儿童支气管哮喘并发胃食管反流血浆MTL和血清GAS的变化及其临床意义

Clinical Significance of Changes of Plasma Motilin and Serum Gastrin Levels in Children with Bronchial Asthma Complicated with Gastro-esophageal Reflux(GER)

目的:探讨血浆胃动素(MTL)和血清胃泌素(GAS)在儿童支气管哮喘中的水平变化,以阐明胃肠激素与支气管哮喘患儿胃肠功能的关系。方法:应用放射免疫分析(R IA)检测98例哮喘患儿MTL和GAS的水平,其中76例患儿通过平卧或抬高床脚进行吞钡X线检查,并对喘息发作的次数、年龄、严重复发性哮喘,结合伴有反胃烧心等食管炎症状的患儿做好详细的统计学处理。结果:哮喘患儿无男女性别差异。哮喘有症状和钡餐阳性者与对照组比较P<0.001,哮喘无症状组与对照组及哮喘有症状组与无症状组比较也有显著性差异。哮喘有症状组血浆MTL和血清GAS水平明显低于对照组和哮喘无症状组,组间比较均有显著性差异(P<0.001)。结论:经观察发现哮喘反复发作可引起血浆MTL和血清GAS水平的严重降低,支气管哮喘伴发胃食管反流(GER)与哮喘反复发作引起血MTL和GAS水平降低有密切的相关性,胃肠激素水平降低是哮喘引发GER的关键所在,而GER又可触发和加剧喘息的发作。

Objective To investigate the relationship between changes of blood levels of motilin gastrin and development of GER in children with bronchial asthma. Methods Altogether 98 children with various forms of bronchial asthma were studied, in which 40 patients were complicated with symptomatic GER. Serum gastrin and plasma motilin levels were measured with RIA in all these 98 children and 30 controls. Barium swallow was performed in 76 children （ including all the 40 with symptomatic GER） and anatomic GER was demonstrated in 31 patients （ all with symptomatic GER except 4 in young infants who could not tell about symptom）. No anatomic GER was shown in children without GER symptoms. Results The blood levels of motilin and gastrin in all patients with symptomatic GER （barium swallow positive or not） were significantly lower than those in patients without GER symptoms and controls （P 〈 0. 001 ）. The hormone levels in asthmatic children without GER symptoms were still significantly lower than those in controls （P 〈 0. 01 ）. Conclusion Plasma motilin and serum gastrin levels were markedly decreased in asthmatic children, especially in those with symptomatic and/or anatomic GER. Lowered motilin and gastrin levels might lead to development of GER and GER could further aggravate the attack of asthma.