功能性出口梗阻型便秘患者肛管直肠功能与血胃动素的相关性研究

目的 研究血胃动素及肛管直肠功能改变在功能性出口梗阻型便秘发病中的作用，探讨胃动素及其受体激动剂可否用于治疗出口梗阻型便秘。方法 根据结肠运输时间和运输指数选择出口梗阻型便秘患者，设健康对照组，行肛管直肠测压检查，测定血胃动素并分析其与肛管直肠测压指标值的相关性。结果 出口梗阻型便秘患者的肛管静息压升高，模拟排便时直肠肛管压差显著降低，引起直肠肛管抑制反射的最小松弛容积及直肠感觉阈值均高于健康人。患者血胃动素无明显变化，胃动素水平与肛管静息压、最大缩榨压及模拟排便时肛管压力成正相关，与模拟排便时直肠肛管压差成负相关。结论 出口梗阻型便秘发病基础是肛门括约肌舒张失调，排便时直肠肛管不协调，直肠敏感性低；血胃动素正常便秘惠者可能有更多出口梗阻问题，出口梗阻型便秘患者不宜采用胃动素或其受体激动剂治疗。

Study on Relationship Between Blood Motilin and Anorectal Function in Functional Outlet Obstructive Constipation

Objective To investigate the role of blood motilin and anorectal function in the pathogenesis of functional outlet obstructive constipation (OOC), and study if motilin and its receptor agonist are effective to treat OOC. WTHZ]Methods Patients with OOC were selected according to colonic transit time and transit index. Twenty healthy subjects were also selected as control group. Anorectal manometry was performed, and blood motilin level was measured in patients with OOC and healthy subjects. Correlation between blood motilin level and anorectal function was analyzed. WTHZ]Results Compared with healthy subjects, OOC patients had higher anal resting pressure, lower defecating pressure difference,larger minimum relaxation volume to elicit anorectal inhibitory reflex, and higher rectal sensation threshold. The plasma level of motilin was positively correlated with anal resting pressure, maximum squeeze pressure and anal defecating pressure, but was negatively correlated with defecating pressure difference between rectum and anal canal. Conclusion OOC patients had anal sphincter dysfunction in relaxtion, discoordination of annorectum during defecation, and Low sensitivity of rectum. OCC patients with the normal level of blood motilin may have more severe outlet obstructive tendency, and motilin and its receptor agonist are not suitable for treating OOC patients.