腹泻型肠易激综合征患者肛管直肠动力及感觉功能与外周血肥大细胞类胰蛋白酶的相关性研究

发布时间：2019-05-10 21:34

【摘要】：背景腹泻型肠易激综合征(D-IBS)的病因由多因素参与,病理生理学机制复杂,至今尚未阐明。其中肛管直肠动力异常和内脏高敏感是参与的重要因素。高分辨率肛管直肠测压(HR-ARM)是一项对肛管直肠运动及感觉功能进行测定的新技术。肥大细胞类胰蛋白酶(MCT)是肥大细胞分泌的重要递质,其水平可作为肥大细胞活化程度的生物学标志。目的采用HR-ARM检测D-IBS患者是否具有肛管直肠动力及感觉功能异常,检测血MCT水平评估DdBS患者肥大细胞活化程度,验证血MCT水平与肛管直肠运动及感觉指标的相关性,探讨血MCT作为D-IBS生物学标志物的可能性。方法选取2014年8月—2016年11月于北京大学第一医院消化内科门诊就诊符合罗马Ⅲ标准的D-IBS患者21例为病例组,进行HR-ARM,检测肛管静息压、静息肛管最大收缩力、高压带长度,自主缩肛运动时肛门最大收缩压、持续挤压时间,模拟排便时肛门残余压、肛门松弛率、直肠压力及直肠肛管压力差,直肠肛门抑制反射(RAIR)、初始感觉阈值、初始排便冲动阈值,最大耐受容量等。同时纳入同时期进行HR-ARM、完成上述指标检测且评估无异常的非D-IBS患者24例为对照组。应用竞争性抑制酶联免疫吸附试验(EHSA)检测血MCT水平。结果对照组与病例组肛管静息压、静息肛管最大收缩力、自主缩肛运动时持续挤压时间、模拟排便时肛门松弛率、RAIR、最大耐受容量比较,差异均无统计学意义(P0.05);病例组静息高压带长度、自主缩肛运动时肛门最大收缩压、模拟排便时肛门残余压、直肠压力、直肠肛管压力差较对照组升高,初始感觉阈值、初始排便冲动阈值较对照组降低(P0.05)。对照组血MCT水平为(15.28±2.66)μg/L,低于病例组的(22.24±7.66)μg/L(Z=-3.628,P0.01)。Spearman相关性分析显示,D-IBS患者血MCT水平与初始感觉阈值呈负相关(r_s=-0.524,P=0.015)。结论 HR-ARM可作为临床检测DdBS患者肛管直肠动力及感觉功能异常的有效手段;血MCT可作为D-IBS的有效生物标志物进一步探讨,并与肛管直肠初始感觉阈值相关。
[Abstract]:Background the etiology of diarrhea irritable bowel syndrome (D-IBS) is involved in many factors and the pathophysiological mechanism is complex. Anorectal motility and visceral hypersensitivity are important factors involved in anorectal motility. High resolution anorectal manometry (HR-ARM) is a new technique for measuring anorectal motility and sensory function. Mast cell trypsin (MCT) is an important transmitter secreted by mast cells, and its level can be used as a biological marker of the degree of activation of mast cells. Objective to detect anorectal motility and sensory dysfunction in patients with D-IBS by HR-ARM, to detect the level of MCT in blood to evaluate the degree of mastocyte activation in patients with DdBS, and to verify the correlation between blood MCT level and anorectal motility and sensory indexes. To explore the possibility of blood MCT as a biomarker of D-IBS. Methods from August 2014 to November 2016, 21 D-IBS patients who met the Rome III standard in the Department of Gastroenterology, the first Hospital of Peking University were selected as the case group. The resting pressure of anal canal and the maximum contractility of resting anal canal were measured by HR-ARM,. High pressure band length, maximum anal systolic pressure during autonomic anal contraction, continuous extrusion time, simulated anal residual pressure during defecation, anal relaxation rate, rectal pressure and rectal anal pressure difference, rectal anal inhibitory reflex (RAIR), initial sensory threshold, Initial defecation impulse threshold, maximum tolerance capacity, etc. At the same time, 24 non-D-IBS patients who had completed the above-mentioned indexes by HR-ARM, and assessed the non-D-IBS patients as control group were included in the study at the same time. The blood MCT level was measured by competitive inhibitory enzyme-linked immunosorbent assay (EHSA). Results there was no significant difference between the control group and the case group in the anal resting pressure, the maximum contractile force of the resting anal canal, the duration of continuous extrusion during the autonomous anal contraction movement, the anal relaxation rate during simulated defecation, and the maximum tolerance capacity of RAIR, (P0.05), and there was no significant difference between the control group and the case group (P0.05). The length of resting high pressure band, the maximum systolic pressure of anus during spontaneous anal contraction, the residual anal pressure, rectal pressure and rectal pressure difference during simulated defecation in the case group were higher than those in the control group, and the initial sensory threshold was higher than that in the control group. The threshold of initial defecation impulse was lower than that of the control group (P 0.05). The serum MCT level in the control group was (15.28 卤2.66) 渭 g / L, which was lower than that in the case group (22.24 卤7.66) 渭 g / L (P 0.01). There was a negative correlation between serum MCT level and initial sensory threshold in D-IBS patients (r = 0. 524, P = 0. 015). Conclusion HR-ARM can be used as an effective method to detect anorectal motility and sensory dysfunction in patients with DdBS, and blood MCT can be used as an effective biomarker of D-IBS and is related to the initial sensory threshold of anorectum.
【作者单位】：北京大学第一医院消化内科;
【基金】：北京自然科学基金资助项目(7152147)
【分类号】：R574.4

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