功能性消化不良患者的胆囊排空功能评价

目的探讨胆囊排空功能及胃肠激素水平变化在功能性消化不良(FD)发病机制中的作用.方法采用放射免疫分析法(RIA)和放射性核素显像法测定32例FD患者、20例健康志愿者空腹及脂餐后60min血浆胃动素(MTL)、胆囊收缩素(CCK)、血管活性肠肽(VIP)、生长抑素(SS)及胆囊排空功能,获得不同时相胆囊排空指数.结果FD组空腹及餐后胆囊排空指数、MTL均低于对照组,差异均有显著性(P均<0.001),且MTL与胆囊排空指数呈正相关(r空腹=0.82,r餐后=0.94,P均<0.01);FD组空腹血浆CCK与对照组比较差异无显著性(P>0.05),餐后低于对照组,差异有显著性(P<0.001),且餐后CCK与胆囊排空指数呈显著正相关(r=0.97,P<0.01);FD组空腹与餐后血浆VIP均高于对照组,差异有显著性(P<0.001),VIP与胆囊排空指数呈负相关(r空腹=-0.81,r餐后=-0.47,P均<0.01).FD组空腹及餐后血浆SS与对照组相比差异无显著性.结论FD患者(运动障碍型)存在空腹及餐后胆囊排空障碍.血浆促胃肠动力激素(MTL、CCK)水平下降和抑制胃肠动力激素(VIP)水平升高是FD患者胆囊排空障碍的病因和重要的病理生理基础.

A study on gallbladder empty of patients with functional dyspepsia by radionuclide imaging and on assessment of plasma levels of gastrointestinal hormones

Objective To study the role of gallbladder kinetics and plasma levels of gastrointestinal hormones in the mechanism of functional dyspepsia. Methods Gallbladder ejection fractions(GBEF) were determined with 99Tcm radionuclide imaging,and plasma levels of motilin(MTL),cholecystokinin(CCK),vasoactive intestinal peptide (VIP) and somatostatin (SS) were measured with radioimmunoassay. Thirty-two patients with funtional dyspepsia of dyskinetic type (FD group) and 20 normal volunteers in control group were studied. Results The preprandial and postprandial gallbladder ejection fractions (GBEF) and MTL levels were both obviously lower in FD group ( P <0.001), and there was a positive correlation between plasma MTL levels and GBEF ( r preprandial=0.82, P <0.01, r postprandial=0.94, P <0.01).The preprandial CCK levels were not different between two groups ( P >0.05),while the levels of postprandial CCK were significantly decreased in FD group ( P <0.001).Also there was a close positive correlation between plasma CCK levels and GBEF( r preprandial=-0.81, P<0.01,r postprandial=-0.47, P <0.01).No significant difference was found in plasma levels of SS between FD and control group ( P> 0.05). Conclusions Patients with FD of dyskinetic type might have a significant decrease of preprandial and postprandial gallbladder emptying.The decrease of plasma levels of gastrointestinal hormones, MTL, CCK and the elevation of VIP might be the cause of slow gallbladder emptying and part of the basic pathophsiology in FD.