weeks; Patients in the third group were received the treatment of aluminum magnesium carbonate tablet (1.0 Tid) for 4 weeks, also received the anti-Hp therapy as anti-Hp triple therapy: using bismuth potassium citrate tablet (0.6 Bid), tinidazole tablet (0.5 Bid), amoxicillin capsule (1.0 Bid) for 1 week; Patients in the fourth group were received treatments of these patients in the second group and anti-Hp treatment for a week, as the anti-Hp program was used in the third group. 84 HP-negative patients were randomly divided into two groups: patients in the fifth group were received the treatment of aluminum magnesium carbonate tablet (1.0 Tid) for 4 weeks; Patients in the other group as the sixth group were received treatments of itopride hydrochloride tablets (50mg Tid) and aluminum carbonate magnesium tablets (1.0 Tid) for 4 weeks.
Patients in each group were collected fasting blood 2ml centrifuged before and after treatment, samples were stored in -40℃refrigerator; Their motilin were tested; fasting and postprandial EGG was recorded by EGG recorder measurements and Gastric emptying rate were tested by using X ray opaque markers before and after treatment.
Results:In four Hp-positive groups: (1) compared with the postprandial / fasting power ratio, reaction area, gastric emptying rate and motilin concentration before and after treatment; The detective results of the second and four groups were statistically significant, but the detective results of the first and the three groups was not statistically significant; (2) Compared with the percentage of gastric dysrhythmia before and after treatment, the detective results of the second group was statistically significant only, and the remaining three groups were not statistically significant.
In the two Hp-negative: (1) Compared with the postprandial / fasting power ratio, the reaction area, the rate of gastric emptying and motilin concentration before and after treatment; the detective results of the sixth groups were statistically significant, but the fifth group was not statistically significant. (2)Compared with the percentage of gastric dysrhythmia before and after treatment, the detective results of the two group were not statistically significant.
Correlation analysis: (1) difference of four indicators motilin (postprandial / fasting power ratio, the reaction area, gastric emptying rate and the concentration of motilin) before and after treatment had significant correlation with the use of itopride, while the stomach dysrhythmia percentage had no significant correlation with the use of itopride before and after treatment; (2) HP infection and the difference of five indicators before and after treatment had no significant correlation; (3) anti-Hp therapy had no significantly correlated with the difference of the five indicators before and after treatment.
Conclusion:(1) Itopride significantly increased postprandial / fasting power ratio, the reaction area, gastric emptying rate, the concentration of motilin of patients with postprandial distress syndrome, and promoted gastric motility effectively; (2) Hp infection and anti-Hp therapy had no significant correlation with gastric dynamics of patients with postprandial distress syndrome.
引文
[1]Mdisch A, Miehlke S·How effective is itopride for the treatment of patients with functional dys pepsia? Nat Clin Pract Gastroenterol Hepatol. 2006, 3(9): 490-491.
[2]Thumshim M.Pathophysiology of functional dyspepsia[J].Gut,2002,51 (suppl):63-66.
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[7]Raymond Jian.临床实践中胃排空的闪烁扫描测量.[J]中华消化杂志,1992,12(2):107-108.
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[15]Domingue Z,Munoz JE.Targeting the abnormalitics of gastroduodenal functions in functional dyspepsia [J].Dig Dis Sci,2001,19:195-200.
[16]马刚,林琳,张红杰,等.功能性消化不良患者胃电图与胃排空率关系研究. [J]南京医科大学学报,2007,27(05):463-466.
[17]Samelli G,Caenepeel P,Geypens B,et al.Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia [J].Am J Gastroen-terol 2003,92:783-788.
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[19]Scott SM, Knowles CH, Wang D, et al. The nocturnal jejunal migrating motor complex: defining normal ranges by study of 51 healthy adult volunteers and meta-analysi-s. Neurogastroenterol Motil. 2006, 18(10): 927-935.
[20]谷成明,柯美云,朱朝晖.胃中间横带在调节糖尿病病人胃内食物分布和胃排空的作用.[J]中华内科杂志.1999,38(7).
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[1]Mdisch A, Miehlke S·How effective is itopride for the treatment of patients with functional dys pepsia? Nat Clin Pract Gastroenterol Hepatol. 2006, 3(9): 490-491.
[2]Frank K,Henry P.Delayed gastric emptying:whom tu test,how to test,and what to do [J].Current Treetment Options in Gastroenterology,2006,9:2,95-304.
[3]Raymond Jian.临床实践中胃排空的闪烁扫描测量.[J]中华消化杂志,1992,12(2):107-108.
[4]Stotzer PO,Fjialing M,Gretarsadtir J,et al.Assessment of gasritc empyting comparision of solid scintigraphic emptying and empyting of radiopague mrkaers in patients and healthy sujbects.[J].Dig Dis Sci,2005,4(4):729-729.
[5]马刚,林琳,张红杰,等.功能性消化不良患者胃电图与胃排空率关系研究. [J]南京医科大学学报,2007,27(05):463-466.
[6]Samelli G,Caenepeel P,Geypens B,et al.Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia [J].Am J Gastroen-terol 2003,92:783-788.
[7]Neubrand MW, Dominquez-Munoz JE, Reichel C, et al.Effect of intraduodenal administration of ursodeoxycholic acid on interdigestive interaction between gallbladdermotility, pancreatic secretion and endocrine activity.Digestion,2004, 69(3): 149-157.
[8]Scott SM, Knowles CH, Wang D, et al. The nocturnal jejunal migrating motor complex: defining normal ranges by study of 51 healthy adult volunteers and meta-analysi-s. Neurogastroenterol Motil. 2006, 18(10): 927-935.
[9]谷成明,柯美云,朱朝晖.胃中间横带在调节糖尿病病人胃内食物分布和胃排空的作用.[J]中华内科杂志.1999,38(7).
[10]Riezzo G,Chiloiro M,Guerra V,Borrelli O,Salvia G,Cucchiara S.Comparison of Gastriec electrical activity and gastric emptying in healthy and dyspeptic children.Dig Dis Sci,2000;45(3):517-524.
[11]Frisen CA,Lin Z,Garola R,et al.Chronic gastritis is not associated with gastric dysrhythmia or delayed solid emptying children with dyspepsia[J].Dig Dis Sci,2005,50(60):1012-1018.
[12]Lin Z,Ekaer EY,Sarosiek I,et la.Gastric myoelectrical Activity and gastric emptying in patients with functional dyspepsia.[J].Am J Gastroenterol,1999,94:2384-238.
[13]Keohane J,Quigley EM. Functional dyspepsia the role of visceral hypersensitiv-ity in its pathogensis. World J Gastroentrol. 2006, 12(17): 2672-2676.
[14]Defilippi C, Madrid AM. Cutaneous electrogastrography: a new incorporated technique for the study of gastric motility. RevMed Chil. 2002, 130(11): 1209-1216.
[15]Domingue Z,Munoz JE.Targeting the abnormalitics of gastroduodenal functions in functional dyspepsia [J].Dig Dis Sci,2001,19:195-200.
[16]Melro AP,Collares,Silva JM.Effect of an isolated mild to moderate ischemic brain injury in the gastric emptying of liquids in rats.[J] Acta Cir Bras. 2008 Nov-Dec;23(6):486-90.
[17]Li H,Yan G. A portable method for assessing gastrointestinal motility by simultaneously measuring transit time and contraction frequency.[J] J Med Eng Technol. 2008 Nov-Dec;32(6):448-55.
[18]Janssen P, Nielsen MA, Hirsch I, et al. A novel method to assess gastric accomm- odation and peristaltic motility in conscious rats.[J] Scand J Gastroenterol. 2008Jan; 43(1):34-43.
[19]McKenna D, Beverstein G, Reichelderfer M, et al. Gastric electrical stimulation is an effective and safe treatment for medically refractory gastroparesis.[J] Surgery. 2008 Oct;144(4):566-72; discussion 572-4.
[20]Nuernberg D, Braden B, Ignee A,et al. Functional ultrasound in gastroenterology. [J] Z Gastroenterol. 2008 Sep;46(9):883-96. Epub 2008 Sep 22.
[21]Jones MP. Satiety testing: ready for the clinic?[J] World J Gastroenterol. 2008 Sep 21;14(35):5371-6.
[22] Vignolo MC, Savassi-Rocha PR, Coelho LG,et al. Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis.[J] Hepatogastroente- rology. 2008 May-Jun;55(84):850-4
[23] Schmidt PT, Abrahamsson H, Dolk A, Methods to assess gastric motility and sen- sation.[J] Scand J Gastroenterol. 2008;43(11):1285-95.
[24] Matsumoto Y, Ito M, Kamino D,et al. Relation between histologic gastritis and gastric motility in Japanese patients with functional dyspepsia: evaluation by transabdominal ultrasonography.
[25] Kong F, Singh RP. Disintegration of solid foods in human stomach.[J] J Food Sci. 2008 Jun;73(5):R67-80.
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[1]Mdisch A, Miehlke S·How effective is itopride for the treatment of patients with functional dys pepsia? Nat Clin Pract Gastroenterol Hepatol. 2006, 3(9): 490-491.
[2]Frank K,Henry P.Delayed gastric emptying:whom tu test,how to test,and what to do [J].Current Treetment Options in Gastroenterology,2006,9:2,95-304.
[3]Raymond Jian.临床实践中胃排空的闪烁扫描测量.[J]中华消化杂志,1992,12(2):107-108.
[4]Stotzer PO,Fjialing M,Gretarsadtir J,et al.Assessment of gasritc empyting comparision of solid scintigraphic emptying and empyting of radiopague mrkaers in patients and healthy sujbects.[J].Dig Dis Sci,2005,4(4):729-729.
[5]马刚,林琳,张红杰,等.功能性消化不良患者胃电图与胃排空率关系研究. [J]南京医科大学学报,2007,27(05):463-466.
[6]Samelli G,Caenepeel P,Geypens B,et al.Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia [J].Am J Gastroen-terol 2003,92:783-788.
[7]Neubrand MW, Dominquez-Munoz JE, Reichel C, et al.Effect of intraduodenal administration of ursodeoxycholic acid on interdigestive interaction between gallbladdermotility, pancreatic secretion and endocrine activity.Digestion,2004, 69(3): 149-157.
[8]Scott SM, Knowles CH, Wang D, et al. The nocturnal jejunal migrating motor complex: defining normal ranges by study of 51 healthy adult volunteers and meta-analysi-s. Neurogastroenterol Motil. 2006, 18(10): 927-935.
[9]谷成明,柯美云,朱朝晖.胃中间横带在调节糖尿病病人胃内食物分布和胃排空的作用.[J]中华内科杂志.1999,38(7).
[10]Riezzo G,Chiloiro M,Guerra V,Borrelli O,Salvia G,Cucchiara S.Comparison of Gastriec electrical activity and gastric emptying in healthy and dyspeptic children.Dig Dis Sci,2000;45(3):517-524.
[11]Frisen CA,Lin Z,Garola R,et al.Chronic gastritis is not associated with gastric dysrhythmia or delayed solid emptying children with dyspepsia[J].Dig Dis Sci,2005,50(60):1012-1018.
[12]Lin Z,Ekaer EY,Sarosiek I,et la.Gastric myoelectrical Activity and gastric emptying in patients with functional dyspepsia.[J].Am J Gastroenterol,1999,94:2384-238.
[13]Keohane J,Quigley EM. Functional dyspepsia the role of visceral hypersensitiv-ity in its pathogensis. World J Gastroentrol. 2006, 12(17): 2672-2676.
[14]Defilippi C, Madrid AM. Cutaneous electrogastrography: a new incorporated technique for the study of gastric motility. RevMed Chil. 2002, 130(11): 1209-1216.
[15]Domingue Z,Munoz JE.Targeting the abnormalitics of gastroduodenal functions in functional dyspepsia [J].Dig Dis Sci,2001,19:195-200.
[16]Melro AP,Collares,Silva JM.Effect of an isolated mild to moderate ischemic brain injury in the gastric emptying of liquids in rats.[J] Acta Cir Bras. 2008 Nov-Dec;23(6):486-90.
[17]Li H,Yan G. A portable method for assessing gastrointestinal motility by simultaneously measuring transit time and contraction frequency.[J] J Med Eng Technol. 2008 Nov-Dec;32(6):448-55.
[18]Janssen P, Nielsen MA, Hirsch I, et al. A novel method to assess gastric accomm- odation and peristaltic motility in conscious rats.[J] Scand J Gastroenterol. 2008Jan; 43(1):34-43.
[19]McKenna D, Beverstein G, Reichelderfer M, et al. Gastric electrical stimulation is an effective and safe treatment for medically refractory gastroparesis.[J] Surgery. 2008 Oct;144(4):566-72; discussion 572-4.
[20]Nuernberg D, Braden B, Ignee A,et al. Functional ultrasound in gastroenterology. [J] Z Gastroenterol. 2008 Sep;46(9):883-96. Epub 2008 Sep 22.
[21]Jones MP. Satiety testing: ready for the clinic?[J] World J Gastroenterol. 2008 Sep 21;14(35):5371-6.
[22] Vignolo MC, Savassi-Rocha PR, Coelho LG,et al. Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis.[J] Hepatogastroente- rology. 2008 May-Jun;55(84):850-4
[23] Schmidt PT, Abrahamsson H, Dolk A, Methods to assess gastric motility and sen- sation.[J] Scand J Gastroenterol. 2008;43(11):1285-95.
[24] Matsumoto Y, Ito M, Kamino D,et al. Relation between histologic gastritis and gastric motility in Japanese patients with functional dyspepsia: evaluation by transabdominal ultrasonography.
[25] Kong F, Singh RP. Disintegration of solid foods in human stomach.[J] J Food Sci. 2008 Jun;73(5):R67-80.
[26] Kong F, Singh RP.A model stomach system to investigate disintegration kinetics of solid foods during gastric digestion.[J] J Food Sci. 2008 Jun;73(5):E202-10.
[27] Bennett J, Rhodes M, Malcolm P,et al.Assessment of the relationship between post-meal satiety, gastric volume and gastric emptying after swedish adjustable gastric banding. A pilot study using magnetic resonance imaging to assess postsurgery gastric function.[J] Obes Surg. 2009 Jun;19(6):757-63. Epub 2008 Jun 24.
[28] Bisschops R, Karamanolis G, Arts J,et al. Relationship between symptoms and ingestion of a meal in functional dyspepsia.[J] Gut. 2008 Nov;57(11):1495-503. Epub 2008 Jun 2.
[29] Mimidis K, Tack J.Pathogenesis of dyspepsia.[J] Dig Dis. 2008;26(3):194-202. Epub 2008 May 6.