食物过敏和十二指肠肥大细胞在功能性消化不良中的关系研究

目的探讨食物过敏及十二指肠肥大细胞对功能性消化不良(functional dyspepsia,FD)的影响及其关系。方法选取2012年1月-2013年12月重庆市北部新区第一人民医院门诊接诊的58例FD患者为观察组,另选取50名健康志愿者为对照组。对两组消化情况进行评分,并于胃镜下取两组十二指肠降段黏膜及球部组织标本。应用ELISA法测定FD患者及健康志愿者血清中14种食物过敏原特异性抗体IgG。甲苯胺蓝染色组织样本并计算肥大细胞总数及脱颗粒肥大细胞所占比例。结果与对照组相比,FD组上腹疼痛、早饱、上腹胀及上腹烧灼感评分显著升高,差异有统计学意义(P0.05)。与对照组相比,FD组十二指肠降段黏膜及球部肥大细胞数量及脱颗粒肥大细胞百分比显著升高,差异有统计学意义(P0.05)。经Pearson相关因素分析,十二指肠降段黏膜及球部肥大细胞总数及脱颗粒肥大细胞比例与各症状评分无相关性(P0.05);FD组牛肉、大豆、虾、小麦的特异性抗体IgG阳性率高于对照组(P0.05);FD组IgG阳性评分高于对照组(P0.05)。经Pearson相关因素分析,IgG阳性评分与症状评分无相关性(P0.05),与十二指肠降段黏膜肥大细胞总数及脱颗粒细胞无相关性(P0.05),而与十二指肠球部黏膜肥大细胞数量及脱颗粒细胞比例呈正相关(P0.05)。结论 FD发病与特异性抗体IgG阳性表达、十二指肠脱粒肥大细胞比例升高及黏膜肥大细胞数量增多有关。     

非溃疡性消化不良及慢性非萎缩性胃炎幽门螺杆菌感染4年前后比较

目的了解成都地区非溃疡性消化不良(NUD)及慢性非萎缩性胃炎(NAG)患者幽门螺杆菌(H.pylori)感染情况及变化趋势。方法纳入经胃镜检查确诊为NUD及NAG患者共2 403例,其中2008年1 042例,2012年1 361例。将NAG患者分为非糜烂性胃炎(NEG)、平坦糜烂性胃炎(FEG)及隆起糜烂性胃炎(REG)三组。所有患者以ASSURE快速血清学方法检测H.pylori感染状态。结果 4年后H.pylori现症感染总体检出率显著下降(35.1%vs 24.8%,P0.01),在NUD、所有NAG患者及FEG患者中均显著下降(P0.05)。H.pylori现症感染检出率FEG患者明显高于同期REG、NEG、NUD患者(P0.05)。REG患者与同期NEG、NUD患者比较,差异无统计学意义(P0.05)。4年后FEG、REG患者H.pylori既往感染率明显升高(FEG:3.5%vs 10.8%,REG:5.2%vs 12.9%,P0.05)。结论 2008年至2012年成都地区NUD及NAG患者H.pylori现症感染率显著下降,FEG、REG H.pylori既往感染率明显升高。NAG患者中可能FEG与H.pylori感染关系更为密切。     

Symptoms of mast cell activation syndrome in functional gastrointestinal disorders

Abstract

Objectives: Mast cell involvement is evident in functional gastrointestinal disorders (FGID). FGID and mast cell activation syndrome (MCAS) are associated with multi-organ symptoms. An overlap has not been assessed.

Methods: MCAS symptoms were determined by questionnaires in 2083 FGID patients.

Results: The median number of MCAS symptoms ([IQR] (range 0–16)) was 6 [4–8] in all FGID, and in functional dyspepsia (FD) patients, 7 [5–9] in overlapping irritable bowel syndrome and FD (IBS+FD), 5 [3–8] in IBS and 5 [3–6] in non-IBS/non-FD (p?<?.001 vs. FD and IBS?+?FD) patients. MCAS symptoms in ≥2 organ-systems existed in 1773 (85%) of all patients.

Conclusions: MCAS symptoms are common in FGID warranting further mechanistic investigation.     

功能性消化不良罗马Ⅲ和罗马Ⅱ标准的比较及精神心理状况调查

目的 分析罗马Ⅲ和罗马Ⅱ标准对功能性消化不良(FD)诊断的临床特点、分型的差异,以及FD患者精神心理状态.方法 随机选取2008年6月至2008年12月间1600例消化科门诊患者(均经胃镜检查)进行问卷调查,按罗马Ⅱ和罗马Ⅲ标准诊断分型并归纳分析.结果 符合罗马Ⅱ标准的FD患者215例(13.44％),符合罗马Ⅲ标准249例(15.56％),两种标准对FD的检出率差异无统计学意义(x2=2.176,P＞0.05).罗马Ⅱ标准诊断的FD患者中71.16％(153/215)同时符合罗马Ⅲ标准;23.26％(50/215)患者有早饱、餐后饱胀不适、上腹痛和上腹烧灼感中的至少一种,但不符合罗马Ⅲ标准.罗马Ⅲ标准诊断的FD中61.45％(153/249)同时符合罗马Ⅱ标准;28.92％(72/249)患者病程不符合罗马Ⅱ标准.按罗马Ⅱ标准分型,溃疡样型51例(23.72％),动力障碍型103例(47.91％),非特异型61例(28.37％).按罗马Ⅲ标准分型,餐后不适综合征(PDS) 190例(76.31％),上腹疼痛综合征(EPS)131例(52.61％),同时符合PDS和EPS诊断72例(28.92％).FD伴焦虑、抑郁者分别为17例(16.83％)和48例(47.52％).符合罗马Ⅲ标准FD患者同时合并焦虑和抑郁时,餐后饱胀不适、早饱、上腹痛和上腹烧灼感症状总积分最高(x2=49.637,P＜0.05).结论 罗马Ⅲ标准更易理解和运用.FD患者常合并精神心理异常,可能加重临床症状.     

Asian consensus report on functional dyspepsia

Background and Aim: Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared with the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. Methods: Consensus team members were selected from Asian experts and consensus development was carried out by using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face‐to‐face meeting, each statement was reviewed and e‐mail voting was done twice. At the second face‐to‐face meeting, final voting on each statement was done using a keypad voting system. A grade of evidence and strength of recommendation were applied to each statement according to the method of the GRADE Working Group. Results: Twenty‐nine consensus statements were finalized, including seven for definition and diagnosis, five for epidemiology, nine for pathophysiology, and eight for management. Algorithms for diagnosis and management of functional dyspepsia were added. Conclusions: This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.     

心理语言、穴位刺激和胃电起搏协同改善功能性消化不良的胃感觉功能

目的研究心理语言、穴位刺激、胃电起搏协同治疗方法(Coordinated Treatment of Psychological language,Acupuncture pointstimulation and Gastric pacing,CTPAG)治疗难治性功能性消化不良的临床疗效及可能机制。方法根据罗马Ⅲ标准选取80例难治性功能性消化不良患者,随机分为两组:口服药物组(n=38)和CTPAG组(n=42),比较两组受试者在症状评分、临床疗效、胃感觉功能中的差异。结果与口服药物组比较,CTPAG组中临床症状评分明显下降,疗效显著率明显升高;胃的初次饱足阈值和最大耐受阈值均明显增加,差异具有统计学意义(P<0.05)。结论心理语言、穴位刺激和胃电起搏协同治疗(CTPAG)可能通过增加胃的可耐受容积,降低内脏敏感性,达到改善早饱、腹胀、进食少等疗效;并且CTPAG组优于常规口服药物组,是难治性FD非药物治疗的一种新选择。     

Comparison of PPIs and H2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia

AIM: To compare efficacy of proton pump inhibitors (PPIs) with H₂-receptor antagonists (H₂RAs) plus prokinetics (Proks) for dysmotility-like symptoms in functional dyspepsia (FD).METHODS: Subjects were randomized to receive open-label treatment with either rabeprazole 10 mg od (n = 57) or famotidine 10 mg bid plus mosapride 5 mg tid (n = 57) for 4 wk. The primary efficacy endpoint was change (%) from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment.RESULTS: The improvement in dysmotility-like dyspepsia symptom score on day 28 was significantly greater in the rabeprazole group (22.5% ± 29.2% of baseline) than the famotidine + mosapride group (53.2% ± 58.6% of baseline, P < 0.0001). The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine + mosapride group (87.7% vs 59.6%, P = 0.0012). Rabeprazole therapy was the only significant predictor of treatment response (P < 0.0001), defined as a total symptom score improvement ≥ 50%.CONCLUSION: PPI monotherapy improves dysmotility-like symptoms significantly better than H₂RAs plus Proks, and should be the treatment of first choice for Japanese FD.     

符合罗马Ⅲ标准FD患者心理测试及自主神经功能观察44例

目的:观察功能性消化不良(functional dyspep-sia1,FD)及其不同类型患者的心理状态和自主神经功能,以了解其特点.方法:对符合罗马Ⅲ标准的44例FD患者根据罗马Ⅲ分类标准分为餐后不适综合征(postprandial distress syndrome,PDS)(n=31)和上腹痛综合征(epigastric pain syndrome,EPS)(n=13)两个类型,16例无症状的健康人作为对照组,对所有受试者均进行上胃肠消化不良症状评分、Zung氏量表进行心理测试和自主神经功能检测.结果:FD组抑郁和(或)焦虑状态的比例(24/44),较对照组(1/16)明显多见(P=0.001).FD抑郁评分(49.36±1.71)和焦虑评分(39.83±1.57)均明显高于对照组(34.42±1.98和27.77±0.75,P值均为0.000).餐后不适组抑郁和焦虑评分(51.40±1.80和40.39±2.01)及上腹痛组抑郁和焦虑评分(45.50±3.68和38.52±2.44),均高于对照组(P值分别为0.000、0.000和0.026、0.001).餐后不适组抑郁评分较上腹痛组有增高趋势(P=0.050).FD组自主神经功能检测中深呼吸心率变异(17.61±1.18)较对照组(22.71±2.12)明显减低(P=0.031),上腹痛组深呼吸心率变异(16.17±1.98)亦较对照组明显减低(P=0.038).存在焦虑抑郁状态患者深呼吸心率变异(17.23±1.49)较对照组(22.71±2.12)明显减低(P=0.036);非焦虑抑郁组与对照组及焦虑抑郁组与非焦虑抑郁组自主神经功能检测无明显差异.结论:FD患者焦虑、抑郁状态较明显,餐后不适组抑郁状态更趋严重;FD患者的自主神经功能受损以副交感神经为主;存在抑郁和(或)焦虑状态的FD患者更易出现自主神经功能受损.     

调中颗粒治疗寒热错杂型功能性消化不良的临床疗效及对血浆胃肠激素水平的影响

[目的]观察调中颗粒对寒热错杂型功能性消化不良(FD)的临床治疗效果及血浆胃肠激素水平的变化.[方法]寒热错杂型FD患者210例,随机分为2组,各105例,治疗组予调中颗粒,对照组予多潘立酮片,2组疗程均为4周.[结果]治疗组、对照组临床疗效总有效率分别为91.43％和76.19％,组间临床疗效比较,差异有统计学意义(P＜0.05).治疗组各项中医症候单项症状改善治疗前后比较差异有统计学意义(P＜0.05).治疗组血浆胃动素及促胃液素水平较前升高明显,与对照组相比差异有统计学意义(P＜0.05).2组治疗期间均未发生不良事件.[结论]调中颗粒可通过对血浆胃肠激素水平的影响缓解寒热错杂型FD患者的临床症状.     

加味柴胡疏肝散治疗功能性消化不良（肝郁气滞证）临床疗效观察

目的：探讨加味柴胡疏肝散治疗功能性消化不良（肝郁气滞证）的临床疗效及其对胃电图的影响。方法选择符合纳入标准的功能性消化不良肝郁气滞证患者120例,随机分为观察组和对照组各60例,观察组服用加味柴胡疏肝散,对照组口服泮托拉唑肠溶胶囊及多潘立酮片剂,观察比较两组治疗后的临床疗效、中医证候积分变化及胃电频率与幅值的变化情况。结果观察组总有效率91.67%,对照组总有效率78.33%,两组比较差异有统计学意义（P＜0.05）;两组治疗后较治疗前中医证候积分均有所降低,且观察组优于对照组,差异有统计学意义（P＜0.05）;两组治疗后空腹及餐后的胃电频率及幅值均较治疗前明显提高,且观察组优于对照组,差异有统计学意义（P＜0.05）。结论加味柴胡疏肝散治疗功能性消化不良肝郁气滞证患者疗效确切,能明显改善中医证候,提高胃电频率和幅值,增加胃动力,安全无副作用,值得临床推广。