肠易激综合征患者小肠移行性复合运动的研究

目的 了解肠易激综合征(IBS)患者移行性复合运动(MMC)与健康人相比是否有差异及IBS患者离散性丛集波(DCC)与腹痛是否有关.同时改进目前胃肠运动的监测方法 .方法 采用16导水灌注测压导管对16例便秘型IBS(IBS-C)患者、18例腹泻型IBS(IBS-D)患者、18例健康对照者进行MMC的监测.结果 IBS-C(127.5±25.5)min]及IBS-D患者(74.5±18.7)min]MMC周期持续时间与健康对照组(87.5±24.2)min]相比存在显著不同(P值均<0.001).与健康对照者相比,IBS-C患者MMC Ⅲ相波幅及传播速度显著降低(39.8±11.7)mm Hg比(61.1±14.1)mm Hg,P<0.001,1 mm Hg=0.133 kPa;(1.8±0.9)cm/min比(2.6±0.8)cm/min,P<0.01];而IBS-D患者MMC Ⅲ相波幅(69.7±20.5)mm Hg]升高,MMC Ⅲ相传播速度(4.1±2.5)cm/min]显著加快.IBS-C、IBS-D患者及健康对照组MMC Ⅱ相DCC发生率分别为87.5%,88.8%,83.3%,各组之间差别无统计学意义(P>0.05).IBS-C及IBS-D患者MMC Ⅲ相波中断、传导障碍等异常现象发生率分别为68.8%、66.7%,且只在空肠部位观察到,而健康人中未见到该异常.结论 (1)IBS-C、IBS-D患者的MMC与健康人相比有明显差异,提示MMC运动异常是IBS重要发病机制之一,而且IBS患者空肠部位MMCⅢ相波的变化可能是IBS重要的胃肠道运动异常.(2)DCC与IBS患者腹痛无明显相关性.

A research of migrating motor complex in patients with irritable bowel syndrome

Objectives To compare the migrating motor complex (MMC) in irritable bowel syndrome (IBS) patients with that in healthy controls. To explore whether discrete clustered contractions (DCC) are connected with abdominal pain in IBS patients. To improve the method of measuring gastroenteric motility (esp. jejunum). Methods By using 16-channel water-perfused catheter and manometry instruments, MMC in 16 cases of IBS with constipation (IBS-C), 18 cases of IBS with diarrhea (IBS-D) and 18 cases of healthy controls were monitored. Results The MMC durations of IBS-C and IBS-D patients were (127.5±25.5) min and (74.5±18.7) min, respectively. Comparision with those in the control group (87.5±24.2) min]showed significant differences (P<0. 001). The contraction amplitudes of stage Ⅲ in different sites of IBS-C patients decreased significantly as compared with those in the controls jejunum, (39.8±11.7) mm Hg vs. (61.1±14.1) mm Hg,P<0.001,1 mm Hg=0.133 kPa]. The propagation velocities of stage Ⅲ in different sites of IBS-C patients also decreased significantly as compared with those in the controls jejunum, (1.8±0.9) cm/min vs. (2.6±0.8) cm/min,P<0.01].The contraction amplitudes of stage Ⅲ in different sites of IBS-D patients increased significantly as compared with those in the controls jejunum, (69.7±20.5) mm Hg vs. (61.1±14.1) mm Hg, P<0.01]. The propagation velocities of stage Ⅲ in different sites of IBS-D patients also increased significantly as compared with those in the controls jejunum, (4.1±2.5) cm/min vs. (2.6±0.8) cm/min, P < 0. 01]. DCC incidences of IBS-C and IBS-D were 87.5% and 88. 8%, respectively. Comperision with those in the normal group (83.3%) did not show significant difference (P>0.05). The prevalences of abnormal stage Ⅲ contractions (include disturbances and interferences of stage Ⅲ contractions) in IBS-C and IBS-D patients were 68.8% and 66. 7%, respectively; there were no significant differences between the two groups (P > 0. 05). However abnormal stage Ⅲ contractions did not exist in healthy controls. Conclusions (1) The MMC of IBS-C and IBS-D patients are changed, as compared with that in healthy people; this implies that small intestinal motility dysfunction is one of the pathogenetic factors of IBS. The abnormal stage Ⅲ contractions in jejunum may be a predominant change in IBS gastroenteric motility. (2) No apparent connection is found between DCC and pain in IBS. (3) By using 16-channel water-perfused catheter, we first carried out the method of monitoring jejunum contractions in China. Parameters of MMC in Chinese healthy people were investigated, esp. those of jejunum.