进行性系统性硬化症上胃肠道动力特征及胃肠激素研究

A STUDY ON THE MOTILITY CHARACTERS OF UPPER GI TRACT AND GIHORMONES IN PROGRESSIVE SYSTEMIC SCLEROSIS(PSS)

测定了１０例健康志愿者及１０例硬皮病（ＰＳＳ）患者进餐前后胃肠道压力及血浆中胃肠激素的变化。结果显示，６６％ＰＳＳ有ＬＥＳ暂时性松弛，ＬＥＳ上１０ｃｍ处蠕动收缩振幅低、胃窦和十二指肠移行性运动复合波（ＭＭＣ）Ⅰ期所占时间长、ＭＭＣⅡ期收缩稀少、振幅低下或振幅不低但极其紊乱，其动力指数和消化期动力指数及ＭＭＣⅢ期收缩振幅均低于正常组。ＰＳＳ患者空腹血浆、ＶＩＰ，ＳＳＴ，ＮＴ和ＭＯＴ的累积增加面积均明显低于正常人。以上结果提示，ＰＳＳ患者胃肠道同时存在肌源性和神经源性病变，并表明其胃肠激素的释放可能有一定障碍。

To investigate the characters of motor pattern and the release of GI hormones in progressive systemic sclerosis(PSS),10 patients with PSS and 10 healthy subjects were studied. The results showed:transient LES relax was seen in 66.6% of patients and the amplitude of contraction at 10cm above LES was 2.59±1.09kPa (normal:11.23±3.25,P<0.01); the duration of phase Ⅰ of MMC in antrum and distalduodenum in PSS(124.8±40.7min,47.4±20.2min) were significantly longer than those in controls (75.8±26.1min,20.0±12.4min,P<0.05).The motor indices(MI) of antrum,duodenum and upper jejunum in PSS were significantly lower than those in contrls(in phase Ⅱof MMC,1678±152.2,470.4±384.3, 390.3±184.6vs 609.5±342.4,1014.3±157.2,668.4±182.5, respectively,P<0.05);in digestive period,409.5 ±245.8, 322.5±201.2 vs 1430.1±782.7, 745.9±345.3, for antrum and duodenum,P<0.05).Remarkably disturbed contractions were observed during phase Ⅱ of MMC in PSS'In phase Ⅲ of MMC'the amplitude of contraxtion in dustal duodenum and upper jejunum in PSS in controls(6.96%±273, 7.81±2.44kPa, P<0.05). The postprandial cumulative increment areas of VIP, SST, NT and MOT release in patients with PSS were significantly lower than those in normal subjects(P<0.05). Conclusions:The smooth muscles and enteric nervous system are ver likely involved in PSS. There is abnormal decrease in release of VIP,SSt,NT and MOT in PSS.