多种胃肠激素对肠易激综合征患者小肠运动功能的研究

Small intestine motility and gastrointestinal hormone levels in irritable bowel syndrome

目的观察血浆胃肠激素的变化与肠易激综合症(IBS)患者小肠消化间期移行性复合运动(MMC)的关系以及在IBS发病过程中的可能作用和临床意义。方法10名健康对照者及19例IBS患者禁食6h以上,用灌注式小肠测压管测压,并在小肠MMCI、Ⅱ和Ⅲ相采集静脉血进行血浆胃动素、生长抑素及5-HT的血浆浓度测定。结果腹泻型IBS患者小肠消化间期MMC周期缩短、Ⅲ相波幅升高、时程延长,传导速度加快;便秘型IBS患者则相反。①血浆胃动素水平在MMCⅢ相升高,各组间Ⅲ相胃动素水平差异有统计学意义。②IBS组血浆生长抑素浓度显著高于对照组,而腹泻组和便秘组之间没有差异。③各组血浆5-HT水平均随MMC发生周期性的变化,Ⅱ相血浆5-HT水平达峰值。3组间相比,IBS腹泻组血浆5-HT水平升高,与便秘组和对照组比较差异有统计学意义(P<0.05)。结论胃肠激素紊乱和小肠动力异常在IBS发病中可能起着重要的作用。

Objective To investigate the relationship between interdigestive migrating motor complex（MMC）and plasma gastrointestinal hormones in patients with diarrhea or constipation-predominant irritable bowel syndrome（IBS）to elucidate the pathophysiology of IBS.Methods A small intestine manometry was used to record the MMC cycles for at least 4-6 h in 19 IBS patients and 10 healthy volunteers.The plasma gastrointestinal hormone levels were examined according to altered MMC phases.Results Compared with the healthy controls,IBS-D patients exhibited shortened duration of the small intestinal MMC cycle,prolonged phase Ⅲ duration with greater amplitude,as well as faster propagation velocity,whereas the contrary alterations were found in IBS-C patients.The peak plasma motilin level occurred in phase Ⅲof the MMC cycle.The plasma somatostatin level was higher in IBS groups than in the healthy controls,but comparable between the diarrhea and constipation groups.Plasma 5-hydroxytryptamine showed periodical fluctuations with the phases of MMC cycles,reaching the peak level in phase Ⅱ.IBS-D patients had higher 5-hydroxytryptamine levels than IBS-C patients and the healthy controls.Conclusion Plasma hormone levels are correlated with the MMC cycles,and the hormone level changes and small intestine motility disorder may play important roles in IBS pathophysiology.