儿童功能性消化不良与胃肠激素、胃动力学相互关系探讨

Study on gastrointestinal hormones and gastric motility in children with functional dyspepsia

为探讨儿童功能性消化不良(FD)与胃动力学和空腹血胃泌素、胃动素之间的相互关系以及对胃动力药物疗效的分析,应用放射免疫方法对40例FD患儿分别测定空腹血胃动素和胃泌素水平;服用吗叮啉混悬液4周前后B型超声扫描,连续观察空腹、饮后即刻、15分钟、30分钟与60分钟胃排空状况。结果显示:吗叮啉治疗4周,对FD患儿上腹痛和/或上腹不适以及腹胀、厌食、早饱等有效率分别高达90％和87.5％;超声显示30分钟胃排空加快。FD患者胃肠激素测定结果无明显异常,但对胃动力药物治疗无效的FD患儿胃肠激素水平较治疗有效的FD患儿明显降低。提示胃十二指肠运动功能异常是儿童FD重要发病原因;吗叮啉治疗儿童FD有一定疗效。大部分FD患儿无明显胃肠激素分泌障碍,胃肠激素水平降低是引起FD的部分因素,但可能是难治性FD的重要病因。

The aim of this study was to explore the mutual relationship among the level of gastrointestinal hormones (gastrin and motilin) in fasting serum, gastric motility and functional dyspepsia(FD) and thereby to analyze therapeutical efficacy of prokinetic drugs in children with this diseases. With the technique of radioimmunoassay, the levels of gastrin and motilin in fasting sreum protocally measured in 40 patients and also with a series of ultrasonographic examination of gastric antrum scanning the gastric emptying time,i.e. the gastric motility,was dynamically evaluated before,immediately after as well as 15, 30 and 60 minutes after oral ingestion of domiperidoni suspension by the end of 4 weeks' treatment of domiperidoni administration. From the results obtained, it was showed that the effective cure rates of 4-weeks' domiperidoni treatment for 1 different categories of presenting symptoms, such as epigastric pain and/ or discomfort as well as distension, anorexia, and satiety, in FD children were separately found to be 90%and 87. 5%. Meanwhile, as shown by ultrasonographic evidences, the gastric emptying time could begin to accelerate at 30 minutes after oral domiperidoni ingestion. On the other hand, there was discovered no apparent change in serum gastrin and motilin levels in most of affected children although these gastrin and motilin levels of a certain patients having no good response to domiperidoni treatment were actually lower than those in patients response to the treatment.Thus, the available conclusion could be reached as follows:just because the fact of this study that domiperidoni treatment could effectively improve the clinical features of FD in chilidren, the disturbance of gastrointestinal motor functions,i.e. delayed gastric emptying time,should be considered as one of the most important causes in the pathogenic mechanism of FD. Instead, no abnormal secretion of serum gastrointestinal hormones could be found in most of the affected children. But, considering that lower secretion of gastrointestinal hormones could sometimes occur in patients having no good response to domiperidoni treatment, the abnormal secretion of these hormones might be the partial pathogenic reason in such FD children, even possibly playing a most principal role in the pathogenesis of refractory FD in children.