多潘立酮改善胆汁返流性胃炎患者胆囊排空

Effect of domperidone on improving gallbladder emptying in patients with bile reflux gastritis

目的 研究胆汁返流性胃炎 (BRG)患者胆囊 (GB)排空不良的发生机制 ,探讨多潘立酮对改善 GB排空的作用 .方法 按随机、双盲和对照的原则应用实时超声观察了多潘立酮对 39例 BRG患者和 30例正常对照者的空腹及餐后 GB排空的影响及其与血浆胃动素 (MT)水平的关系 .结果 BRG患者空腹 GB容量显著大于对照组 (P<0 .0 1) ,po多潘立酮后 GB排空无明显变化 (P>0 .0 5 ) .餐后 15 min BRG患者GB排出量 (GEF)即显著减少 (P<0 .0 1) ,45 min减少达最大(4 5 .3% vs70 .3% ) .po10 mg多潘立酮后 2 5 m in(餐后 15min) GEF即显著增加 (P<0 .0 1) ,2 0 m g者更著 (P<0 .0 1) ;至 po药后 5 5 min增加幅度达最大 (77.7% vs 45 .3% ) .餐后6 0 m in GB排空速度明显增快 (P<0 .0 1) ,最大 GB排空时间明显缩短 (P<0 .0 1) .对照组 po多潘立酮后 GEF显著减少(P<0 .0 1) ,2 0 mg者更显著 (P<0 .0 1) .po多潘立酮前后患者血浆 MT水平无明显变化 (P>0 .0 5 ) .结论 GB收缩无力为 BGR患者餐后 GB排空不良进而造成 BR的主要机制之一 ;治疗剂量的多潘立酮不改变 BRG患者空腹 GB排空 ,而通过增加其餐后 GB收缩使 GB排空增加 ,其作用不依赖MT;

AIM To study the mechanisms of abnormal gallbl adder (GB) emptying and the effect of domperidone (DO) on the GB emptying (GBE) in pa tients with bile reflux gastritis (BRG). METHODS GBE function was observed and the effects of domperidone on fasting, postprandial GBE and their relationship with plasma motilin level in thirty-nine BRG patients an d 30 normal controls were studied by using real-time ultrasonography and RIA according to a randmized, double-blind and controlled procotol. RESULTS Fasting GB volume was more in the BRG patients than in con trols (P<0.01). No marked increase was found in GBE after DO. GB ejection fracti on (GEF) was decreased 15 min after the meal (P<0.01), and reached the boff om at postprandial 45 min (45.3% vs 70.3% ) in BRG patients, as compared with the controls (P<0.001) . The GEF was significantly increased 25 min aft er oral adminisfration of 10 mg DO (P<0.01), and the increase was at its maximum (77.7% vs 45.3%) 55 m in after oral adminisfration 20 mg DO.A marked difference in GEF was found b etween 10 mg and 20 mg DO (P<0.01). The speed of GBE was faster 60 min after the meal (P< 0.01), and maximum GBE time was shorter (P<0.01) af ter oral of DO in BRG patients than in controls. The concentrations of pl asma motilin were comparable before and after oral of DO (P>0.05). CONCLUSION An important cause of abnormal postprandial GBE function in BRG patients may be weak contraction of GB smooth muscle. DO improves postprandial (but not fasting) GBE significantly through increasing GB contraction, which does not depend on plasma motilin. DO may be effective for p atients with BRG through prompting postprandial contraction of GB and decreasing fasting GB volume thereby decreasing bile reflux.