不同分型功能性便秘患者结肠传输功能、胃肠激素以及一氧化氮合酶的研究

Study on Colonic Transit Function,Gastrointestinal Hormones and Nitric Oxide Synthase in Different Types of Functional Constipation Patients

背景:功能性便秘(FC)是一种常见的功能性胃肠病,其病因和发病机制目前尚不明确。目的:探讨不同分型FC患者结肠传输功能、胃肠激素以及一氧化氮合酶(NOS)的变化。方法:56例符合罗马Ⅲ标准的FC患者和20名健康志愿者纳入本研究。采用不透X线标记物法行结肠传输试验,放射免疫法测定降结肠、直肠黏膜促胃动素(MTL)、P物质(SP)、生长抑素(SS)、血管活性肠肽(VIP)和NOS水平。结果:56例FC患者中,传输时间正常者19例,传输时间延长者37例,其中结肠慢传输型(STC)21例,出口梗阻型(OOC)9例,混合型(MC)7例。与正常对照组相比,传输时间正常组降结肠、直肠黏膜MTL、SP、SS、VIP和NOS水平无明显差异;STC组降结肠、直肠黏膜MTL水平显著降低(P<0.05);STC、MC组降结肠、直肠黏膜SP水平显著降低而NOS水平显著升高(P<0.05);STC、MC组降结肠黏膜SS水平显著升高(P<0.05);STC、OOC组降结肠、直肠黏膜VIP水平显著降低(P<0.05)。结论:各型FC降结肠、直肠黏膜胃肠激素和NOS水平改变不同,其异常导致胃肠平滑肌功能紊乱.可能与FC的发病有关。

Background： Functional constipation （FC） is a common functional gastrointestinal disorder, its etiology and mechanism remain unclear. Aims： To assess the changes of colonic transit function, gastrointestinal hormones and nitric oxide synthase （NOS） in different types of FC patients. Methods： Fifty-six FC patients diagnosed by Rome Ⅲ criteria and 20 healthy volunteers were enrolled in this study. The colonic transit test was performed by radioopaque markers method. The concentrations of motilin （MTL）, substance P （SP）, somatostatin （SS）, vasoactive intestinal peptide （VIP） and NOS in descending colonic and rectal mucosa were measured by radioimmunoassay. Results： Of the 56 FC patients, transit time was normal in 19 patients, and was prolonged in 37 patients, including slow colonic transit constipation （STC） in 21 patients, outlet obstructive constipation （OOC） in 9 patients and mixed constipation （MC） in 7 patients. There were no significant differences in concentrations of MTL, SP, SS, VIP and NOS in descending colonic and rectal mucosa between FC patients with normal transit time and healthy volunteers. Compared with healthy volunteers, MTL concentration in descending colonic and rectal mucosa was significantly decreased in STC group （P〈0.05）; and SP concentration was significantly decreased while NOS concentration was significantly increased in descending colonic and rectal mucosa in STC and MC groups （P〈0.05）. SS concentration in descending colonic mucosa was significantly increased in STC and MC groups （P〈0.05）; and VIP concentration in descending colonic and rectal mucosa was significantly decreased in STC and OOC groups （P〈0.05）. Conclusions： Concentrations of gastrointestinal hormones and NOS in descending colonic and rectal mucosa are various in different types of FC, and the abnormal concentrations of gastrointestinal hormones and NOS induce the disorder of gastrointestinal smooth muscle, which may play a role in the pathogenesis of FC.