改良结肠传输试验在慢性便秘分型诊断中的应用价值及临床特征分析

Application value and clinical characteristics of modified colonic transit test in classification and diagnosis of chronic constipation

目的探讨慢性便秘患者改良结肠传输试验(colonic transit test,CTT)分型与肛门直肠检查结果及患者临床特点的关系。方法纳入189例慢性便秘患者,记录患者的生活质量量表(patient assessment of constipation quality of life,PAC-QoL)、便秘评分系统量表(constipation scoring system scale,CSS)、Bristol粪便性状量表(Bristol stool form scale,BSFS)。根据72 h后改良CTT结果将患者分为慢传输型便秘(slow transit constipation,STC)、混合型便秘(mixed constipation,MC)、排便障碍型便秘(defecatory disorder,DD)和正常传输型便秘(normal transit constipation,NTC)四组,同时行肛门直肠测压(anorectal manometry,ARM)和排粪造影检查。比较各分型患者的肛门直肠检查结果、人口学特征和相关调查问卷的关系。结果共189例患者,其中STC 67例(35.4%)、DD 19例(10.1%)、MC39例(20.6%)和NTC 64例(33.9%)。四组间BMI、CSS评分中大便次数评分和病程评分、BSFS评分、肛门静息压、直肠肛管压力梯度(rectoanal pressure gradient,RAPG)、肛管松弛率差异有统计学意义(P<0.05)。STC组BMI显著高于NTC组,病程评分显著高于DD组,且BSFS显著小于NTC组(P<0.05)。DD组肛门静息压和肛管松弛率显著低于STC组、MC组和NTC组(P<0.05),STC组RAPG显著低于NTC组(P<0.05)。相关性分析显示,便秘患者结肠72 h钡剂传输部位与BMI、CSS评分中大便次数评分呈负相关(r=-0.245,P=0.001;r=-0.185,P=0.011),与RAPG、BSFS呈正相关(r=0.257,P=0.003;r=0.224,P=0.002)。结论慢性便秘患者改良CTT分型与ARM结果及患者临床特点相关,其在区分便秘类型,了解便秘病理生理上有一定的价值,在无胃肠动力检测的医疗中心可以初步进行便秘分型诊断并进一步指导治疗。

Objective To investigate the relationship between modified colonic transit test(CTT)classification and anorectal examination results and clinical characteristics in patients with chronic constipation.Methods A total of 189 patients with chronic constipation were enrolled and the scores of patient assessment of constipation quality of life(PAC-QoL),constipation scoring system scale(CSS),Bristol stool form scale(BSFS)were recorded.The patients were divided into four groups according to the results after 72 hours of modified CTT,including slow transit constipation(STC),mixed constipation(MC),defecatory disorder(DD)and normal transit constipation(NTC).Anorectal manometry(ARM)and defecography were also performed.The results of anorectal examination,demographic characteristics and related questionnaires were compared among the four groups.Results The 189 patients were classified as STC 67 patients(35.4%),DD 19 patients(10.1%),MC 39 patients(20.6%)and NTC 64 patients(33.9%).BMI,stool frequency and constipation duration in CSS score,BSFS,anal resting pressure,rectoanal pressure gradient(RAPG),and the percentage of anal relaxation had statistical differences among the four groups(P<0.05).BMI in STC group was significantly higher than that in NTC group,the constipation duration score was significantly higher than that in DD group,and BSFS was significantly lower than that in NTC group(P<0.05).Anal resting pressure and the percentage of anal relaxation were significantly lower in DD group than those in STC,MC and NTC groups(P<0.05).RAPG was significantly lower in the STC group than that in the NTC group(P<0.05).Correlation analysis showed a negative correlation between BMI,stool frequency score and colonic 72 hours barium transmit site in constipated patients(r=-0.245,P=0.001;r=-0.185,P=0.011).RAPG and BSFS were positively correlated with colonic 72 hours barium transmit site(r=0.257,P=0.003;r=0.224,P=0.002).Conclusion The classification of modified CTT is related to the results of ARM and the clinical characteristics in chronic constipation patients,which has certain value in distinguishing the subtypes of constipation and understanding the pathophysiology of constipation,and can preliminarily perform constipation classification diagnosis and further guide treatment in medical centers without gastrointestinal motility testing.