胆道良性疾病致胆汁反流对胃运动的影响及机制探讨

Effect and mechanism of bile reflux disease on gastric motility induced by benign biliary disease

目的观察良性胆道疾病致胆汁反流对胃运动的影响,并同步观察某些相关胃肠激素水平的变化,初步探讨其可能的机制。方法采用B超确立试验组患者为胆道良性疾病,同时设立健康对照组。采用B超、胃电测定的方法,测定各组胃运动功能;采用胃镜检查并抽取胃液,测定胆汁酸浓度确定胆汁反流;同步抽取患者和健康人空腹静脉血,测定血浆胃动素(motilin,MTL)、胆囊收缩素(cholecystokinin,CCK)水平,并检测胃窦部黏膜中一氧化氮(NO)水平。结果良性胆道疾病患者胆汁反流发生率显著升高,与对照组比较差异有统计学意义(P<0.05);胆汁反流患者较无反流者胃肌电正常慢波百分比、主频及振幅显著降低(P<0.05);胃排空时间、胃窦收缩频率及胃排空速率存在显著差异(P<0.05);胆汁反流患者胃窦黏膜组织NO较无反流者显著增高(P<0.05),而胆汁反流患者空腹血浆中MTL水平显著降低(P<0.05);良性胆道疾病患者空腹血浆CCK与正常组比较无明显差异(P>0.05)。结论良性胆道疾病致胆汁反流患者存在胃肌电紊乱及胃排空延缓,其原因可能与胆道疾病所致某些胃肠道激素水平变化存在密切关系。

Objective To analyze the effect and mechanism of bile reflux disease on gastric motility induced by benign biliary disease. Methods The gastric electric activity and gastric emptying were evaluated by ultrasound B and electrogastrogram （EGG）. The bile reflux was examed by endoscopy. The levels of MTL and CCK in venous blood and NO levels of gastric antrum mucosa were detected synchronously. Results The rate of bile reflux on patients with benign biliary disease was higher than that in normal control. Percentage of basic gastric electric slow wave dominant frequency and vibriation amplitude decreased in bile reflux patients. Gastric emptying time, gastric antrum contract frequency and gastric emptying velocity were significantly different with normal control. The level of NO in gastric antrum mucosa increased in bile reflux patients. The levels of MTL and CCK in plasma decreased significantly. Conclusion Abnormality of gastric electric activity and prolongation of gastric emptying time are exist in patients with bile reflux induced by benign biliary disease, the reason is probably associated with changes of gut hormone induced by biliary tract disease.