胆汁反流性胃炎胃排空和胃窦平滑肌电改变的研究

Retarded gastric emptying and abnormal antral myoelectric activities in patients with bile reflux gastritis

目的：本文着重探讨胃排空改变以及胃窦平滑肌电节律紊乱在胆汁反流性胃炎发病中的可能机制。方法：１８例胆汁反流性胃炎患者（ＢＲＧ组）、１７例非胆汁反流性胃炎患者（ＮＲＧ组）和１０名健康志愿者（ＨＣ组）用双核素标记的固、液体混合标准餐用ｙ照相机以１帧／２分钟连续动态照相１２０分钟检测胃排空，根据胃排空拟合曲线计算固体相延滞期（ＳＬＰ）和滞后期半排空时间（ＨＳＥＴ），以及液体相半排空时间（ＨＬＥＴ）。其中ＢＲＧ组１３人、ＮＲＧ组１０人和ＨＣ组７人又在空腹时检测胃窦肌电，时程３０分钟以上，计算平均慢波频率（ＭＳＷＦ）和胃电节律失常（ＤＲＭ）。结果：ＢＲＧ组有明显的固、液体双相排空延迟，ＳＬＰ为４３．３±１７．０ｍｉｎ（与ＮＲＧ组２４．７１２．３ｍｉｎ和ＨＣ组２１．６±８．１ｍｉｎ比，Ｐ均＜０．０１），ＨＳＥＴ为１０３．９：：３０．６ｍｉｎ（与ＮＲＧ组８０．５±２３．７ｍｉｎ比，Ｐ＜０．０５，与ＨＣ组５８．２±１７．７ｍｉｎ比，Ｐ＜０．０１），ＨＬＥＴ为４３０±１７．１ｍｉｎ（与ＮＲＧ组３１．０±１３．９ｍｉｎ及ＨＣ组胃２３．５±９．４ｍｉｎ比，Ｐ均＜０．０１）；ＮＲＧ组仅有ＨＳＥＴ显著延长（与ＨＣ组比Ｐ＜０．０５）。?

Objective: In this study, we investigated the patterns of gastric emptying for solid and liquid and antral myoelectric activities to explore the possible mechanisms of gastric motility disturbances in the pathogenesis of bile reflux gastritis. Methods: 18 patients with bile reflux gastritis (BRG) and 17 patients with non-reflux gastritis (NRG) were chosen for measurement of gastric emptying, and 10 healthy volunteers were selected as controls (HC). Gastric emptying was measured by a standardized meal labeled with dual isotope by scintigraphy. Parameters of solid lag period (SLP), half solid emptying time (HSET) and half liquid emptying time (HLET) were obtained from gastric emptying curves. 13 subjects from group BRG, 10 from group NRG and 7 from group HC were randomly selected for the examination of antral myoelectric activities during fasting for at least 30min. The electric signals were analysed for mean slow-wave frequencies (MSWF) and dysrhythmias (DRM). Results: The patients with bile reflux gastritis showed a significant prolongation of SLP (43.3 ± 17.0min, vs group NRG 24.7 ±12.3min, P<0,01; vs group HC 21.6±8.1min, P<0.01), of HSET (l03.9±30.6 min, vs group NRG 80.5± 23.7 min, P<0.05; vs group HC 58.2±17.7 min, P<0.0l) and of HLET (43.0± 17.1 min, vs group NRG 3l.0±13.9 min, P<0.01; vs group HC 23.5±9.4 min, P<0.01). Patients with non-reflux gastritis also showed prolonged HSET when compared with group HC (P<0.05), while parameters of SLP and HLET revealed no statistical difference between these two groups. Among the three groups, no significant difference of MSWF was observed, while eleven subjects showed obvious dysrhythmias which showed high occurrence in group BRG (7/13), low in group NRG (3/10) and group HC (1/7). In comparison, dysrhythmias were severe in group BRG and in group NRG, and mild in group HC. Conclusions: Patients with BRG have a notable delay in gastric emptying for both solid and liquid and high occurrences of dysrhythmias in antrum, indicating that severe gastric dyamotility, especially in antrum, is an important factor in the induction of pathologic bile reflux. Dysfunctional antrum fails to evacuate effectively the excessive refluxates and incurred prolonged retention after meals, which may play a critical role in the pathogenesis of bile reflux gastritis.