奥替溴铵对腹泻型肠易激综合征患者肛门直肠感觉运动功能的影响

Effects of otilonium bromide on anorectal visceral sensorimotor functions of patients with diarrhea-predominant irritable bowel syndrome

目的:探讨奥替溴铵对腹泻型肠易激综合征(D-IBS)患者肛门直肠感觉运动功能的效应.方法:用电子气压泵(barostat)及液流灌注压力监测系统对20例 D-IBS 患者及20名健康人进行肛门直肠测压检查.并对D-IBS 患者用奥替溴铵治疗2wk,再复查肛门直肠测压;治疗前后均对患者行临床症状评分.结果:肛门内括约肌静息压(kPa)、肛门内括约肌最大收缩压(kPa)、最小抑制容量(mL)、直肠顺应性(mL/0.133kPa)在D-IBS 患者与健康人之间无显著性差异(P>0.05);D-IBS 患者的直肠初始感党阈、排便阈、疼痛阈分别为52.6±17.3mL、84.6±34.3mL 及128.6±24.3mL,分别低于健康人的87.3±14.5mL(P<0.05)、128.4±26.5mL(P±0.05)及206.1±36.5mL(P<0.05).奥替溴铵治疗前患者腹痛、腹胀、排便频率、粪便性状及 IBS 总体症状感觉评分分别为1.90±0.72、1.75±0.78、1.85±0.67、1.70±0.73及1.91±0.68,治疗后明显下降,分别为0.70±0.57(P<0.01)、0.55±0.51(P<0.01)、0.65±0.59(P<0.01)、0.75±0.50(P<0.01)、0.65±0.59(P<0.01).与治疗前比较,患者的直肠初始感觉阈、排便阈及疼痛阈均明显升高,分别为79.3±13.2mL(P<0.05)、112.2±23.2 mL(P<0.05)及189.1±33.8 mL(P<0.05).结论:奥替溴铵可改善 D-IBS 患者的直肠内脏高敏感性、并有效地缓解患者的临床症状.

AIM:To study the effects of otilonium bromide on rectal visceral sensation and anorectal motility in patients with diarrhea-predominant irritable bowel syndrome(d-IBS). METHODS:Anorectal manometry and rectal visceral per- ception to balloon distention were done in 20 patients with d-IBS and in 20 health subjects(HS)by means of electric barostat and perfusion catheter manometer.Then the pa- tients received otilonium bromide 40mg t.i.d for 2 weeks, and the examinations were repeated.The symptom score of the patients was assessed before and after treatment. RESULTS:The resting pressure of internal anal sphincter, the maximal squeeze pressure,the minimal rectal distention volume that could induce the rectum-ano inhibition reflex and the rectal compliance in the patients with d-IBS were similar to those in HS(P>0.05).The thresholds of the first sensation volume,defecation volume and pain volume of rectum in patients with d-IBS were(52.6±17.3 mL), (84.6±34.3 mL)and(128.6±24.3 mL)respectively,and they were significant lower than those of(87.3±14.5 mL), (128.4±26.5 mL)and(206.1±36.5 mL)in HS(P<0.05). After treatment with otilonium bromide,the thresholds of rectal visceral sensation volume in the above patients with d- IBS were significantly increased to(79.3±13.2 mL)P<0.05, (112.2±23.2 mL)(P<0.05),and(189.1±33.8 mL)(P<0.05) respectively,and patients'symptom scores of IBS were significantly decreased at the same time(P<0.05). CONCLUSION:Otilonium bromide can improve rectal visceral: hypersensitivity,and alleviate effectively the symptoms in patients with d-IBS.