FD患者红霉素对胃十二指肠动力的影响

目的研究红霉素对功能性消化不良（ＦＤ）患者消化间期胃窦和十二指肠的运动功能的影响．方法ＦＤ患者２０例，采用导管灌注技术测定胃窦和十二指肠的压力，空腹连续测定３５ｈ，若未发现移行运动复合波（ＭＭＣ）３期，于ＭＭＣ１期匀速静滴红霉素２００ｍｇ，滴速６６ｍｇ／ｍｉｎ，测定静滴红霉素期间胃窦和十二指肠的压力．结果空腹测定３５ｈ，８例ＦＤ未出现ＭＭＣ３期，仅１期和２期交替出现，此后在静滴红霉素期间，胃窦和十二指肠均出现了宽大的收缩波，５例出现了ＭＭＣ３期，且各项动力参数值较静滴红霉素前显著增加（Ｐ＜００５）．结论部分ＦＤ于消化间期胃窦和十二指肠缺乏ＭＭＣ３期，动力减低，静滴红霉素能诱发ＭＭＣ３期，促进胃和十二指肠的运动功能     

胃十二指肠疾病患者的胃排空功能

了解常见胃十二指肠疾病患者的液体胃排空情况．方法采用放射性核素９９ｍＴＣ标记的液体试餐法，对正常人１８例及慢性胃十二指肠疾病患者４５例，进行液体胃排空功能测定．结果十二指肠溃疡组（ｎ＝１３）胃半排空时间为２８１ｍｉｎ±１４０ｍｉｎ，较正常对照组３９７ｍｉｎ±１４７ｍｉｎ明显缩短（Ｐ＜００５）．ＦＤ及ＣＡＧ组与对照组比较无显著差异（Ｐ＞０２０）．结论ＤＵ患者液体胃排空加快，合并幽门变形者胃排空延缓     

脾肾阴虚证血清氧自由基损伤初探

目的从氧自由基损伤及机体抗氧化能力方面探讨脾阴虚证、肾阴虚证患者的客观病理学改变．方法观察脾阴虚组３０例，肾阴虚组１６例和健康人对照组１６例．取受检者清晨空腹静脉血分离血清后分别测定：总ＳＯＤ，Ｃｕ，ＺｎＳＯＤ（黄嘌呤氧化酶法）；ＭＤＡ（ＴＢＡ法）；总抗氧化能力（比色法）．ＶｉｔＣ（２，４ＤＮＰＨ比色法）；ＶｉｔＥ（高效液相色谱法）；Ｃｕ，Ｚｎ（原子吸收法）；数据以均数±标准差表示．用单因素方差分析，Ｓｃｈｅｆｅ法作两两比较，Ｐ＜００５为显著性检验界值．结果总ＳＯＤ及Ｃｕ，ＺｎＳＯＤ肾阴虚组低于脾阴虚与健康人组（Ｆ＝１７６９和３０３２，Ｐ＜００５）．脾阴虚组和肾阴虚组ＭＤＡ高于健康人组（Ｆ＝４９１，Ｐ＜００５），而总抗氧化能力却低于健康人组（Ｆ＝５９０１，Ｐ＜００５）．ＶｉｔＥ肾阴虚组低于脾阴虚组和健康人（Ｆ＝６７２，Ｐ＜００５）．结论脾阴虚证、肾阴虚证患者都有一定程度的氧自由基损伤，但在形成的原因和机体防御消除的机制等方面是不同的     

胃窦十二指肠运动与胆汁反流的关系

目的分析胃肠运动与十二指肠胃胆汁反流（ＤＧＲ）的关系．方法测定了３９例功能性消化不良（ＦＤ）患者及１５例正常人空腹胃液胆酸（ＲＩＡ法）和胃窦十二指肠运动，包括收缩振幅、频率，运动指数及胃窦十二指肠协调收缩，分析两者的关系．结果正常组空腹甘胆酸浓度（ｍｇ／Ｌ）为７７２±１０１０，ＦＤ组为８６３±１２３０），与正常人比较无明显差异．提示ＦＤ患者空腹ＤＧＲ无明显增加；空腹胃液甘胆酸浓度与胃窦十二指肠协调收缩呈显著负相关（ｒ＝－０５９７７，Ｐ＜００１）；与十二指肠非推进性收缩呈显著正相关（ｒ＝０３８７２，Ｐ＜００５）；与十二指肠逆蠕动无明显相关（ｒ＝０１９８２，Ｐ＞００５）．结论十二指肠逆蠕动不是ＤＧＲ的主要原因；非推进性十二指肠环形收缩可能是ＤＧＲ的主要因素     

糖尿病酮症酸中毒并肝损害临床分析

目的探讨导致糖尿病酮症（ＤＫ）及酮症酸中毒（ＤＫＡ）患者肝损害的相关因素．方法ＤＫ或ＤＫＡ患者９９例,其中ＡＬＴ及ＡＳＴ均异常升高１１例（Ａ组）,单项ＡＬＴ异常升高１３例（Ｂ组）,肝功能正常７５例（Ｃ组）,对以上各组患者的血二氧化碳结合力（ＣＯ２ＣＰ）、尿素氮（ＢＵＮ）、血糖（ＢＧ）和血浆渗透压（ＯＳＭ）进行了统计分析．结果Ａ,Ｂ两组患者的ＣＯ２ＣＰ明显低于Ｃ组（Ｐ＜００１,ｔ＝６３３和ｔ＝６４３）,而ＢＵＮ则明显升高（Ｐ＜００１,ｔ＝３６１,ＡｖｓＣ;Ｐ＜００１,ｔ＝４３５,ＢｖｓＣ）,Ａ组的ＢＧ（Ｐ＜００５,ｔ＝２８４）和血浆ＯＳＭ（Ｐ＜００５,ｔ＝３１０）水平也显著高于Ｃ组,而Ｂ组患者的ＢＧ及血浆ＯＳＭ与Ｃ组比较无差异;与Ｂ组相比,Ａ组患者的ＣＯ２ＣＰ明显降低（Ｐ＜００２,ｔ＝２７１）,ＢＧ（Ｐ＜００５,ｔ＝２８９）和血浆ＯＳＭ（Ｐ＜００５,ｔ＝２３６）明显升高．此外,Ⅰ型糖尿病患者血清转氨酶异常升高的发生率明显高于Ⅱ型糖尿病患者（Ｐ＜００５,χ２＝４３８）．结论酸中毒和脱水是导致糖尿病酮症及酮症酸中毒患者肝损害的重要因素,酸中毒及脱水程度与肝损害程度相关．     

FD患者Hp感染对胃排空的影响

目的探讨幽门螺杆菌（Ｈｐ）感染在功能性消化不良（ＦＤ）患者胃排空功能障碍中的作用．方法采用放射性同位素γ－照相法观测了５６例ＦＤ患者胃固－液体排空情况，并用胃窦粘膜印片Ｇｉｅｍｓａ染色及石蜡切片ＨＥ，Ｗ＿Ｓ银染色镜检Ｈｐ．结果ＦＤ患者餐后３０，６０及９０ｍｉｎ时的胃排空率均显著低于正常对照组（Ｐ＜００５－００１）；ＦＤ患者Ｈｐ感染率无明显增高（Ｐ＞００５），Ｈｐ阳性组与阴性组在３个时相的胃排空率差异均无显著性（Ｐ＞００５）结论ＦＤ患者胃排空功能与Ｈｐ感染无关     

糖尿病患者消化间期移行性复合运动规律的研究

目的探讨糖尿病患者消化间期移行性复合运动（ＭＭＣ）的规律。方法应用胃十二指肠测压技术对５１例Ⅱ型糖尿病患者和１５名健康志愿者进行了ＭＭＣ检测，测定时间为２４０～３６０分钟。结果糖尿病患者ＭＭＣⅢ期正常者仅２７．５％，明显低于对照组（７３．４％，Ｐ值＜０．０１），其中ＭＭＣⅢ期缺失者占４１．１％（对照组为１３．３％，Ｐ值＜０．０１）。糖尿病组ＭＭＣⅢ期胃窦部收缩波幅较对照组减低（Ｐ值＜０．０５）。ＭＭＣ各期持续时间个体差异较大，糖尿病组与对照组相比表现为Ⅱ期延长（Ｐ值＜０．０１）。结论本研究提示约７０％糖尿病患者在未出现消化系统症状之前已表现为ＭＭＣ异常，胃十二指肠测压为糖尿病胃肠运动功能障碍、尤其是糖尿病胃轻瘫的早期诊断和治疗提供了有效的手段。     

胃癌及消化性溃疡患者胃窦粘膜胃肠激素的变化

目的探讨胃癌及消化性溃疡（ＰＵ）患者胃窦粘膜胃肠激素变化的意义．方法内镜及活检确诊的浅表性胃炎（ＣＳＧ）１０例，胃溃疡（ＧＵ）１５例，十二指肠溃疡（ＤＵ）１２例，胃癌（ＧＣ）６例．胃镜下取胃窦粘膜，用ＲＩＡ法测定胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ物质（ＳＰ）的含量，各组间进行比较．结果胃窦粘膜ＳＳ含量在ＧＵ，ＤＵ，ＣＳＧ，ＧＣ组分别为２５１ｐｇ／ｍｇ±１９４ｐｇ／ｍｇ（以下同），４７０±１７９，５３２±２１１及１２９３±５２３。其中ＧＵ组低于其余各组（Ｐ＜００５），而ＧＣ时则显著升高（Ｐ＜００１）．ＳＰ含量在ＤＵ组显著降低，与ＧＵ，ＣＳＧ，ＧＣ比较分别为４７９±１５７ｖｓ７６５±４１５，７８９±３９０及８０１±３４６，Ｐ＜００５；ＧＣ患者Ｇａｓ水平显著高于ＣＳＧ组，为４６４５±２９４４，ｖｓ２７６８±１５７２，Ｐ＜００１．结论胃粘膜中Ｇａｓ，ＳＳ，ＳＰ含量的变化可能在ＰＵ及胃癌的发病机理中起重要作用．     

乳果糖氢呼吸试验测定口-盲肠传递时间

目的测定功能性消化不良（ＦＤ）和肠易激综合征（ＩＢＳ）患者口－盲肠传递时间（ＯＣＴＴ）．方法应用乳果糖氢呼吸试验（ＬＨＢＴ）测定了正常人１３例，ＦＤ２０例和ＩＢＳ（其中１５例主诉腹泻，１６例主诉便秘）３１例患者的ＯＣＴＴ．结果正常人ＯＣＴＴ为９５４±１９６ｍｉｎ，ＦＤ患者（９９２±２４５ｍｉｎ）与正常人比较无显著性差异（Ｐ＞００５），但其中５例动力障碍型ＦＤ的ＯＣＴＴ则显著延长（１２９０±１２０ｍｉｎ，Ｐ＜００１），以便秘为主的ＩＢＳ患者ＯＣＴＴ显著延长（１５４４±５５７ｍｉｎ，Ｐ＜００１），以腹泻为主的ＩＢＳ患者ＯＣＴＴ显著缩短（７３１±２２２ｍｉｎ，Ｐ＜００５）．结论ＦＤ和ＩＢＳ患者存在小肠动力学异常，ＬＨＢＴ可作为辅助检查小肠动力学异常的手段之一．     

西沙必利对功能性消化不良患者胃动力、胃动素、胃泌素影响的研究

对３０例功能性消化不良（ＦＤ）患者服用西沙必利前后的胃腔内压力、血中胃动素及胃泌素的变化进行检测，并以１１例正常人作对照。结果：①ＦＤ患者胃窦和胃体基础压、胃窦蠕动压及血中胃动素浓度，明显低于正常对照组（Ｐ值分别＜００５，＜００１）；而胃窦蠕动波持续时间、血中胃泌素浓度与正常组无显著差异（Ｐ＞００５）。②服用西沙必利后，ＦＤ患者与正常对照组胃窦和胃体基础压、胃窦蠕动压及血中胃动素浓度，均较服药前明显升高（Ｐ＜００５，Ｐ＜００１）。而胃窦蠕动波持续时间和血中胃泌素浓度，正常组和ＦＤ组服药前后均无显著差异（Ｐ＞００５）。结论：ＦＤ与胃动力障碍有关，西沙必利治疗ＦＤ是合理、有效的     

功能性消化不良及其分型组的胃窦十二指肠运动

本研究对功能性消化不症状分型的常规标准做了一些调整，并观测了３９例ＦＤ患者空腹及餐后胃窦十二指肠运动，以探讨ＦＤ患乾胃窦十二指肠运动状况及其与分型组之间的关系。结果显示〈ＦＤ患者空腹及餐后胃窦十二指肠动力减弱，在胃窦表现为运动指数、平均振幅和频率均显著低于正常组，在十二指肠表现为平均振     

Different effects of atropine and cimetropium bromide on gastric emptying of liquids and antroduodenal motor activity in man

Atropine (1 mg intravenously) and a new antimuscarinic compound, cimetropium bromide (5 mg intravenously), as well as placebo (physiological saline) were tested for their effects on gastric emptying and antroduodenal motility in healthy humans. In a first single-blind cross-over study, the emptying rate was assessed in 12 subjects by measuring paracetamol absorption. In a second single-blind parallel-group study, antroduodenal motor activity was measured in 20 subjects through four perfused open tip catheters with orifices positioned in the antroduodenal region. Atropine, unlike cimetropium bromide, significantly delayed gastric emptying. Antral and duodenal motility index was reduced significantly by atropine, but not by cimetropium bromide. Heart rate significantly increased only after atropine. Three subjects taking atropine complained of dry mouth and one of blurred vision. In conclusion, the results of these studies show that atropine, unlike cimetropium bromide, strongly inhibits gastric emptying of liquids and reduces antroduodenal motor activity in man.     

Antroduodenal motility studied by real-time ultrasonography. Effect of enprostil

Transabdominal real-time ultrasonography was used to investigate antroduodenal motility effects of the prostaglandin E2 analogue enprostil. Ten healthy subjects were studied on two separate days, once after oral administration of one capsule of enprostil 35 micrograms 1 hour before the ingestion of 500 mL of meat soup and once without drug administration before the meal. The ultrasound probe was positioned at the level of the transpyloric plane to visualize the antrum, pylorus, and proximal duodenum simultaneously and thereafter vertically to visualize the antrum, superior mesenteric vein, and aorta simultaneously. The motility was videotaped for 15 minutes. The antroduodenal coordination, frequency and amplitude of antral contractions, and size of antral area were reduced, whereas the time during which the pylorus was wide open (greater than 5 mm) was increased after enprostil. It is concluded that antroduodenal motility can easily be visualized by ultrasonography. Therapeutic doses of enprostil impair antroduodenal peristalsis and coordination and open the pylorus in healthy subjects.     

Gastrointestinal motor mechanisms in hyperglycaemia induced delayed gastric emptying in type I diabetes mellitus.

BACKGROUND: Hyperglycaemia delays gastric emptying, both in healthy controls and in patients with diabetes mellitus. The effect of hyperglycaemia on antroduodenal motility in diabetes has not yet been studied. AIM: To investigate the gastrointestinal motor mechanisms involved in the hyperglycaemia induced retardation of gastric emptying in patients with type I diabetes mellitus and autonomic neuropathy. In eight diabetic patients antroduodenal manometry was performed simultaneously with scintigraphic measurement of emptying of a mixed solid-liquid meal, during euglycaemia (5-8 mmol/l glucose) and hyperglycaemia (16-19 mmol/l glucose), on separate days, in random order. RESULTS: Hyperglycaemia decreased the cumulative antral motility index from 38.3 (range 24.2-47.6) to 30.8 (range 17.3-38.1) (p = 0.025) and reduced the number of antral pressure waves propagated over > or = 4.5 cm (p = 0.04). Duodenal phase III-like activity was seen irrespective of the glycaemic state (in three patients during euglycaemia and in four patients during hyperglycaemia). Hyperglycaemia significantly affected gastric emptying of the solid meal: it prolonged the lag phase from 20.0 minutes to 28.5 minutes (P = 0.02), increased the 50% emptying time from 73.5 minutes to 104.5 minutes (p = 0.03), and increased the percentage of isotope remaining in the stomach after 120 minutes from 33.5% to 46.5% (p = 0.02). The cumulative antral motility index was correlated with the 50% emptying time (r = 0.75, p = 0.02) during euglycaemia, but not during hyperglycaemia (r = 0.28, P = 0.31). Liquid emptying was not influenced by the blood glucose concentration. CONCLUSIONS: Hyperglycaemia reduces postprandial antral contractile activity and its organisation in patients with type I diabetes and autonomic neuropathy. These changes in antroduodenal motility are likely to constitute the mechanism through which gastric emptying of solids is delayed during high blood glucose concentrations in these diabetic patients.     

功能性消化不良食管运动功能研究

目的:探讨FD患者食管运动功能变化。方法:采用PC polygraf HR台式高分辨上消化道气液压毛细管连续灌注测压系统对36例FD患者进行食管测压。结果:FD组食管下段平均蠕动收缩波幅显著低于对照组。FD组食管下段蠕动压低于上段蠕动压的发生率显著高于对照组。FD组出现异常蠕动波55.5％例,表现为类型不同、次数不等的双峰波、三峰波、多发重复收缩波、逆行收缩波、非传导性同步收缩波及自发性收缩波等。以双峰波最多见。7例存在两种或以上异常波,8例同时伴有食管下段低幅蠕动。本组食管体运动异常检出共86%。结论:FD患者存在食管运动功能异常,主要表现为食管体运动不协凋,其次为食管下段运动减弱。     

功能性消化不良与幽门螺杆菌感染的关系研究

目的：检测功能性消化不良（FD）病人幽门螺杆菌（HP）感染情况,探讨HP感染与FD的关系。方法：对137例FD患者及56例正常对照组行快速尿素酶检测,Warthin-Starry银染及（或)^14C呼气试验,对FD并HP感染病人行抗HP治疗,以症状积分比较症状改善情况及总有效率。结果：1．FD病人HP感染率为67．15％。2．经抗HP治疗FD患者症状明显改善。结论：HP感染可能是FD的一个致病因素,抗HP是治疗的FD的一个重要手段。     

Abnormalities of upper gut motility in patients with slow-transit constipation.

OBJECTIVE: To further delineate motor activity of the upper gastrointestinal tract in patients with slow-transit constipation. DESIGN: A prospective study comparing healthy volunteers with patients with a clinical diagnosis of slow-transit constipation. METHODS: Eighteen patients with clinical diagnosis of slow-transit constipation and 10 healthy controls were included in the study. Fasting antroduodenal motility was measured by perfusion manometry for at least one complete cycle of the migrating motor complex or a maximum of 300 min. Oesophageal manometry, gastric emptying and orocaecal transit time measurements were also performed. RESULTS: At least one complete cycle of the migrating motor complex was observed in all controls, but in only nine patients (P < 0.01 versus control). The migrating motor complex cycle was incomplete (n = 5) or phase 3 activity was absent (n = 4) in the other patients. The incidence of clustered contractions was significantly increased in slow-transit constipation (P = 0.05 versus controls). The area under the contraction curve during late phase 2 (1509+/-296 mmHg x s) in patients with a complete cycle was significantly smaller than that in controls (2997+/-614 mmHg x s; P = 0.05). Orocaecal transit time was not significantly different among patients and controls, but oesophageal motility was abnormal in five of 18 patients and gastric emptying was abnormal in eight of 15 patients. CONCLUSION: Abnormalities of upper gut motility occur frequently in patients with slow-transit constipation. Interdigestive antroduodenal motility is characterized by (i) absence or prolonged duration of the migrating motor complex, (ii) an increased number of clustered contractions, or (iii) a decreased motility during late phase 2 of the migrating motor complex.     

Comparative effect of gastrin on hydrogen ion secretion,antroduodenal motility and the interdigestive motility complex (IDMC) in man

The physiological role of gastrin in H⁺ secretion is well established. We decided to study the effects of physiological doses of gastrin (as evidenced by H⁺ secretion and postprandial serum gastrin levels) on antroduodenal motility in order to delineate its role in antral motility regulation. Nine healthy male subjects, mean age 31 years, had two studies on different days. On day 1, gastroduodenal motility was monitored with a continuously perfused catheter system while gastric secretions were aspirated. After a basal period of 45 min, human synthetic gastrin (hG-17) was infused intravenously in consecutive doses of 6.25, 25, 100, and 400 pmol/kg/hr during 45 min each. On day 2, all subjects had a standard protein meal. Blood was withdrawn on both days for gastrin measurement by RIA. Increasing amounts of hG-17 caused a stepwise increase in serum gastrin and acid output. The D ₅₀ for H⁺ secretion was 25 pmol/kg/hr hG-17. The mean postprandial gastrin level was 31±5 pM, a level which was comparable to that seen during infusion of hG-17 6.25 pmol/kg/hr. At these serum gastrin levels, antral motility was either reduced or unchanged. Duodenal motility was unchanged. A reduction in the antroduodenal motility ratio was seen at these levels, but there was no interruption of the interdigestive motility complex. These results suggest that at physiological levels, gastrin by itself does not seem to have a major role in human antroduodenal motility regulation.