胆汁反流性胃炎患者Oddi括约肌松弛不良:硝苯吡啶改善胆囊排空作用研究

Dysrelaxation of Sphincter of Oddi in patients with bile reflux gastritis: study on effect of nifedipine on gallbladder emptying

目的 研究胆汁反流性胃炎（ＢＲＧ） 患者胆囊（ＧＢ） 排空异常的发生机制．方法 按随机、双盲及对照的原则，用实时超声研究了３８ 例ＢＲＧ 患者和３０ 例正常对照组ＧＢ 排空功能及硝苯吡啶（Ｎｉ） 对ＧＢ 排空的影响．结果 空腹ＧＢ 容量ＢＲＧ 组明显多于对照组（ Ｐ＜ ０－０１） ，服Ｎｉ前后ＧＢ 容量无明显变化（ Ｐ＞ ０－０５） ． 餐后１５ｍｉｎ 起ＧＢ 排出量（ＧＥＦ） 即明显少于对照组（ Ｐ＜ ０－０１） ，４５ｍｉｎ 时更著． 口服Ｎｉ 后２５ｍｉｎ ＢＲＧ 组ＧＥＦ 即显著增加（ Ｐ＜ ０－０１） ，２０ ｍｇ Ｎｉ 更著；ＧＢ排空速度明显增快（ Ｐ＜ ０－０１） ；最大ＧＢ 排空时间明显缩短（ Ｐ＜ ０－０１） ． 服Ｎｉ 前后血浆促胃液素水平无明显差异（ Ｐ＞ ０－０５） ． 对照组口服Ｎｉ 后ＧＥＦ 明显减少（ Ｐ＜ ０－０１） ，２０ ｍｇ者更著．结论 Ｏｄｄｉ 括约肌松弛不良可能为ＢＲＧ 患者ＧＢ 排空异常的发生机制之一；口服Ｎｉ 有明显改善其ＧＢ 排空的作用，但对消化间期ＧＢ 排空无明显影响，Ｎｉ 改善ＧＢ 排空不依赖促胃液素．

AIM To study the mechanism of abnormal gallbladder (GB) emptying in patients with bile reflux gastritis (BRG). METHODS GB emptying function and the effect of nifedipine on it were studied by using real time ultrasonography in thirty eight BRG patients and 30 normal controls by randomized, double blind controlled methods. RESULTS Fasting GB volume was higher in BRG patients than in controls ( P <0 01) and no notable change was found before and after taking nifedipine ( P >0 05) . GB ejection fraction (GEF) was markedly decreased 15min after the meal, and the decrease was more significant at 45min postprandial in BRG patients compared with controls ( P <0 01) . The GEF was significantly increased 25min after taking oral nifedipine 10*!mg ( P <0 01) , and even more marked after 20*!mg nifedipine ( P <0 01) in BRG patients than in controls. The speed of GB emptying was faster 60min after the meal ( P <0 01) , and maximum GEF time was notably shortened after oral nifedipine ( P <0 01) in BRG patients. No notable difference was found in the concentration of plasma motilin before and after taking nifedipine ( P >0 05). In controls GEF was markedly decreased after taking nifedipine 10*!mg ( P <0 01), and more marked after taking nifedipine 20*!mg . CONCLUSION One of mechanisms of abnormal GB emptying in BRG patients may be dysrelaxation of Oddi sphincter; nifedipine can significantly improve postprandial (but not fasting) GB emptying function, which does not depend on motilin.