标准餐、平板运动试验对健康人体表胃肠电图的影响

Effects of standard meal and treadmill exercise test on cutaneous gastrointestinal electrogram in healthy subjects

目的探究标准餐、平板运动试验对健康人体表胃肠电图的影响,为胃肠电图的临床应用提供更多依据。方法于2021年1月至6月招募100名无症状健康志愿者分别在空腹、标准餐和平板运动后进行体表胃肠电描记。受试者空腹8 h以上,在胃体、胃小弯、胃大弯、胃窦、升结肠、横结肠、降结肠、直肠体表投影位置放置电极。受试者平卧待安静、呼吸平稳后进行胃肠电采集,记录6 min空腹胃肠电图;进食标准餐(面包100 g,牛奶250 mL)后平卧5~10 min,记录6 min餐后胃肠电图;平板运动试验后平卧5~10 min,记录6 min平板运动后胃肠电图。比较3个时间点的胃肠电波形平均频率和幅值,以及胃肠电节律紊乱百分比、慢波频率不稳定系数等。根据年龄、性别、体重指数进行胃动力分层分析。统计学方法采用配对t检验、Pearson卡方检验、连续性校正卡方检验、Fisher确切概率法和Spearman相关性分析。结果标准餐后胃电的波形平均频率与空腹时比较无改变;波形平均幅值较空腹时显著增高,在胃小弯[(148.5±8.7)μV比(113.2±5.0)μV]、胃大弯[(176.3±11.3)μV比(126.1±7.3)μV]和胃窦[(161.8±10.6)μV比(117.6±4.9)μV]差异均有统计学意义(t=4.63、4.63、3.99,均P<0.001);胃电节律和稳定性无明显改变。标准餐后肠电波形平均频率较空腹时下降,在升结肠[(10.8±0.2)次/min比(11.5±0.2)次/min]、横结肠[(10.5±0.2)次/min比(11.2±1.6)次/min]、降结肠[(10.9±0.2)次/min比(11.7±0.2)次/min]、直肠[(11.1±0.2)次/min比(11.8±0.2)次/min]差异均有统计学意义(t=3.82、4.55、4.39、3.98,均P<0.001);肠电波形平均幅值较空腹时增高,在升结肠[(129.8±6.1)μV比(110.9±6.4)μV]、横结肠[(119.6±4.1)μV比(101.3±4.7)μV]、直肠[(124.1±4.6)μV比(106.2±5.7)μV]差异均有统计学意义(t=2.62、3.76、3.16,P=0.010、<0.001、=0.002);肠电节律紊乱导联总数增多[398条比389条(总导联数均为400条)],差异有统计学意义(χ^(2)=7.31,P=0.026)。平板运动后胃窦导联波形平均频率较标准餐后增高[(3.4±0.4)次/min比(3.3±0.3)次/min],差异有统计学意义(t=2.45,P=0.016);波形平均幅值较标准餐后增高,在胃体[(160.2±8.6)μV比(133.9±6.4)μV]、胃小弯[(178.1±10.0)μV比(148.5±8.7)μV]、胃窦[(202.5±10.2)μV比(161.8±10.6)μV]差异均有统计学意义(t=2.30、2.35、2.48,P=0.024、0.021、0.015);胃电节律和稳定性改变,慢波频率不稳定系数异常导联数增多[25条比1条(总导联数为400条),χ^(2)=22.90,P<0.001]。平板运动后肠电波形平均频率较标准餐后无明显改变;肠电波形平均幅值较标准餐后增高,在升结肠[(171.2±8.4)μV比(129.8±6.1)μV]、横结肠[(166.1±7.7)μV比(119.6±4.1)μV]、降结肠[(147.2±7.2)μV比(121.1±4.9)μV]、直肠[(149.6±7.3)μV比(124.1±4.6)μV],差异均有统计学意义(t=3.51、5.49、3.09、2.83,P=0.001、<0.001、=0.003、=0.006);肠电节律与稳定性受到影响,肠电慢波频率不稳定系数异常导联数增多[10条比3条(总导联数均为400条),χ^(2)=4.04,P=0.040]。性别与标准餐后、平板运动后胃电波形平均频率及空腹、标准餐后胃电平均幅值相关(r=0.242、-0.272、0.286、0.242,P=0.015、0.006、0.004、0.015),与空腹、标准餐后肠电波形平均幅值相关(r=0.225、0.460,P=0.024、<0.001);年龄仅与空腹时胃电波形平均频率相关(r=-0.214,P=0.033);体重指数与空腹、标准餐后、平板运动后的胃电波形平均幅值均相关(r=-0.347、-0.260、-0.211,P<0.001、=0.009、=0.036),与平板运动后的胃电波形平均频率亦相关(r=0.242,P=0.016),与空腹、标准餐后的肠电波形平均幅值和频率均相关(r=-0.261、-0.296,-0.400、-0.286,P=0.009、0.003,<0.001、=0.003)。在女性、体重指数<24 kg/m^(2)的健康志愿者中,标准餐后胃动力改变差异均有统计学意义(Fisher确切概率法,P=0.022、0.024)。结论标准餐和平板运动试验对胃肠电的活动均有影响,运动较进餐引起更多胃肠电活动改变。

Objective To explore the effects of standard meal and treadmill exercise test on body surface gastrointestinal electrogram in healthy subjects,and to provide more evidence for the clinical application of gastrointestinal electrogram.Methods From January to June 2021,a total of 100 healthy asymptomatic volunteers underwent gastrointestinal electrogram after fasting,standard meal and treadmill exercise test.After the subjects fasted for more than 8 hours,the gastrointestinal electrogram was performed after the subjects were lying flat,quiet,and breathing steadily,electrodes were placed on the the body surface projection positions of the gastric body,the lesser curvature,the greater curvature,the antrum,the ascending colon,the transverse colon,the descending colon,and the rectum.The fasting gastrointestinal electrogram was recorded for 6 min.Then lay for 5 to 10 min after the standard meal(100 g bread,250 mL milk),the postprandial gastrointestinal electrogram was recorded for 6 min.And lay for 5 to 10 min after treadmill exercise test,then the postexercise gastrointestinal electrogram was recorded for 6 min.The frequency and amplitude of gastrointestinal electrogram waveforms of the three time points were compared,and the percentage of gastrointestinal electrical rhythm disorder,and slow wave frequency instability coefficient were also compared.Stratified analysis of gastric motility was performed according to age,sex and body mass index.Paired t-test,Pearson Chi-squared test,continuity correction Chi-squared test,Fisher′s exact method and Speraman correlation were used for statistical analysis.Results The standard meal did not obviously affect the mean frequency of the gastric electrocardiogram,however the mean amplitude of gastric electrocardiogram significantly increased after standard meal compared with that of fasting,especially in the electrodes placed at lesser curvature((148.5±8.7)μV vs.(113.2±5.0)μV),greater curvature((176.3±11.3)μV vs.(126.1±7.3)μV),and antrum((161.8±10.6)μV vs.(117.6±4.91)μV),and the differences were statistically significant(t=4.63,4.63 and 3.99,all P<0.001).There were no significant changs in rhythm and stability of the gastric electrocardiogram.The mean frequency of intestinal electrograms at the ascending colon,the transverse colon,the descending colon,and the rectum decreased after the standard meal compared with that of fasting((10.8±0.2)count per minute(cpm)vs.(11.5±0.2)cpm,(10.5±0.2)cpm vs.(11.2±1.6)cpm,(10.9±0.2)cpm vs.(11.7±0.2)cpm,(11.1±0.2)cpm vs.(11.8±0.2)cpm),and the differences were statistically significant(t=3.82,4.55,4.39,and 3.98,all P<0.001);the mean amplitude of the ascending colon,the transverse colon,and the rectum increased compared with that of fasting((129.8±6.1)μV vs.(110.9±6.4)μV,(119.6±4.1)μV vs.(101.3±4.7)μV,(124.1±4.6)μV vs.(106.2±5.7)μV),and the differences were statistically significant(t=2.62,3.76,and 3.16;P=0.010,<0.001,=0.002);and the number of leads with enteroelectric rhythm disorder increased(398 vs.389,the total number of leads is 400),and the difference was statistically significant(χ^(2)=7.31,P=0.026).The mean frequency of gastric electricity after treadmill exercise in electrode placed at antrum increased compared with that after standard meal((3.4±0.4)cpm vs.(3.3±0.3)cpm),and the differences were statistically significant(t=2.45,P=0.016),and the mean amplitude of gastric electricity in electrodes placed at gastric body,lesser curvature and antrum increased compared with those after standard meal((160.2±8.6)μV vs.(133.9±6.4)μV,(178.1±10.0)μV vs.(148.5±8.7)μV,(202.5±10.2)μV vs.(161.8±10.6)μV),and the differences were statistically significant(t=2.30,2.35,and 2.48;P=0.024,0.021,and 0.015).Treadmill exercise affected the rhythm and stability of gastric electricity,and the number of electrodes with instable and abnormal coefficient frequency slow-wave significantly increased(25 vs.1,the total number of electrodes is 400),and the difference was statistically significant(χ^(2)=22.90,P<0.001).There was no significant change in the mean frequency of the colonic electricity after treadmill exercise compared with that after standard meal,however the mean amplitude of intestinal electrical waveform at the ascending colon,the transverse colon,the descending colon,and the rectum increased compared with those after standard meal((171.2±8.4)μV vs.(129.8±6.1)μV,(166.1±7.7)μV vs.(119.6±4.1)μV,(147.2±7.2)μV vs.(121.1±4.9)μV,(149.6±7.3)μV vs.(124.1±4.6)μV),and the differences were statistically significant(t=3.51,5.49,3.09,and 2.83;P=0.001,<0.001,=0.003,and=0.006),which affected the rhythm and stability of the colonic electricity,and the number of electrodes with instable and abnormal coefficient frequency slow-wave significantly increased(10 vs.3,the total number of electrodes is 400,χ^(2)=4.04,P=0.040).Gender was correlated with mean frequency of gastric electricity after standrdmeal and treadmill exercise test and mean amplitude of fasting and standard postprandial gastric electricity(r=0.242,-0.272,0.286,0.242;P=0.015,0.006,0.004,0.015),and with mean amplitude of fasting and standard postprandial electricity(r=0.225,0.460;P=0.024,<0.001).Age was only associated with mean frequency of fasting gastric electricity(r=-0.214,P=0.033).Body mass index was correlated with mean gastric electrical amplitude after fasting,standard meal and treadmill exercise(r=-0.347,-0.260,-0.211;P<0.001,=0.009,=0.036),as well as with the mean gastric electricity frequency after treadmill exercise(r=0.242,P=0.016).Body mass index was correlated with the mean amplitude and frequency of fasting and standard postprandial intestinal electricity(r=-0.261,-0.296,-0.400,-0.286;P=0.009,=0.003,<0.001,=0.003).In the healthy volunteers with female gender and body mass index<24 kg/m^(2),there were statistically significant differences in the changes of gastric motility after standard meal(Fisher′s exact method,P=0.022 and 0.024).Conclusion Both standard meal and treadmill exercise test affect gastrointestinal electrical activity,and exercise caused more changes in gastrointestinal electrical activity than standard meal.