帕金森病伴便秘与功能性便秘的直肠肛门测压特点分析

The characteristics of anorectal manometry in Parkinson＇s disease with constipation and functionalconstipation

目的观察帕金森病（PD）伴便秘患者与功能性便秘（FC）患者的直肠肛门动力和感觉功能及其异同。方法顺序纳入男性PD伴便秘患者15例及男性FC患者45例，均经全结肠镜或结肠钡灌肠除外肠道器质性疾病。经直肠肛门测压，分析患者直肠肛门动力参数及感觉参数，将排便障碍患者进一步分为排便协同障碍（F3a）及排便推进力不足（F3b）两种亚型。结果PD伴便秘组年龄（70±11）岁，FC组年龄为（68±11）岁，差异无统计学意义。PD伴便秘组直肠静息压较Fc组偏高[9．0（4．0，15．0）mlnHg比6．0（3．0，9．5）mmHg，1mmHg=0．133kPa]，但差异无统计学意义（P=0．082）；两组肛管静息压的差异无统计学意义[（51．2±17．2）mmHg比（59．7±20．4）mmHg，P=0．152]。缩紧肛门时，PD伴便秘组的肛管最大缩榨压及持续缩榨曲线下面积均显著低于Fc组f（136．9±43．8）mittHg比（183．0±62．1）mmHg，P=0．010；（823．5±635．7）mmI-Ig·s比（1392．4±939．9）llq．mHg·S，P：0．033]。模拟排便时，PD伴便秘组的直肠力排压及肛管力排剩余压也明显低于FC组[22．0（15．0，30．0）ml／lHg比42．0（3ll0，55．0）mmHg，P=0．000；（46．3±23．3）mmHg比（77．9±35．1）mmHg，P=0．002]；两组力排时的直肠肛管压差均为负值，异于正常排便压差，但两组间差异无统计学意义。PD伴便秘患者排便障碍以F3b型为主（10／15）；FC组中以F3a型多见f46．7％（21／45）]；但两组的排便障碍类型构成比的差异无统计学意义（P=0．120）。PD伴便秘患者及Fc患者的直肠扩张初始感觉阈值分别为（91．3±56．9）ml与（67．2±38．9）ml，均高于正常参考值，但两组间差异尚无统计学意义（P=0．074）。结论PD伴便秘患者及Fc患者均存在直肠肛门动力和感觉异常。与FC患者相比，PD伴便秘患者的缩肛及力排的重要参数值明显降低，且测压分型以F3b型为主，感觉阈值有升高趋势。上述指标可作为PD伴便秘患者直肠肛门测压的特征参数，对PD发病机制的理解及其与相关疾病的鉴别可起重要作用。

Objective To investigate the discrepancy of anorectal function in patients of Parkinson＇s disease （PD） with constipation and functional constipation （FC）. Methods Fifteen consecutive male PD patients with constipation and 45 male FC patients were recruited for the study. All subjects underwent colonoscopy or barium enema in order to exclude organic colon diseases. Every patient underwent anorectal manometry and was categorized into subgroups of either dyssynergic defecation （F3a） or inadequate defecatory propulsion （F3b）. Results The ages of PD with constipation and FC patients were （70 ± 11 ） and （68 ± 11 ） years old respectively. The rectal resting pressure in PD with constipation was higher than that in FC group without statistical significance [ 9. 0 （4. O, 15.0） mm Hg vs 6. 0 （3.0,9. 5 ） mm Hg, P =0. 082,1 mm Hg=0. 133 kPa]. The anal resting pressure in PD group was not different from FC group [（51.2±17.2） mm Hg vs （59.7 ±20.4） mm Hg, P =0.152]. During anal squeezing, the maximal contraction pressure and area under the squeeze curve in PD with constipation group were bothsignificantly lower than FC patients [ maximal contraction pressure： （ 136. 9 ±43.8） mm Hg vs （ 183.0± 62. 1） mm Hg, P=0.010; area under the squeeze curve： （823.5 ±635.7） mm Hg · s vs （1392.4 ± 939. 9） mm Hg · s, P = 0. 033 ]. During forced defecation, both of the defecation rectal pressure and defecation anal pressure in PD with constipation group were significantly lower than that of FC patients [ 22.0 （15.0,30.0） vs 42.0（31.0,55.0）mm Hg, P=O. 000; and （46.3 ±23.3） vs （77.9 ±35. 1） mm Hg, P =0. 0021. The proportions of F3a subtype were 10/15 and 46. 7% （21/45） in PD with constipation and FC patients respectively. There was no significant difference in the constituent ratio （P = 0. 120）. Initial rectal sensory volumes were （ 91.3· 56. 9 ） ml and （ 67. 2 · 38. 9 ） ml in PD with constipation and FC patients respectively. Even both volumes were higher than the normal controls, there was no significant difference between the two groups （P = O. 074）. Conclusions Both PD with constipation and FC patients have abnormal anoreetal motility and sensation comparing to the FC group, the parameters of anal contraction and defecation are significantly lower, F3b is dominant, and rectal sensory threshold is higher in PD with constipation patients. These parameters could possibly characterize the anoreetal manometry for PD with constipation patients, which is helpful to understand the pathogenesis of PD and differentiate from other diseases.