功能性便秘伴焦虑抑郁患者血清血管活性肠肽、生长抑素水平及肛肠动力学特征

Serum levels of vasoactive intestinal peptide and somatostatin and characteristics of colo-anarectal dynamics in patients with functional constipation with anxiety and depression

目的探讨功能性便秘伴焦虑抑郁患者血清血管活性肠肽(VIP)、生长抑素水平及肛肠动力学特征。方法选择60例伴焦虑抑郁的功能性便秘患者(A组)、60例不伴焦虑抑郁的功能性便秘患者(B组)、60例健康志愿者(C组)作为研究对象。3组研究对象均完成肛肠动力学检测,比较3组患者的肛管静息压、直肠肛管压力梯度、直肠感觉阈值、排便感觉阈值;比较3组研究对象的焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分,血清VIP、生长抑素水平,以及便秘临床症状评分。结果A组、B组、C组的SAS评分、SDS评分,腹胀、排便时间、排便困难、排便次数、粪便形状评分,以及血清VIP、生长抑素水平依次降低(均P<0.05)。3组研究对象的肛管静息压比较,差异无统计学意义(P>0.05);A组、B组、C组的直肠肛管压力梯度依次增高,直肠感觉阈值、排便感觉阈值依次降低(均P<0.05)。结论功能性便秘患者伴有肛肠动力学及VIP、生长抑素分泌异常,焦虑、抑郁情绪可能通过脑-肠轴神经调节通路调控血清VIP、生长抑素水平,加重肛肠动力感觉功能异常,进一步加重功能性便秘患者的临床症状。

Objective To investigate serum levels of vasoactive intestinal peptide(VIP)and somatostatin and the characteristics of colo-anarectal dynamics in patients with functional constipation with anxiety and depression.Methods Sixty patients with functional constipation with anxiety and depression(group A),60 patients with functional constipation without concomitant anxiety and depression(group B),and 60 healthy volunteers(group C)were selected as the research subjects.All subjects completed colo-anarectal dynamics detection.Anal resting pressure,anorectal pressure gradient,rectal sensory threshold,and rectal defecation sensory threshold were compared between the three groups;additionally,the Self-Rating Anxiety Scale(SAS)score,the Self-Rating Depression Scale(SDS)score,serum VIP and somatostatin levels,as well as the score for clinical symptoms of constipation were compared between the three groups.Results Among the three groups,the subjects′SAS score,SDS score,abdominal distension duration,defecation time,defecation difficulty,defecation times,stool shape score,as well as serum VIP and somatostatin levels decreased in the sequence of group A,group B and group C(all P<0.05).There was no statistically significant difference in the anal resting pressure among the three groups(P>0.05);furthermore,from low to high,the anorectal pressure gradient increased in the sequence of group A,group B and group C,and the rectal sensory threshold and the defecation sensory threshold decreased in the order of group A,group B and group C(all P<0.05).Conclusion Patients with functional constipation are accompanied by abnormalities in colo-anarectal dynamics and the secretion of VIP and somatostatin.Anxiety and depression may modulate pathways and regulate serum VIP and somatostatin levels through the brain-intestinal axis nerve,aggravate colo-anarectal dynamic sensory dysfunction,and further aggravate the clinical symptoms of patients with functional constipation.