肠易激综合征中医证型与肛管直肠动力学的相关性研究

Relativity between Differential TCM Syndromes of IBS and Anus-recta Kinetics

目的 :观察肠易激综合征 (IBS)不同中医证型肛管直肠动力学变化及临床意义。方法 :选择符合罗马 标准的 IBS患者 5 9例 ,按中医标准分为肝郁脾虚组 2 5例 ,脾胃虚弱组 2 0例 ,脾胃阴虚组 14例 ;另选健康志愿者2 3例为正常对照组 (正常组 )。采用水灌注式测压系统 ,测定其肛管直肠动力学。结果 :3型患者直肠静息压、肛管静息压及肛管缩窄压均与正常组差异无显著性意义 ;但肝郁脾虚组直肠最大耐受量较正常组降低 ,出现肛管直肠抑制反射 (RAIR)所需最小空气量、直肠初始感觉阈值与正常组差异无显著性意义 ;脾胃虚弱组出现 RAIR所需最小空气量、直肠初始感觉阈值、直肠最大耐受量均与正常组差异无显著性意义 ;脾胃阴虚组上述 3项指标均较正常组明显增高。结论 :肝郁脾虚组直肠耐受性降低 ;脾胃阴虚组排便反射不协调。

Objective:To observe the clinical value and the changes of anus recta kinetics in patients with irratabl bowel syndrome(IBS) in differential TCM syndromes. Methods:Fifty nine cases of patients with IBS, who were selected with the standard of Rome Ⅱ, were divided into three groups according to differential TCM syndromes: the group of liver qi stasis and spleen deficiency (n=25), the group of qi deficiency of spleen and stomach(n=20) and the group of yin deficiency of spleen and stomach (n=14).Water perfused manometry was applied to measure the movement of anus recta.Results:Compared with those of the normal group, the rectal stationary pressure, anal stationary pressure and anal squeeze pressure in all patients showed no significant difference. The rectal maximal tolerable volume in the group of liver qi stasis and spleen deficiency was lower than that of the normal group. The minimal volume which could induce recta anus inhibitory reflex(RAIR) and the preliminary rectal sensory threshold showed no significant difference. The minimal volume which could induce RAIR, the preliminary rectal sensory threshold and the rectal maximal tolerable volume in the group of qi deficiency of spleen and stomach showed no significance, while those in the group of yin deficiency of spleen and stomach were higher than those in the normal group. Conclusion: The rectal tolerance in the IBS patients with liver qi stasis and spleen deficiency deereased. Defecation reflection in the patients of yin deficiency of spleen and stomach was incoordinate, and rectal sensitivity reduced while rectal tolerance rised.