功能性消化不良患者胆囊排空及激素水平的研究

Gallbladder emptying and gastrointestinal hormones in functional dyspepsia

目的 研究胆囊排空及血浆胃肠激素水平变化在功能性消化不良 (FD)发病机制中的作用。方法 采用放射性核素序列成像和放免技术检测 2 0例健康志愿者 (对照组 )和 32例功能性消化不良患者 (FD组 )空腹及餐后胆囊排空指数和血浆胃动素 (MTL)、胆囊收缩素 (CCK)、血管活性肠肽(VIP)和生长抑素 (SS)水平。结果 FD组空腹及餐后胆囊排空指数均明显低于对照组 ,差异有非常显著性 (P <0 .0 0 1) ;FD组空腹及餐后血浆MTL值均低于对照组 ,差异有非常显著性 (P <0 .0 0 1) ,MTL值与胆囊排空指数呈正相关 (r空腹 =0 .82 ,P <0 .0 1,r餐后 =0 .94,P <0 .0 1) ;FD组空腹血浆CCK值与对照组比较 ,差异无显著性 (P >0 .0 5 ) ,餐后差异有非常显著性 (P <0 .0 0 1) ,CCK值与胆囊排空指数呈显著正相关 (r =0 .97,P <0 .0 1) ;FD组空腹与餐后血浆VIP值均高于对照组 ,差异有非常显著性 (P <0 .0 0 1) ,VIP值与胆囊排空指数呈负相关 (r空腹 =- 0 .81,P <0 .0 1,r餐后 =- 0 .47,P <0 .0 1) ;FD组空腹及餐后血浆SS值与对照组相比 ,差异无显著性 (P >0 .0 5 )。结论 (1)FD患者存在空腹及餐后胆囊排空下降 ,血浆促胃肠动力激素 (MTL、CCK)水平下降和抑制胃肠动力激素 (VIP)水平升高 ,可能是其病因和发病机制之一 ;(2 )

Objective To study the role of plasma levels of gastrointestinal hormones and gallbladder kinetics in the pathogenesis of functional dyspepsia. Methods Thirty two patients with functional dyspepsia (FD) and 20 normal subjects as controls were studied. Gallbladder ejection fractions (GBEF) were determined with 99m Tc radionucleography, and plasma levels of motilin (MTL)、cholecystokinin (CCK)、 vasoactive intestinal peptide (VIP) and somatostatin (SS) were measured with radioimmunoassay. Results Both preprandial and postprandial GBEF and MTL levels were markedly lower in FD group than those in control group ( P <0.001). There was a positive correlation between plasma MTL levels and GBEF ( r preprandial =0.82, P < 0.01, r postprandial =0.94, P <0.01). There was no difference in preprandial CCK levels between two groups ( P >0.05), while the levels of postprandial CCK were significantly decreased in FD group ( P <0.001). There was a closely positive correlation between plasma CCK levels and GBEF ( r=0.97, P<0.01 ). The preprandial and postprandial VIP levels were much higher in FD group than those in the controls ( P <0.001). The plasma VIP levels were negatively correlated with GBEF ( r preprandial =-0.81, P <0.01, r postcilbal =-0.47, P <0.01). No significant difference was found in plasma levels of SS between FD and controls ( P >0.05). Conclusion (1) Patients with FD might have a decreased level of preprandial and postprandial gallbladder emptying. The decrease of plasma levels of MTL、CCK and the elevation of VIP might be the cause of gallbladder slow emptying in FD. (2) Radionucleography is non invasive and safe. It can be used in the quantitative analysis and dynamic study of gallbladder and Oddi sphincter functions, and provide accurate, physiological results.