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。

A study of cerebral evoked potentials response to esophageal distention in non-erosive gastroesophageal reflux disease

Objective To study the mechanism of visceral hypersensitivity in patients with non-erosive gastroesophageal reflux disease (NERD) and to get further objective evidence in the abnormal alteration of the afferents involved in mediating esophageal sensation by cerebral evoked potentials (CEP). Methods We recruited 21 NERD patients and 10 normal healthy volunteers for the study. Mechanical distention stimulation was performed using a balloon-affixed polyvinyl multilumen catheter. First,maximally tolerated pain threshold of all subjects were recorded, then esophageal mechanical stimulation at an intensity of 75% maximum tolerated intensity and a frequency of 0.2 Hz was inflated in a total of 64 times by means of a computer-controlled barostat. The alternation of esophageal CEP was recorded before and after acid perfusion with a multi-channel international 10-20 system of electroencephalograph. Results Esophageal mucosal distention may evoke recognizable and reproducible multi-peak CEP. CEP morphology of the NERD patients was characterized by randomly distributed patterns and the peak latencies for N1, P1, and N2 were significantly shorter for mechanical stimulation as compared with the control group (respectively, P=0.016, 0.003, 0.031) , and the amplitude of the P1-N2 components was significantly increased in NERD patients (P=0.03). Conclusions Characterization and alternation of CEP morphology and peak latencies and P1-N2 amplitudes elicited by esophageal distention in NERD patients provides evidence for defective hypersensitivity of afferent neural pathways and cortical processing.