非糜烂性反流病内脏高敏感的外周与中枢机制研究

目的研究非糜烂性反流病(NERD)患者食管腔内气囊扩张刺激-脑诱发电位(ED-CEP)的特征及其食管黏膜中降钙素基因相关肽(CGRP)、P物质(SP)表达的改变,探讨NERD内脏高敏的机制。方法收集第二军医大学长海医院消化内科2004-10—2005-03NERD患者26例和健康对照者12名,采用ED-CEP技术记录分析CEP的变化,并观察远端食管黏膜组织中CGRP、SP免疫反应阳性产物的分布和表达。结果NERD患者CEP波形变异性大,其N1、P1、N2波潜伏期明显缩短(P<0·05),CEP的P1-N2峰间波幅也明显增加(7·8±3·2)μV对(6·2±1·9)μV,P=0·03]。其远端食管黏膜的CGRP、SP阳性产物OD值分别较对照组升高(0·46±0·16)对(0·23±0·10),(0·42±0·12)对(0·29±0·05)](P<0·05)。结论NERD患者ED-CEP和食管黏膜中CGRP、SP的表达与对照组存在差异,提示NERD患者的食管-中枢内脏感觉传导通路存在一定的异常改变。

Study of peripheral and central mechanism of visceral hypersensitivity in non - erosive reflux disease patients

Objective The aim of this study was to evaluate and to characterize the visceral hypersensitivity in non-erosive reflux disease(NERD)through the detection of esophageal distension-cerebral evoked potentials(ED-CEP)and calcitonin gene related peptide(CGRP)and substance P(SP)levels in esophageal mucosa.Methods NERD patients(N 26)and 12 controls were enrolled in this study from Oct.2004 to Mar.2005.Mechanical distention stimulation was performed using the balloon-affixed and polyvinyl multilumen catheter.The ED- CEP was recorded with a muti-channel international 10~20 system of electroencephalograph.The esophageal specimens were immune-histologically evaluated for CGRP/SP-stain positive contents.Results Esophageal distention may evoke recognizable and reproducible muti-peak CEP.CEP morphology of NERD patients was characterized by randomly distributed patterns,and the peak latencies for N1,P1,and N2 were significantly shorter compared with control group(P <0.05),and the P1-N2 components amplitude was significantly increased in NERD patients(P = 0.03).The mean optical density(OD)values of CGRP/SP-positive contents observed in NERD patients were significantly increased than those of the control(P< 0.05).Conclusion Our results suggest a significant change of ED-CEP and CGRP and SP expression in NERD patients,may explain both the primary afferents and central level involved in processing of the esophageal hypersensitivity.