硝苯吡啶改善肠易激综合征患者胆囊排空不良的机制

Mechanism of nifedipine for improving abnormal gallbladder emptying function in patients with irritable bowel syndrome

目的研究肠易激综合征（ＩＢＳ）患者胆囊（ＧＢ）排空不良的发生机制，探讨硝苯吡啶对ＧＢ排空不良的治疗作用．方法按随机双盲和对照的方法，应用实时超声研究不同亚型ＩＢＳ患者３７例和正常对照组２６例（两组性别、年龄、身高、体重等均相匹配）的ＧＢ排空功能．结果ＩＢＳ患者餐后６０ｍｉｎＧＢ排出量（ＧＥＦ，ｘ±ｓ，％，６５１±２１）明显少于对照组（８０２±１５，Ｐ＜００１）．对照组口服硝苯吡啶１０ｍｇ后７０ｍｉｎ，ＧＥＦ显著减少（８０２±１５～６８２±２０，Ｐ＜００１），２０ｍｇ（６０６±１９）较１０ｍｇ者更著；ＧＢ排空时间明显延长（６０４ｍｉｎ±１１ｍｉｎ～７８５ｍｉｎ±１３ｍｉｎ，Ｐ＜００１）．ＩＢＳ患者口服硝苯吡啶１０ｍｇ后２５ｍｉｎＧＥＦ（２５４±１６～２９７±１６，Ｐ＜００１）即明显增加，２０ｍｇ者（２５４±１６～３３１±１８，Ｐ＜００１）尤著，７０ｍｉｎ达最大；ＧＢ排空速度明显加快，平均最大ＧＥＦ时间（服药前、服硝苯吡啶１０ｍｇ和２０ｍｇ后分别为８３６，７６２和６９１ｍｉｎ）明显缩短（Ｐ＜００１）．餐后４５ｍｉｎ节段收缩型（４８５±２２）和其他?

AIM To study the pathogenesis of abnormal gallbladder (GB) emptying function and the effect of nifedipine on improving GB emptying in patients with irritable bowel syndrome (IBS). METHODS According to a randomized, double blind and controlled protocol, GB emptying function in 37 IBS patients with different subtypes (hypermotor type, 18 cases; segmental contraction type, 13 cases and other, 6 cases) and 26 normal controls (sex, age, height, weight were comparable in these two groups) were studied by using real time ultrasonography. RESULTS In IBS patients GB ejection fraction (GEF ±s , %) was markedly less 60min after meal (80 2±1 5) than that in controls (65 1±2 1, P <0 01) The GEF was notably decreased (80 2±1 5 to 68 2±2 0, P <0 01) 70min after oral 10mg nifedipine, and more notable after oral 20mg nifedipine (60 6±1 9) accompanying a markedly prolonged GB emptying time ( 60 4min ± 1 1min to 78 5min ± 1 3min , P <0 01) in controls. The GEF was significantly increased (25 4±1 6 to 29 7±1 6, P <0 01) 25min after oral 10mg nifedipine, and more markedly after 20mg nifedipine (25 4±1 6→33 1±1 8, P <0 01). These differences were up to maximum 70min after nifedipine adnunistration in IBS patients. The speed of GB emptying was faster, and mean maximum GEF 83 6, 76 2 and 69 1min ,(before and after oral 10mg and 20mg nifedipine respectively) was significantly shorter ( P <0 01) in IBS patients. The GEF was markedly decreased in patients with segmental contraction type (48 5±2 2) and other type (44 6±1 7) than that in patients with hypermotor type (62 9±2 9, P <0 01), and there was a more marked response to nifedipine in the former than in the latter. CONCLUSION Dysfunction of Oddi sphincter (OS) may be one of the main pathogeneses of abnormal GB emptying in patients with IBS, and there are differences between subtypes. A therapeutic oral dosage of nifedipine has significantly relaxing effect on OS, which makes GB emptying increase.