功能性消化不良患者症状分型、胃排空功能、胃肠激素水平的相关性

Relationships among symptom subgroups,gastric emptying and blood gut hormones in patients with functional dyspepsia

目的:通过放射性核素胃排空检测及血中胃肠激素检测,了解功能性消化不良(functional dyspepsia,FD)患者症状分型、胃排空和胃肠激素的相互关系,探讨其发病机制.方法:以 FD 患者为观察对象.依据罗马Ⅱ标准,将符合纳入标准的患者分为三个临床亚型,每型患者随机取10人为一组,并以10名健康志愿者作为对照组,同步观察胃排空及相关胃肠激素的变化.胃排空检测后,再将30例 FD 患者分为2组,胃排空正常组和胃排空延迟组.通过^(99m)Tc 标记的固体餐检测胃排空,应用放射免疫法测定外周血中胃动素(motilin,MTL),生长抑素(somatostatin,SS),P物质(substance P,SP)的含量.应用硝酸还原酶法测定外周血中一氧化氮(nitric oxide,NO)的含量.结果:溃疡样型组40%胃排空延缓,胃半排空时间(GET_(1/2))及各时间段胃排空率(GE%)与健康对照组比较无显著差异(P>0.05),与动力障碍样型组、非特异性型组比较亦无显著差异(P>0.05);外周血 SS 升高(P<0.05),MTL,SP,NO 与健康对照组比较无显著性差异(P>0.05).动力障碍样型组70%胃排空延缓,GET_(1/2)延长(P<0.05),GE%15min,30min 与健康对照组比较差别不显著(P>0.05),45min 及45min 以后各时间段减低(45min,P<0.05;60min,P<0.05;90min,P<0.01;120min,P<0.01);外周血 SS 升高(P<0.05),MTL、SP、NO 与健康对照组比较无显著性差异(P>0.05).非特异性型组70%胃排空延缓,GET_(1/2)延长(P<0.05),GE%15min、30min 与健康对照组比较差别不显著(P>0.05),45min 及45min 以后各时间段减低(45min,P<0.05;60min,P<0.05;90min,P<0.01;120min,P<0.01);外周血 SS升高(P<0.05),MTL,SP,NO 与健康对照组比较无显著性差异(P>0.05).FD 胃排空正常组与健康对照组比较外周血SS 升高(P<0.05),MTL,SP,NO 无显著性差异(P>0.05),FD 胃排空延迟组与健康对照组比较外周血 SS,NO 升高(P<0.05),MTL 降低(P<0.05),SP 无显著性差异(P>0.05).结论:FD 患者有明显的胃动力障碍,以动力障碍样型和非特异型为明显,各亚型间存在不同发病机制,症状分型有利于经验性治疗,对 FD 患者进一步行胃排空检测,有利于明确胃排空情况,为治疗提供可靠依据外周血 MTL 降低、NO 含量升高与 FD 患者胃排空延迟有关.SS,SP 与 FD 的关系有待进一步研究.

AIM:To study the relationships among symptom subgroups, gastric emptying and gastrointestinal hormones in patients with functional dyspepsia(FD)and to explore pathogenesis of FD. METHODS:The patients with FD were divided into 3 sub- groups according to the Rome Ⅱ criteria and 10 cases were selected randomly from each subgroup.Ten healthy sub- jects served as control.Thus 4 subgroups were set up, including the ulcer-like dyspepsia group(10 cases),the dysmotility-like dyspepsia group(10 cases),the unspeci- fied dyspepsia group(10 cases)and the control group(10 healthy subjects).Changes of radionuclide gastric emptying and blood levels of relevant gastrointestinal hormones were observed synchronously.After gastric emptying was measured,the 30 cases of FD were divided into 2 groups: the normal gastric emptying group and the delayed gastric emptying group.Gastric emptying was recorded by ^(99m)Tc- labelled solid food.Changes in motilin(MTL),somatostatin (SS),substance P(SP)and nitric oxide(NO)contents in pe- ripheral blood were determined by radioimmunoassay and nitrate reductase technique. RESULTS:In the ulcer-like group,40% patients had gas- tric emptying delay while the half gastric emptying time (GET_(1/2))and gastric emptying rate(GE%)at every time- point did not show significant changes(P<0.05)compared with control group and the other two subgroups of FD. The levels of SS in peripheral blood were increased sig- nificantly(P<0.05).However,the levels of MTL,SP,NO did not show significant changes(P<0.05)compared with control group.In the dysmotility-like group,70% patients had gastric emptying delay,meanwhile,GET_(1/2) was pro- longed significantly(P<0.05),and GE% was decreased significantly(15 min,P>0.05;30 min,P>0.05;45 min, P<0.05;60 min,P<0.05;90 min,P<0.01;and 120 min, P<0.01,respectively).Levels of SS in peripheral blood were increased significantly(P<0.05),whereas levels of MTL,SP,NO did not show significant changes(P>0.05). In the unspecified group,70% of patients had gastric emptying delay,meanwhile,GET_(1/2) was prolonged signifi- cantly(P<0.05),and GE% was decreased significantly (15 min P>0.05;30 min,P>0.05;45 min,P<0.05;60 min, P<0.05;90 min,P<0.01;and 120 min,P<0.01, respectively).Levels of SS in peripheral blood were in- creased significantly(P<0.05),whereas levels of MTL, SP,NO did not show significant changes(P>0.05).In the normal gastric emptying group of FD,levels of SS in pe- ripheral blood were increased significantly(P<0.05), whereas levels of MTL,SP,NO did not show significant changes(P>0.05).In the delayed gastric emptying group of FD,levels of SS and NO in peripheral blood were in- creased significantly(P<0.05),whereas levels of MTL were decreased significantly(P<0.05),meanwhile,lev- els of SP did not show significant changes(P>0.05). CONCLUSION:Gastric motility disturbance plays an im- portant role in pathogenesis of dysmotility-like dyspepsia and unspecified dyspepsia.Three subgroups of FD have different mechanisms and the Rome Ⅱ criteria have practical importance in diagnosis and therapy of FD.Therefore, gastric emptying test has significance in evaluation of gastric motility function and in the treatment of FD.The increase of NO and the decrease of MTL are related to gastric emp- tying delay.The roles of SS and SP need to be studied further.