炎症性肠病患者的自主神经功能研究

Research on the Autonomic Nervous Function of Patients with Inflammatory Bowel Disease

目的:探讨炎症性肠病患者的自主神经功能状态。方法:选取炎症性肠病(IBD)患者60例作为观察组,包括活动期溃疡性结肠炎(UC)37例,活动期克罗恩病(CD)23例,同期健康体检者50例作为对照组。交感神经功能采用握力试验以及卧立位血压差的方式进行检查;迷走神经功能则采用卧立位心率变化和Valsalva动作反应指数检查方法。结果:(1)观察组卧立位心率变化均值明显低于对照组,其中溃疡性结肠炎和克罗恩病心率变化均值均明显低于对照组,差异有统计学意义(P<0.05);溃疡性结肠炎与克罗恩病心率变化均值差异无统计学意义(P>0.05);溃疡性结肠炎和克罗恩病Valsalva动作反应指数与对照组相比差异无统计学意义(F=1.06,P>0.05)。(2)观察组卧立位血压差均值明显高于对照组,握力试验的血压反应均值明显低于对照组,溃疡性结肠炎和克罗恩病卧立位血压差均值均明显低于对照组,握力试验的血压反应均值均明显低于对照组差异有统计学意义(P<0.05);而溃疡性结肠炎和克罗恩病卧立位血压差均值及血压反应均值比较均无统计学差异。结论:炎症性肠病患者存在自主神经功能紊乱,交感神经功能增强而迷走神经功能相对减弱。

Objective： To investigate the status of autonomic nervous function in patients with inflammatory bowel disease. Methods： 60 cases of patients with inflammatory bowel disease （BD） were chosen as the observation group, including 37 cases of active ulcerative colitis （UC） and 23 cases of active Crohn＇s disease （CD）; in the same period, 50 healthy persons were selected as the control group. The autonomic nervous functions of the patients were detected： sympathetic nerve function by handgrip test and postural difference of blood pressure by way of lying and standing blood pressure difference; vagus nerve function was examined through the change of heart rate in lying position as well as the Valsalva action response index. Results： ① In the observation group, the change of heart rate was significantly lower than that of the control group （P〈0.05）; the mean value of heart rate in patients with ulcerative colitis and Crohn＇s disease were dramatically lower than that in the control group （P〈0.05）. There was no significant difference between the observation group and the control group （P〉0.05） in the Valsalva action response index of ulcerative colitis and Crohn＇s disease in the observation group. ② The difference of blood pressure in the observation group was significantly higher than that in the control group（P〈0.05）. The mean difference of blood pressure in the patients with ulcerative colitis and Croln＇s disease was significantly lower than that in the control group （P〈0. 05）; there was no significant difference in the mean blood pressure difference between ulcerative colitis and Crohn＇s disease （P〉0.05）. The mean blood pressure response to handgrip test in observation group was significantly lower than the control group （P〈0.01）. The mean blood pressure response of ulcerative colitis and Crohn＇s disease grip test were significantly lower than the control group （P〈0.01）, while there was no significant difference between the two groups mean blood pressure response to the handgrip test （P〉0.05）. Conclusion： Autonomic nerve dysfunction existed in patients with inflammatory bowel disease： sympathetic nerve function was erthanced, while the vagus nerve function was relatively weakened.