慢性阻塞性肺疾病患者胃肠道症状调查及原因分析

Investigation and analysis of the gastrointestinal symptoms in patients with chronic obstructive pulmonary disease

目的 调查慢性阻塞性肺疾病（COPD）患者的胃肠道症状情况并探讨其可能的原因.方法 36例稳定期COPD患者依据肺功能进行分组,第1秒用力呼气容积（FEV1）实测值/预计值≥50％设为轻度组（21例）,FEV1实测值/预计值＜50％设为重度组（15例）,与19例健康志愿者（对照组）共同完成胃肠道症状评估量表（GSRS）评分,并接受胃电图描记及血浆血管活性肠肽（VIP）、肠脂肪酸结合蛋白（Ⅰ-FABP）检测.结果 重度组和轻度组GSRS评分均显著高于对照组[（17.73±4.64）、（14.29±5.44）分比（8.00±2.29）分],且重度组高于轻度组,差异均有统计学意义（P＜0.05）.重度组和轻度组患者空腹及餐后正常慢波百分率、胃动过缓百分率均低于对照组,差异有统计学意义（P＜0.05）.重度组患者VIP水平明显低于轻度组和对照组[（36.07±9.22）μg/L比（44.16±7.88）、（46.53±4.54） μg/L],Ⅰ-FABP水平明显高于轻度组和对照组[（35.80±11.69） μg/L比（27.40±9.53）、（23.58±8.18）μg/L],差异均有统计学意义（P＜0.05）,但轻度组与对照组比较差异无统计学意义（P＞0.05）.结论 COPD患者存在严重的胃肠道症状和胃电节律紊乱,重度COPD可伴有外周血VIP的下降和Ⅰ-FABP的上升.

Objective To investigate the gastrointestinal symptoms in patients with chronic obstructive pulmonary disease （COPD） and explore its possible reasons.Methods Thirty-six patients with stable COPD were divided into mild group [21 cases,forced expiratory volume in first second （FEV1） measured values/predictive values ≥50%] and severe group （15 cases,FEV1 measured values/predictive values 〈 50%） according to the pulmonary function.Replacement of 19 healthy volunteers as control group.The patients and volunteers completed the Gastrointestinal Symptom Rating Scales （GSRS） scores and received electrogastrography,the plasma vasoactive intestinal peptide （VIP） and intestinal fatty acid binding protein （Ⅰ-FABP） were detected.Results The GSRS scores in severe group and mild group was higher than that in control group[（17.73 ± 4.64）,（14.29 ± 5.44） scores vs.（8.00 ± 2.29） scores],and severe group was higher than that in mild group,there was significant difference （P 〈 0.05）.The percentage of normal slow waves of fasting and postprandial,the percentage of bradygastria in severe group and mild group were lower than those in control group,there were significant differences（P 〈 0.05）.The level of VIP in severe group was lower than that in mild group and control group [（36.07 ± 9.22） μ g/L vs.（44.16 ± 7.88）,（46.53 ± 4.54） μ g/L],the level of I-FABP was higher than that in mild group and control group [（35.80 ± 11.69） μ g/L vs.（27.40 ±9.53）,（23.58 ±8.18） μg/L],there was significant difference （P 〈0.05）,but there was no significant difference between mild group and control group （P 〉 0.05）.Conclusion The patients with COPD are accompanied with serious gastrointestinal symptoms and gastric dysrhythmia,severe COPD can be associated with VIP decrease and Ⅰ-FABP rise in peripheral blood.