帕金森病伴便秘高分辨率肛门直肠测压特点分析
发布时间：2018-09-06 14:53
【摘要】：研究背景:帕金森病(Parkinson'sdisease,PD)是一组以静止性震颤、肌强直、运动迟缓、姿势步态异常等运动症状为主的神经系统慢性变性疾病。近几年来,随着人们对PD的了解逐步深入,人们对PD非运动症状(non-motor symptoms,NMS)有了一系列新的认识。国内外研究发现,在帕金森便秘中出口梗阻型便秘占绝大多数。目前仅应用改善胃肠动力药物来治疗PD便秘,因此应该寻求一个针对便秘分型的根本治疗手段,从而减轻患者痛苦。高分辨率肛门直肠测压(High resolution Anorectal Manometry)是采取动静力学结合的手段研究各段肠道与肛管(包括盆底)不同状态下的各种运动方式。它可以测量患者静息、收缩、排便状态下直肠肛管压力变化,从而反映出三种状态下肛管、直肠、盆底各肌群功能以及协调功能。研究目的:分析帕金森便秘患者肛肠测压特点,根据测压结果对帕金森便秘进行分型,从而探讨帕金森便秘的机制,以期为肉毒素及生物反馈治疗提供理论依据。研究方法:选取来自于大连医科大学附属第一医院符合英国脑库及罗马III诊断标准的15例帕金森便秘患者作为帕金森便秘组(Parkinson Defecatory Disorder,PDD),符合罗马III诊断标准并排除胃肠疾病的24例患者作为功能性便秘组(Functional Defecatory Disorder,FDD)。按照 Hoehn-Yahr 分期(2014 年中国帕金森病治疗指南)将PDD组分为早期(H-Y1-2期)、晚期(H-Y2.5,3.0期)。收集两组患者临床资料,包括起病年龄、性别、疾病病程等。采用高分辨率肛门直肠测压对两组患者进行参数测评。将两组患者按照HRAM分为两型:①直肠推进力不足:直肠力排压70mmHg,伴或不伴肛管矛盾运动,或肛管松弛率≤20%;②肛管矛盾运动:直肠力排压≥70mmHg,且肛管矛盾运动(肛门内外括约肌及耻骨直肠肌异常收缩所致肛管残余压肛管静息压)或肛管松弛率≤20%(肛管松弛率=肛管静息压-肛管残余压/肛管静息压×100%)。采用SPSS 23.0统计学软件进行分析。各项指标进行正态性检验,计量资料符合正态分布数据用x±s表示,采用独立样本t检验;计数资料以例数表示,采用卡方检验。以P0.05为差异有统计学意义。研究结果:帕金森便秘组15例(男12例,女3例),年龄(66.6±7.3)岁;功能性便秘组24例(男17例,女7例),年龄(70.7±8.9)岁。两组患者年龄、性别、便秘病程差异无统计学意义(P0.05)。PDD组15例中,10例以直肠推进力不足为主(66.7%),4例以肛管矛盾运动为主(26.7%),1例测量参数未见明显异常(6.7%)。FDD组24例中,4例以直肠推进力不足为主(16.7%),18例以肛管矛盾运动为主(75%),2例测量参数未见明显异常(8.3%)。PDD组以直肠推进力不足型为主,FDD组以肛管矛盾运动型为主,两者存在显著统计学差异(χ2=10.207,P0.05。PDD组肛门最大收缩压(Maximum Squeeze Pressure,MSP)及直肠力排压、直肠压力增加明显低于FDD组,差异有统计学意义;两组直肠静息压、肛管静息压、持续收缩时间、排便时肛管剩余压及直肠感觉阈值差异均无统计学意义(P0.05)。15例PDD患者根据H-Y分期分为早晚期,其中早期(H-Y 1.0～2.0)7例,晚期(H-Y 2.5,3.0)8例。PDD组早晚期静息态、收缩态、排便态、直肠感觉功能等各个参数差异无统计学意义。研究结论:1.帕金森便秘患者以直肠推进力不足为主,功能性便秘患者以肛管矛盾运动为主;2.帕金森便秘患者最大缩榨压、直肠力排压、直肠压力增加较功能性便秘患者明显减少,结果有统计学差异;3.帕金森便秘患者便秘的原因是直肠推进力不足以及肌张力所致的盆底矛盾运动;4.帕金森早晚期肛肠测压结果无明显差异,提示肛门直肠动力异常可以存在于帕金森早期。
[Abstract]:BACKGROUND: Parkinson's disease (PD) is a group of chronic degenerative diseases of the nervous system characterized by quiescent tremor, myotonia, bradykinesia, postural gait abnormalities and other motor symptoms. High resolution Anorectal Manometry (HRAM) It can measure the pressure changes of recto-anal canal in resting, contracting and defecating state, thus reflecting the functions of anal canal, rectum and pelvic floor muscle groups and coordination in three states. Methods: 15 cases of Parkinson's constipation were selected from the First Affiliated Hospital of Dalian Medical University, which met the diagnostic criteria of British Brain Bank and Roman III. Patients with senile constipation were classified as Parkinson Defecatory Disorder (PDD) according to the Rome III diagnostic criteria and excluding gastrointestinal diseases as Functional Defecatory Disorder (FDD). Phase (H-Y2.5, 3.0). The clinical data of the two groups were collected, including onset age, sex, course of disease and so on. 20%; 2) Anal contradictory movement: rectal force drainage pressure (> 70mmHg), and anal contradictory movement (anal residual pressure caused by abnormal contraction of anal internal and external sphincter and puborectal muscle) or anal relaxation rate (> 20%) (anal relaxation rate = anal resting pressure - Anal residual pressure / anal resting pressure (> 100%). The results showed that there were 15 cases (12 males, 3 females) in Parkinson's constipation group and 24 cases (17 males) in functional constipation group. There was no significant difference in age, sex and course of constipation between the two groups (P 0.05). Among the 15 cases in PDD group, 10 cases (66.7%) were mainly rectal insufficiency, 4 cases (26.7%) were anal contradictory motion, and 1 case (6.7%) had no significant abnormality in measurement parameters. Anal contradictory movement was predominant in 18 cases (75%) and no significant abnormality was found in 2 cases (8.3%). In PDD group, rectal insufficiency was predominant, while in FDD group, rectal contradictory movement was predominant. There were significant differences between the two groups (_2 = 10.207, P 0.05). There was no significant difference in rectal resting pressure, anal resting pressure, persistent contraction time, residual anal pressure during defecation and rectal sensory threshold between the two groups (P 0.05). Fifteen patients with PDD were divided into early and late stages according to H-Y staging, including 7 cases in early stage (H-Y 1.0-2.0) and 8 cases in late stage (H-Y 2.5, 3.0). There was no significant difference in resting state, systolic state, defecation state, rectal sensory function and other parameters. Conclusion: 1. Parkinson's constipation patients with insufficient rectal propulsion, functional constipation patients with anal contradictory movement mainly; 2. Parkinson's constipation patients with maximum compression, rectal pressure, rectal pressure increased than functional constipation. Parkinson's constipation was caused by insufficient rectal propulsion and pelvic floor contradictory movement caused by muscle tone; 4. There was no significant difference in the results of early and late Parkinson's anorectal manometry, suggesting that anorectal motility abnormalities may exist in early Parkinson's disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5;R574.62
，
本文编号：2226692
[Abstract]:BACKGROUND: Parkinson's disease (PD) is a group of chronic degenerative diseases of the nervous system characterized by quiescent tremor, myotonia, bradykinesia, postural gait abnormalities and other motor symptoms. High resolution Anorectal Manometry (HRAM) It can measure the pressure changes of recto-anal canal in resting, contracting and defecating state, thus reflecting the functions of anal canal, rectum and pelvic floor muscle groups and coordination in three states. Methods: 15 cases of Parkinson's constipation were selected from the First Affiliated Hospital of Dalian Medical University, which met the diagnostic criteria of British Brain Bank and Roman III. Patients with senile constipation were classified as Parkinson Defecatory Disorder (PDD) according to the Rome III diagnostic criteria and excluding gastrointestinal diseases as Functional Defecatory Disorder (FDD). Phase (H-Y2.5, 3.0). The clinical data of the two groups were collected, including onset age, sex, course of disease and so on. 20%; 2) Anal contradictory movement: rectal force drainage pressure (> 70mmHg), and anal contradictory movement (anal residual pressure caused by abnormal contraction of anal internal and external sphincter and puborectal muscle) or anal relaxation rate (> 20%) (anal relaxation rate = anal resting pressure - Anal residual pressure / anal resting pressure (> 100%). The results showed that there were 15 cases (12 males, 3 females) in Parkinson's constipation group and 24 cases (17 males) in functional constipation group. There was no significant difference in age, sex and course of constipation between the two groups (P 0.05). Among the 15 cases in PDD group, 10 cases (66.7%) were mainly rectal insufficiency, 4 cases (26.7%) were anal contradictory motion, and 1 case (6.7%) had no significant abnormality in measurement parameters. Anal contradictory movement was predominant in 18 cases (75%) and no significant abnormality was found in 2 cases (8.3%). In PDD group, rectal insufficiency was predominant, while in FDD group, rectal contradictory movement was predominant. There were significant differences between the two groups (_2 = 10.207, P 0.05). There was no significant difference in rectal resting pressure, anal resting pressure, persistent contraction time, residual anal pressure during defecation and rectal sensory threshold between the two groups (P 0.05). Fifteen patients with PDD were divided into early and late stages according to H-Y staging, including 7 cases in early stage (H-Y 1.0-2.0) and 8 cases in late stage (H-Y 2.5, 3.0). There was no significant difference in resting state, systolic state, defecation state, rectal sensory function and other parameters. Conclusion: 1. Parkinson's constipation patients with insufficient rectal propulsion, functional constipation patients with anal contradictory movement mainly; 2. Parkinson's constipation patients with maximum compression, rectal pressure, rectal pressure increased than functional constipation. Parkinson's constipation was caused by insufficient rectal propulsion and pelvic floor contradictory movement caused by muscle tone; 4. There was no significant difference in the results of early and late Parkinson's anorectal manometry, suggesting that anorectal motility abnormalities may exist in early Parkinson's disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5;R574.62
，
本文编号：2226692
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