肠易激综合征患者饮冰水及直肠扩张脑诱发电位的研究

目的　通过记录并比较直肠扩张脑诱发电位 (CEP)的特征及饮冰水后CEP的改变 ,探讨肠易激综合征 (IBS)患者内脏高敏感性的发生机制 ,旨在进一步获得IBS感觉传入通路异常的客观依据。方法　根据罗马Ⅱ标准选择女性IBS患者 2 0例 ,其中腹泻型 10例 ,便秘型 6例 ,腹泻 便秘交替型4例 ,另设 12例女性健康志愿者为对照组 ,对其进行快速直肠气囊扩张 ,首先测出每例受试者感觉阈值 ,用该阈值空气体积作为刺激 (频率 1Hz,连续 10 0次 ,休息 10min ,重复 1次 ) ,启动并记录两组受试者CEP的变化。随后 ,每例受试者饮 4℃冰水 2 2 0ml,2 0min后重复上述步骤。结果　直肠节律性机械扩张引出可识别、复制的CEP。与健康对照者 [(87± 17)ms,(14 0± 2 3)ms ,(198± 31)ms]相比 ,IBS患者N1、P1、N2 潜伏期 [(6 9± 15 )ms,(12 1± 2 1)ms,(177± 2 4 )ms) ]明显缩短 (P <0 .0 5 ) ;腹泻型较便秘型IBS患者CEP潜伏期明显缩短 (P <0 .0 5 ) ;饮冰水后 ,IBS患者N1、P1、N2 潜伏期缩短 ,与饮冰水前相比差异有显著性 [分别为 (5 4± 16 )ms,(10 8± 2 0 )ms,(16 1± 2 4 )ms比 (6 9± 15 )ms,(12 1± 2 1)ms,(177± 2 4 )ms;P <0 .0 5 ],而健康对照组饮冰水后CEP无明显变化 ,两组CEP波幅无明显改变。结论　IBS患者经直肠节律性     

饮冰水对肠易激综合征患者内脏感觉的影响

肠易激综合征(IBS)患者进冷食和腹部受凉后可出现腹痛、腹胀、腹泻等症状和肠鸣音的改变，但其发生机制尚不清楚。目的：观察IBS患者与对照者饮冰水前后内脏感觉阈值和腹部症状的差异，探讨温度刺激对IBS患者内脏敏感性的影响。方法：测定IBS患者和对照者的初始感觉阈值和排便阈值：予受试者饮4℃冰水220ml，20min后重复上述测定,并连续观察1h受试者的腹痛、腹胀、腹泻等症状和肠鸣音的改变情况。结果：直肠气囊内注入空气后，IBS患者的初始感觉阈值显著低于对照组，排便阈值与对照组无显著差异。饮冰水后，除便秘型IBS，其余各型IBS患者的初始感觉阈值和排便阈值均显著低于对照组.与单纯直肠气囊扩张(即饮冰水前)相比，对照组饮冰水后的初始感觉阈值和排便阈值无明显改变：除便秘型IBS，其余各型IBS患者饮冰水后的初始感觉阈值和排便阈值明显降低。有腹部症状的腹泻型IBS患者饮冰水后的症状轻重与内脏感觉阈值呈直线负相关。结论：饮冰水所致的温度刺激可明显降低IBS患者(除便秘型)的内脏感觉阈值，并与部分腹泻型IBS患者的腹部症状相关，证实’IBS患者的内脏敏感性增高，不同类型IBS患者的内脏感觉功能存在一定差异。     

肠易激综合征病人内脏高敏感性的研究

目的 比较肠易激综合征(IBS)病人和健康对照者在直肠内温度变化刺激后所产生感觉阈值的差异，探讨IBS内脏敏感性的变化。方法 对46例IBS病人和13例健康对照者，用直肠测压导管依次向球囊内注入38℃温水和4℃冰水，记录相应的初始感觉阈值及排便阈值，注意温度变化刺激对IBS病人症状的影响。结果 ①直肠球囊内温水刺激后，IBS组病人的初始感觉阈值明显低于对照组，排便阈值差异不明显。IBS组中腹泻型与交替型病人的初始感觉阈值及排便阈值均显著降低；便秘型病人的初始感觉阈值稍低于对照组，排便阈值明显增高。②直肠球囊内冰水刺激后，除便秘型IBS的排便阈值稍有所增加外，其余病人初始感觉阈值及排便阈值均显著降低，以腹泻型变化最明显。结论 直肠温度变化刺激可明显降低IBS病人的初始感觉阈值和排便阈值，以腹泻型病人最显著。内脏对温度的敏感性增高，可能是IBS发病的重要机理之一。     

不同类型便秘患者直肠敏感性的差异

目的通过对不同类型便秘患者直肠敏感性的研究,比较两者病理生理机制上的异同。方法对功能性便秘和便秘型-肠易激综合征(IBS)患者直肠敏感性进行检测,通过Barostat采用500ml的聚乙烯囊对直肠进行快速时相性扩张,同时选择正常健康人作对照组。结果功能性便秘患者直肠排便窘迫阈值和最大耐受阈值(22.61mmHg±10.03mmHg,32.11mmHg±9.73mmHg)较对照组(14.64mmHg±4.20mmHg,25.18mmHg±5.38mmHg)明显增高,便秘型-IBS初始感觉阈值较对照降低(5.58mmHg±3.48mmHg比8.81mmHg±5.90mmHg)。两者间比较发现便秘型-IBS较功能性便秘各项感觉阈值均显著降低。三组间直肠、肛管的静息压和最大缩榨压比较未见明显异常。结论直肠感觉迟钝是便秘的一个重要的病理生理机制,在功能性便秘中更常见;IBS-便秘型直肠感觉过敏占有更重要的地位。     

直肠内温度变化影响肠易激综合征患者内脏感觉阈值

目的 探讨直肠内温度及压力变化对肠易激综合征(IBS)患者内脏感觉阈值的影响，进一步研究IBS的发病机制。方法 通过直肠球囊内注入空气(压力刺激)、38℃温水、4℃冰水(温度刺激)及脐部放置冰袋加直肠球囊内充气，研究直肠温度和压力变化刺激对初始感觉阈值和排便阈值的影响。结果 (1)直肠球囊内注气后，IBS组患者的初始感觉阈值明显低于对照组，排便阈值差异不明显。IBS组中腹泻型与交替型患者的初始感觉阈值及排便阈值均明显降低；便秘型患者的初始感觉阈值稍低于对照组，排便阈值明显增高。(2)直肠球囊内注入4℃冰水后，除便秘型IBS的排便阈值稍有所增加外，其余患者初始感觉阈值及排便阈值均显著降低，以腹泻型变化最明显。(3)脐部放置冰袋可诱发部分患者产生症状，但对初始感觉阈值和排便阈值无明显影响。结论 直肠温度和压力刺激可明显降低IBS患者的初始感觉阈值和排便阈值，以腹泻型患者最显著。内脏对压力和温度的敏感性增高可能是IBS发病的重要机制之一。     

肠易激综合征便秘型和功能性便秘结、直肠肛门动力学研究

目的 研究肠易激综合征(IBS)便秘型和功能性便秘患者结肠、直肠动力,直肠感觉功能.方法 对IBS便秘型患者52例和功能性便秘患者48例进行肛门直肠测压检查,并做结肠传输试验.同时选择正常健康人作对照组.结果 IBS便秘型组和功能性便秘组与对照组间直肠静息压、肛管静息压和肛门括约肌最大缩榨压比较均未见明显差异.IBS便秘型组初感阈值及排便阈值(75.00±34.04 ml,117.31±37.60 ml)较正常对照(97.14±20.54 ml,138.57±19.94 ml)明显降低.功能性便秘组排便阈值及最大耐受阈值(187.92 ±68.62 ml,252.5±93.40ml)较正常对照组(138.57±19.94 ml,181.43±18.34 ml)明显升高.IBS便秘型组各项感觉阈值较功能性便秘组均明显降低.功能性便秘组较IBS便秘型组患者结肠传输试验符合出口梗阻的比例高,但无统计学差异.结论 IBS便秘型直肠感觉过敏,功能性便秘直肠感觉迟钝.     

肠易激综合征患者胃窦十二指肠移行性复合波的研究

目的　观察肠易激综合征 (IBS)患者的胃窦十二指肠移行性复合波 (MMC)变化 ,并分析其与症状之间的关系。方法　 2 0名健康对照者及 17例IBS患者 (8例腹泻型 ,9例便秘型 )禁食 6h以上 ,用瑞典CTD公司生产的灌注式小肠测压管记录至少 2个完整的MMC周期 ,之后给每位受试者服标准餐 ,用餐时间为 15～ 30min ,继续观察餐后波 1～ 2h。结果　腹泻型IBS患者消化间期MMC周期短、Ⅲ相波幅高、时程长 ,便秘型IBS患者MMC周期长、时程短。IBS患者MMCⅡ相小肠离散丛集簇(DCC)波的时程延长 ,但腹泻组与便秘组之间差异无显著性 (P >0 .0 5 )。IBS腹泻组的Ⅱ、Ⅲ相的运动指数高于便秘组和对照组。进餐后IBS患者小肠运动形式无明显改变。结论　IBS患者消化间期MMC的各相时程及波幅异常与IBS症状密切相关 ,DCC可能与IBS腹泻、便秘症状发生的关系较小 ,IBS患者餐后胃肠运动无明显异常 ,可能与病例数较少有关 ,有待今后增加例数进一步观察     

替加色罗联合聚乙二醇治疗便秘型肠易激综合征临床观察

肠易激综合征（IBS）是最常见的消化系疾病之一，是腹部不适或腹痛伴排便异常的一组肠功能障碍综合征，无任何器质性或异常的生化指标。根据症状分为腹泻型、便秘型和腹泻便秘交替型。便秘型IBS的病因可能是小肠或结肠转运减慢，以及直肠敏感性过低等，但临床单独使用各种药物治疗效果不尽理想。自2003年10月至2005年5月我们用替加色罗联合聚乙二醇4000治疗便秘型（CIBS）患者78例，现报道如下。     

腹部冷刺激对肠易激综合征患者内脏感觉阈值的影响

目的 探讨腹部冷刺激对肠易激综合征（IBS）患者内脏褡珠影响。方法 通过脐部放置冰袋加直肠球囊内充气（时相性）和直肠球囊内注入冰水，观察46例IBS患者症状变化及直肠初始感觉阈值和排便阈值，并与13例健康人对照。结果 （1）脐部放置冰袋加直肠球囊内充气可诱发部分患者症状的产生，如腹痛、腹部不适等，但对初始感觉阈值和排便阈值无明显影响。（2）直肠球囊内注入冰水后，除便秘型IBS的排便阈值稍有所增加但差异不显著外，其余患者初始感觉阈值及排便阈值均明显低于对照组，以腹泻型变化最明显。结论 腹部冷刺激对IBS患者内脏感觉阈值无明显影响，而直肠内冷刺激可明显降低初始感觉阈值，说明IBS患者感觉过敏并非整体痛阈降低所致，而仅指内脏感觉过敏。     

便秘型肠易激综合征患者结、直肠肛门动力学的临床研究

目的研究便秘型肠易激综合征患者结肠、直肠动力,直肠感觉功能.方法用结肠传输试验检测结肠传输时间,并用结肠传输指数分型,用肛门直肠测压方法测定便秘型IBS直肠静息压,肛管静息压,肛门括约肌最大缩榨压,模拟排便时,直肠收缩压,肛门括约肌剩余压,直肠对容量扩张刺激的初始感觉阈值,最大耐受容量,直肠顺应性.结果便秘型IBS患者全结肠及各节段结肠传输时间均高于对照组,便秘型IBS患者肛管静息压,直肠静息压与对照组无差异(P＞0.05),肛门括约肌最大缩榨压低于正常对照组,最大耐受容量及直肠顺应性均明显高于对照组(P＜0.01),且发现不同传输类型的便秘型IBS肛门直肠测压表现不同.结论便秘型IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,可体现不同传输类型便秘型IBS肛门直肠动力学病因机制.     

Alterations in cerebral potentials evoked by rectal distention and drinking ice water in patients with irritable bowel syndrome

AIM: Visceral hypersensitivity has been found to be present in irritable bowel syndrome (IBS). The current study sought to study visceral afferent hypersensitivity in IBS patients and obtain further objective evidence of alterations in intestinal afferent pathways in IBS patients by cerebral evoked potentials (CEP). METHOD: We studied 30 female IBS patients and 12 female healthy subjects. Rectal perception thresholds to balloon distention were measured and CEP was recorded in response to rhythmic rectal distention (two distention series, each of 100 repetitions at a frequency of 1 Hz) at the volume of perception thresholds. All subjects were then asked to drink 220 mL 4 degrees C ice water and the above steps were repeated 20 min later. RESULTS: Rectal distention led to recognizable and reproducible CEP. Compared to healthy subjects, IBS patients demonstrated significantly shorter N1, P1 and N2 latencies (P < 0.05). After drinking ice water, IBS patients exhibited further shortened N1, P1 and N2 latencies (P < 0.05), but drinking did not alter the latencies of healthy controls and the amplitudes of both IBS patients and healthy controls. CONCLUSION: The shorter latency of cerebral potentials evoked by rectal distention and ice water stimulation in IBS patients provided further objective evidence for defective visceral afferent transmission in IBS patients.     

Visceral afferent hypersensitivity in irritable bowel syndrome—evaluation by cerebral evoked potential after rectal stimulation

OBJECTIVES: Gut hypersensitivity has been shown to be present in irritable bowel syndrome. The current study sought to determine the involvement or hypersensitivity of the gut afferents, objectively, by recording cerebral evoked potential after rectal stimulation. METHODS: In 13 patients with irritable bowel syndrome and nine healthy controls, rectal perception thresholds to electrical stimulation were measured, and cerebral evoked potentials were recorded from 2 cm behind vertex (Cz') after rectal stimulation electrically (frequency 1 Hz, duration 0.5 ms) at an intensity 50% above perception threshold and with filter setting 1-250 Hz. RESULTS: Perception thresholds to rectal electrical stimuli in patients with irritable bowel syndrome were lower than controls (p < 0.05). Rectal stimulation led to recognizable and reproducible cerebral evoked potentials. P1, N1, P2 latencies in patients with irritable bowel syndrome were shorter than that in controls (p < 0.05). P1/N1 amplitude was greater in patients with irritable bowel syndrome than in controls (p < 0.05). CONCLUSIONS: The shorter latency and increased amplitude of cerebral evoked potential after rectal stimulation in patients with irritable bowel syndrome compared to controls provide objective evidence supporting visceral afferent hypersensitivity as the underlying mechanism in irritable bowel syndrome.     

Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome

OBJECTIVE: Central nervous system correlates of the visceral hyperalgesia documented in patients with irritable bowel syndrome are limited. Reproducible cerebral evoked potentials can be recorded in response to rhythmic balloon distension of the rectum in healthy adults. Irritable bowel syndrome patients and healthy subjects were studied to compare the characteristics of mechanically-evoked rectal cerebral potentials obtained during fasting and after the ingestion of a standard meal. METHODS: Twenty-two pairs of age-matched healthy female subjects and female irritable bowel syndrome patients were studied. Cerebral evoked potentials were recorded in response to rhythmic rectal distension (two distension series each of 100 repetitions at 0.8 hertz); cerebral evoked potential recordings were repeated after a 1000 kcal (46% fat) liquid meal. Trait and state anxiety questionnaires were also completed. RESULTS: Compared to healthy subjects, irritable bowel syndrome patients demonstrated higher prevalence of cerebral evoked potential early peaks (latency < 100 ms) postprandially, and uniformly shorter cerebral evoked potential latencies both before and after feeding. CONCLUSION: These findings provide further objective evidence for defective visceral afferent transmission in irritable bowel syndrome patients.     

非糜烂性胃食管反流病患者大脑皮质诱发电位的研究

目的通过比较食管扩张刺激-脑诱发电位(OD-CEP)的改变,探讨非糜烂性胃食管反流病(NERD)患者食管内脏高敏感性的发生机制,旨在进一步获得NERD患者食管-中枢内脏感觉传导通路失调的客观依据。方法10例正常健康自愿者和21例NERD患者参与试验;采用Synectics内脏刺激器/电子气压泵和带有低顺应性气囊的导管给食管以时相性扩张刺激;利用食管气囊扩张术检测受试者食管最大耐受痛阈,用75%最大疼痛耐受容积作为诱发刺激的强度(刺激频率为12次/分,连续64次);采用OD-CEP系列技术记录并分析NERD患者和正常人CEP的变化。结果食管气囊扩张刺激能诱发出可识别、可重复的、多峰的CEP波形,以NP型为主。与正常对照者比较,NERD患者CEP波形变异性大,其N1、P1、N2波潜伏期明显缩短(P值分别为0·016,0·003,0·031),且NERD患者CEP的P1-N2峰间波幅明显增加(P=0·03)。结论NERD患者经食管时相性扩张后产生的特征性CEP改变证实其食管内脏高敏感性及食管-中枢内脏感觉传导通路的失调。     

Visceral hypersensitivity following cold water intake in subjects with irritable bowel syndrome

Background Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). This study sought to investigate rectal sensitivity and abdominal symptoms in IBS patients before and after 220 ml cold water intake. Methods A total of 60 IBS patients and 18 healthy controls participated in this study. Both the perception thresholds and defecation thresholds to rectal balloon distension were measured. Then, all subjects were asked to drink 220 ml 37°C warm water or 4°C cold water, and these steps were repeated 20 min later. Symptoms including abdominal pain/discomfort, bloating, and diarrhea were recorded during the study. Results Compared with the controls, the thresholds of initial sensation to rectal balloon distention in IBS patients were significantly lower while the defecation thresholds were higher in constipation-predominant IBS patients. After drinking cold water, the perception thresholds in IBS patients and the defecation thresholds in diarrhea-predominant IBS patients were further decreased. However, warm water intake did not change the perception thresholds significantly in either IBS patients or controls. A negative linear correlation was found between the symptoms and the visceral perception thresholds in diarrhea-predominant IBS patients who showed significant symptoms after cold water intake. Conclusion The results indicated that cold water intake leads to lowered visceral perception thresholds in IBS patients that were inversely relevant to the abdominal symptoms in symptomatic diarrhea-predominant IBS patients. The alteration of rectal sensitivity and abdominal symptoms following cold water stimulation provided further objective evidence for visceral hypersensitivity in IBS patients.     

肠易激综合征内脏感觉过敏大鼠脊髓诱发电位的研究

背景:内脏感觉过敏是肠易激综合征(IBS)的主要发病机制之一,临床上缺乏客观、无创的内脏敏感性检测方法。目的:建立直肠球囊扩张下脊髓诱发电位(SEP)的检测方法,并通过IBS内脏感觉过敏大鼠与正常大鼠的比较以及雌雄大鼠之间的比较,取得IBS存在内脏感觉过敏的客观证据。方法:通过直肠球囊有节律的充气、放气,给予直肠一定频率的反复刺激,记录诱发得到的脊髓相应节段(L6～S2)的SEP。结果:实验组雌雄大鼠分别与对照组同性别大鼠相比,SEP各波潜伏期显著缩短(P<0.05),峰间波幅显著增高(P<0.01)。实验组雌性大鼠的各波潜伏期显著短于雄性大鼠(P<0.05),峰间波幅也低于雄性大鼠(P<0.05);对照组雌性与雄性大鼠的各波潜伏期和峰间波幅无显著差异。结论:通过有节律的直肠球囊扩张,能诱发得到重复性好、易识别的SEP,可作为内脏敏感性的客观依据。     

Visceral perception thresholds after rectal thermal and pressure stimuli in irritable bowel syndrome patients

BACKGROUND AND AIM: Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). The current study sought to compare the characteristics of visceral perception thresholds after rectal thermal and pressure stimuli between IBS patients and healthy subjects. METHODS: A total of 46 patients with IBS were diagnosed using Rome II criteria. Thirteen healthy individuals participated in the study. Rectal visceral perception thresholds were examined in patients with IBS and in normal controls after thermal and pressure stimuli. Subjects were asked to report the sensation type, location, and spread. RESULTS: Compared with healthy subjects, IBS patients demonstrated significantly initially lower perception thresholds and defecation thresholds to rectal thermal and pressure stimuli, particularly in patients with diarrhea-predominant IBS. Ice stimuli on the abdominal wall had varied effects on symptoms in patients with IBS and did not affect perception thresholds. CONCLUSIONS: Visceral perception thresholds were decreased significantly after rectal thermal and pressure stimuli in patients with IBS. Visceral hypersensitivity may be one of the important pathogenic mechanisms in IBS.