支气管肺炎患儿胃动力改变及其机制研究

Changes of gastric motility in children with bronchopneumonia and its mechanism

目的观察支气管肺炎患儿胃电参数和胃肠激素变化,探究其胃动力改变及可能机制,期待为胃肠功能评估提供客观依据。方法对48例支气管肺炎患儿及45例正常儿童的体表胃电图、血清胃动素(motilin,MLT)及血清血管活性肠肽(vasoactive intestinal pepptide,VIP)进行检测。比较2组的胃电参数及胃肠激素的变化,同时分析胃电参数及胃肠激素的相关性。结果 1肺炎组餐前波形平均幅值(VPP)、餐前主频率(DF)高于正常组(P<0.05),餐后/餐前功率比(PR)低于正常组(P<0.05),餐后DF、餐后VPP及餐前、餐后PNSW较正常组差异均无统计学意义(P>0.05)。2肺炎组VIP高于正常组(P<0.05),MLT较正常组差异无统计学意义(P>0.05)。3血清MLT水平与餐前DF呈负相关(P<0.01),与餐后DF(P<0.01)、餐后PNSW(P<0.05)呈正相关。血清VIP水平与餐前VPP(P<0.01)、餐前PNSW(P<0.05)呈正相关,与餐后VPP(P<0.01)、餐后DF(P<0.01),餐后PNSW(P<0.05)和PR(P<0.01)呈负相关。结论肺炎患儿存在胃电活动异常和胃肠激素分泌紊乱。其中,胃动力异常主要为餐后胃动力相对不足、胃排空异常,与血清VIP的升高密切相关。

Objective To obser ve the changes of gastric electrical parameters and gastrointestinal hor mones in children with bronchopneumonia and to explore the possible mechanism of gastric motility.Methods Forty-eighty children with bronchopneumonia and forty-five healthy children were recruited to detect gastric electrical parameters and the blood serum contents of motilin（MLT） and vasoactive intestinal peptide（VIP）.The difference of gastric electrical parameters and gastrointestinal hormones between the two groups was analyzed.The correlations between gastric electrical parameters and gastrointestinal hormones were also evaluated.Results ①Compared with the normal group,values of preprandial average amplitude（VPP） and preprandial dominant frequency（DF） in pneumonia group increased significantly（all P〈0.01）,while postprandial/pretprandial power ratio（PR） was reduced（P〈0.05）,but values of postprandial VPP,postprandial DF and pre-and postprandial percentage of normal slow wave（PNSW） showed no obvious change（P〈0.05）.② Compared with the normal group,the VIP level of pneumonia group increased significantly（P〈0.05）,while MLT level changed little（all P〈0.05）.③Correlation analysis showed that MLT level was negatively correlated with preprandial DF（P〈0.01）,but positively correlated with postprandial PNSW（P〈0.05） and postprandial DF（P〈0.01）.Fasting serum VIP level was positively correlated with preprandial VPP（P〈0.01） and preprandial PNSW（P〈0.05）,but negatively correlated with postprandial VPP（P〈0.01）,postprandial DF（P〈0.01）,postprandial PNSW（P〈0.05） and PR（P〈0.01）.Conclusion There is abnormal gastric electrical activity and gastrointestinal hormone secretion disorders in children with pneumonia.The main cause of abnormal gastric motility is relatively insufficient postprandial gastric motility and abnormal gastric emptying,which is closely related to the increase of serum VIP.