功能性腹胀发病机制的研究

The pathogenesis of functional abdominal bloating

目的探讨功能性腹胀的发病机制。方法对符合罗马Ⅲ标准的64例功能性腹胀患者、33例便秘型肠易激综合征(IBS)伴中重度腹胀患者、33例功能性便秘伴中重度腹胀患者及20例正常对照者进行研究。应用X线腹部立位平片对肠道气体量进行评估;采用乳果糖呼氢的方法对肠道菌群改变进行评估;采用不透X线的标志物测定4h胃及48h结肠排空率;采用ELISA法测定空腹血清降钙素基因相关肽(CGRP)及P物质的水平对患者内脏敏感性状况进行评估;采用SAS及SDS量表对心理因素进行评分。结果①乳果糖呼氢阳性率、胃肠排空率、血清CGRP、血清P物质含量及SDS、SAS评分各组间比较差异均有统计学意义(P均<0.05),而肠道气体量各组间比较无统计学差异(P>0.05)。②功能性腹胀组与正常对照组比较,乳果糖呼氢阳性率、胃肠排空率、血清P物质含量及SDS和SAS评分差异有统计学意义(P均<0.05),而肠道气体量与血清CGRP含量相比较则无统计学差异(P均>0.05)。结论功能性腹胀的发病可能与患者肠道菌群异常、胃肠运动功能障碍、精神心理异常、内脏高敏感性有关,而与肠道气体产生量无关。

Objective To investigate the pathogenesis of functional abdominal bloating （FAB）. Methods All of the subjects recruited met the Rome m Diagnostic Criteria： 64 patients with functional abdominal distension, 33 patients with constipation-predominant irritable bowel syndrome （IBS） with moderate to severe abdominal bloating, 33 patients with functional constipation （FC） with moderate to severe abdominal bloating, and 20 healthy volunteers. Abdominal plain films were used to assess the intestinal gas volume increase. Lactulose hydrogen breath test （LHBT） was used to analyze whether the alteration of intestinal flora was present. Gastric and gut emptying rates were evaluated by non-radio-paque marks at 4 h and 48 h. The concentrations of fasting serum substance P （SP） and calcitonin gene related peptide （CGRP） were measured by ELISA method. Psychosocial risk factors were assessed with self-rating depression scale （SDS） and self-rating anxiety scale （SAS）. Results The positive rate of LHBT, gastric and gut emptying, serum CGRP and SP concentrations, and SAS and SDS scores differed significantly among the 4 groups （all P^0.05）, but intestinal gas volumes had no difference （P~〉0.05）. FAB and control groups differed obviously in the positive rate of LHBT, gastrointestinal emptying rate, serum SP concentration, and SAS and SDS scores （all P 〈 0. 05）, but not in intestinal gas volumes or serum CGRP concentration （both P〉0.05）. Conclusion Alteration of intestinal flora, gastrointestinal dysfunction, visceral hypersensitivity and abnormal psychological factors may play more prominent roles in the pathogenesis of FAB than the increase of intestinal gas contents.