超声检查对脾胃虚寒(弱)证和肝胃不和证餐后不适综合征患者胃容受性及胃排空功能的评估

Evaluation of ultrasonography for gastric accommodation and gastric emptying function in patients with postprandial distress syndrome of spleen-stomach deficiency cold and liver-stomach disharmony syndrome

通过超声检查评估脾胃虚寒(弱)证和肝胃不和证餐后不适综合征(PDS)患者的胃容受性及胃排空功能的差异。方法收集2020年6月至2021年1月就诊于福建中医药大学附属第二人民医院脾胃病科的PDS患者共60例,其中脾胃虚寒(弱)证组32例,肝胃不和证组28例,另选健康志愿者15例为健康对照组。所有受试者均进行液体营养餐负荷试验,然后通过超声检查分别记录3组受试者阈值饮入量和最大饮入量,并通过超声测量比较3组受试者近端胃和远端胃饮后30、60、90、120 min时排空率情况及胃半排空时间情况。结果与健康对照组比较,脾胃虚寒(弱)证组最大饮入量少于健康对照组(P<0.05),肝胃不和证组阈值饮入量和最大饮入量均少于健康对照组(P<0.05);与肝胃不和证组比较,脾胃虚寒(弱)组阈值饮入量和最大饮入量均多于肝胃不和证组(P<0.05)。与健康对照组比较,脾胃虚寒(弱)证组近端胃饮后60、120 min排空率及远端胃饮后120 min排空率均低于健康对照组(P<0.05),肝胃不和证组近端胃饮后120 min排空率低于健康对照组(P<0.05);与肝胃不和证组比较,脾胃虚寒(弱)证组近端胃饮后60、120 min排空率及远端胃饮后120 min排空率均低于肝胃不和证组(P<0.05)。健康对照组比较,脾胃虚寒(弱)证组近端胃和远端胃半排空时间长于健康对照组(P<0.05),肝胃不和证组近端胃半排空时间长于健康对照组(P<0.05);与肝胃不和证组比较,脾胃虚寒(弱)证组远端胃和远端胃半排空时间均长于肝胃不和证组(P<0.05)。结论超声检查能有效反映PDS患者的胃容受性及胃排空功能改变情况,其中脾胃虚寒(弱)证以胃排空延迟为主,肝胃不和证以胃容受舒张功能减弱为主,说明超声检查对PDS的诊断和治疗效果评估具有重要临床意义。

Objective To evaluate the differences of gastric accommodation(GA)and gastric emptying function(GEF)in patients with postprandial distress syndrome(PDS)of spleen-stomach deficiency cold and liver-stomach disharmony syndrome by ultrasonography(US).Methods From June 2020 to January 2021,a total of 60 patients with PDS admitted to the Department of Spleen and Stomach Diseases,Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine were divided into the spleen-stomach deficiency cold group(treatment group,n=32)and the liver-stomach disharmony group(control group,n=28),another 15 healthy volunteers were selected as the health control group.All the subjects were tested by the liquid nutrient load test,the threshold intake and the maximum intake were recorded respectively using US,the emptying rates of proximal and distal stomach at 30,60,90,120 min after intake,the gastric half-emptying time were measured by the ultrasonic measurement.Results Compared with the health control group,the maximum intake in the treatment group and the control group were decreased(all P<0.05),which in the treatment group were more prevalent(P<0.05);lower emptying rates of proximal stomach at 60,120 min after intake and emptying rates of distal stomach at 120 min after intake were found in the treatment group,which were lower in the treatment group than the control group(P<0.05);and lower emptying rates of proximal stomach at 120 min after intake in the control group were detected than those in the health control group(all P<0.05).Compared with the health control group,the gastric half-emptying time in the treatment group and the control group was longer(all P<0.05),which in the treatment group were common(P<0.05).Conclusion For PDS patients,US can effectively reflect the changes in GA and GEF.Among them,weakened GA and delayed GEF corresponds to liver-stomach disharmony syndrome and spleen-stomach deficiency cold syndrome,respectively.Therefore,US has important clinical significance in the evaluation for PDS.