非糜烂性胃食管反流病患者酸灌注及食管扩张脑诱发电位的研究

Cerebral evoked potentials response to esophageal mucosal acid exposure and distention in patients with non-erosive gastro-oesophageal reflux disease

目的研究非糜烂性胃食管反流病(NERD)患者和正常人食管扩张刺激(OD)-脑诱发电位(CEP)的特征及食管酸灌注后 CEP 的改变,探讨 NERD 患者食管内脏高敏感性的发生机制。方法10例健康志愿者和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及多个灌注式压力通道的导管给食管以时相性扩张刺激和酸灌注;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/min,连续64次);采用 OD-CEP 系列技术记录并分析食管酸灌注前后 NERD 患者和正常人 CEP 的变化。组间比较采用 t 检验,多组间比较采用单因素方差分析。结果食管时相性机械扩张刺激诱发出可识别、可重复、多峰的 CEP 波形,以 NP 型为主。正常对照者 N1、P1、N2波潜伏期分别为(246±77)、(388±84)和(502±78)ms,NERD 患者 CEP 波形变异性大,其 N1、P1、N2波潜伏期分别为(192±46)、(293±76)和(440±79)ms,较对照组明显缩短(P 值均<0.05);P1-N2峰间波幅明显增加[(6.2±1.9)μV 比(7.8±3.2)μV,P<0.05]。食管酸灌注能明显缩短 NERD 患者 N1、P1、N2波潜伏期,与酸灌注前相比差异有统计学意义(P 值均<0.05),且酸灌注后 NERD 患者 P1-N2皮层波幅值较酸灌注前显著增加(p<0.05),健康对照组除 CEP 的 N1波潜伏期较对应基线值显著降低(P=0.05)外,其余 CEP 参数均无明显改变。结论 NERD 患者存在食管对机械和酸刺激的高敏感性及食管-中枢内脏感觉传导通路失凋。

Objective To investigate characteristics and alternation of cerebral evoked potentials （CEP） response to esophageal mucosal acid exposure and distention in patients with non-erosive gastro-oesophageal reflux disease （NERD） and in healthy subjects, and to study the mechanism of visceral hypersensitivity in NERD. Methods Twenty-one NERD patients and 10 volunteers were recruited. Mechanical distention stimulation and acid perfusion of the esophagus were performed using the balloon-affixed and polyvinyl multilumen catheter. First, maximally tolerated pain thresholds of all subjects were recorded, then esophageal mechanical stimulation with a 75% of maximal tolerated intensity and a frequency of 0. 2 Hz was performed altogether 64 times by means of a computer-controlled barostat. The alternation of esophageal CEP was recorded before and after acid perfusion with a multichannel international 10-20 system of electroencephalography. Experimental data was analyzed by student＇s t-test and one way analysis of variance. Results Esophageal mucosal distention may evoke recognizable and reproducible and multi-peak CEP. The latencies for N1, P1 and N2 in volunteers were （246 ± 77 ）, （388 ±84 ）and （502 ± 78 ） ms, CEP morphology of NERD patients was characterized by randomly distributed patterns, and the latencies for N1 ,P1 and N2 were （ 192 ±46）, （293±76） and （440 ± 79 ） ms, significantly shorter for mechanical stimulation compared with those of control group respectively （ all P value 〈 0. 05 ）. Its amplitude of the P1 -N2 components was significantly increased in NERD patients [ （6. 2 ± 1.9）μV vs. （7. 8 ± 3. 2 ） μV, P 〈 0. 05 ]. Esophageal mucosal acid exposure might markedly decrease the peak latencies for N1 ,P1 and N2 components of NERD patients compared with before acid perfusion respectively （ all P value 〈 0. 05 ） , and its amplitude of the P 1 - N 2 components was significantly larger after acid perfusion compared with before acid perfusion （P 〈 0. 05 ）. However, only peak latencies for N1 were significantly shorter in healthy control after esophageal mucosal acid exposure, but there were no statistical alterations of other CEP parameters. Conclusions The results support the evidence for defective hypersensitivity of afferent neural pathways and cortical processing in patients with NERD.