李文艷,顧 鵬,岳文勝,劉 健,劉曙東
(川北醫(yī)學(xué)院附屬醫(yī)院:1.超聲科;2.神經(jīng)內(nèi)科,四川南充 637000)
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口服胃腸超聲造影對焦慮癥患者胃動(dòng)力的評價(jià)
李文艷1,顧鵬1,岳文勝1,劉健1,劉曙東2△
(川北醫(yī)學(xué)院附屬醫(yī)院:1.超聲科;2.神經(jīng)內(nèi)科,四川南充 637000)
目的應(yīng)用口服胃腸超聲造影評價(jià)伴有功能性消化不良的焦慮癥患者胃腸動(dòng)力的異常。方法選取伴有上消化道癥狀但無器質(zhì)性病變的焦慮癥患者20例和健康對照20例,口服胃腸超聲造影劑,測量各時(shí)間點(diǎn)的胃竇收縮頻率、胃竇收縮幅度、胃竇動(dòng)力指數(shù)(MI),計(jì)算胃排空率(GER),評價(jià)焦慮癥患者的胃腸動(dòng)力參數(shù)。結(jié)果焦慮癥組胃竇收縮頻率及MI在最初2 min內(nèi)與對照組比較差異無統(tǒng)計(jì)學(xué)意義。焦慮癥組造影后5~30 min內(nèi)各時(shí)間點(diǎn)胃竇收縮幅度、胃竇收縮頻率及MI均較對照組降低,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。造影20 min后,對照組GER明顯高于焦慮癥組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論口服胃腸超聲造影是一種經(jīng)濟(jì)、可操作性強(qiáng),且無創(chuàng)、可重復(fù)性高的評價(jià)焦慮癥患者胃腸動(dòng)力異常的方法。
焦慮;胃腸超聲造影;胃排空;功能性消化不良
焦慮癥是神經(jīng)癥中最常見的一種,常常主訴有嚴(yán)重的腹脹、噯氣、上腹痛等消化不良癥狀[1],而胃鏡等檢查往往無器質(zhì)性的改變。目前,對于焦慮癥患者消化系統(tǒng)胃腸動(dòng)力參數(shù)異常及異常程度的研究國內(nèi)外報(bào)道較少,本試驗(yàn)擬對比研究成人焦慮癥患者與健康成人胃腸動(dòng)力學(xué)各參數(shù)的差異,為焦慮癥伴功能性消化不良的明確診斷提供檢查依據(jù)。
1.1一般資料試驗(yàn)組入組標(biāo)準(zhǔn):同時(shí)滿足年齡大于或等于18歲;依據(jù)《CCMD-3中國精神疾病診斷標(biāo)準(zhǔn)》中焦慮癥的診斷標(biāo)準(zhǔn),確診為焦慮癥的患者;伴有噯氣、上腹飽脹不適等上消化道癥狀;胃鏡檢查無胃器質(zhì)性病變。選擇20例伴游上消化道癥狀但無器質(zhì)性病變的焦慮癥患者為試驗(yàn)組,其中男2例,女18例,年齡26~55歲,平均(43±7)歲。選取健康對照組20例,其中男10例,女10例,年齡21~50歲,平均(39±6)歲。
胃竇收縮頻率=3 min內(nèi)胃竇的收縮次數(shù),
表1 試驗(yàn)組和對照組各時(shí)間點(diǎn)胃竇收縮幅度、胃竇收縮頻率、MI比較±s)
竇收縮頻率、胃竇收縮幅度、MI及GER,以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
兩組胃竇收縮頻率、胃竇收縮幅度及MI均于口服造影劑后逐漸增高,服用后10 min達(dá)峰值,之后逐漸降低。試驗(yàn)組胃竇收縮頻率及MI在造影最初的2 min內(nèi)與對照組差異無統(tǒng)計(jì)學(xué)意義,但服用后5~30 min內(nèi)各時(shí)間點(diǎn)試驗(yàn)組的胃竇收縮幅度、胃竇收縮頻率及MI均較健康對照組降低,其差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),見表1。20 min后,健康對照組GER(45.86±5.99)明顯高于試驗(yàn)組(45.86±5.99),差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),本試驗(yàn)中,服用造影劑初期,兩組收縮次數(shù)相似,但試驗(yàn)組患者胃竇收縮幅度小于對照組(圖1、2)。
A:收縮前 B:收縮后。
圖1試驗(yàn)組10 min時(shí)胃竇收縮前后面積比較
A:收縮前B:收縮后。
圖2對照組10 min時(shí)胃竇收縮前后面積比較
口服胃腸超聲造影,即讓患者飲入一定量的造影劑,在胃腸道內(nèi)填充,形成均勻的點(diǎn)狀回聲,以減少或消除胃腸道超聲偽像,使胃腸局部層次結(jié)構(gòu)顯示更加清晰,以利于胃腸疾病的診斷。1978年,Warren等首次利用口服胃腸超聲造影劑對胃占位病變進(jìn)行檢查開始,胃腸超聲造影劑經(jīng)過不斷的改良與發(fā)展,目前已能很好的增加胃腸腔與胃腸壁病變的對比度,延緩胃排空時(shí)間,清晰顯示病變部位[2],且該檢查具有無創(chuàng)、經(jīng)濟(jì)、耗時(shí)短、可重復(fù)性強(qiáng)、患者易于接受等諸多優(yōu)點(diǎn),故得到了比較廣泛的臨床應(yīng)用。
胃腸動(dòng)力障礙性疾病是客觀上未能證實(shí)有病理學(xué)變化的情況下出現(xiàn)的胃腸功能紊亂,它是一種常見病、多發(fā)病,包括功能性消化不良、胃食管反流、胃輕癱、假性腸梗阻和腸易激綜合征。其中,功能性消化不良(functional dyspepsia,F(xiàn)D)最為常見。當(dāng)患者出現(xiàn)腹脹、噯氣等癥狀時(shí),常常首選胃鏡檢查,但目前胃鏡僅能對胃、十二指腸的黏膜表面的異常進(jìn)行檢查,無法對其動(dòng)力的異常進(jìn)行判定,當(dāng)臨床胃鏡檢查結(jié)果無陽性發(fā)現(xiàn)時(shí),F(xiàn)D疾病的診斷面臨困難。目前,臨床上針對胃腸動(dòng)力的檢查方法有限,常用的是胃電圖,即通過檢測異常胃電節(jié)律進(jìn)行診斷。但胃電圖僅能對胃腸動(dòng)力障礙進(jìn)行定性判定,尚不能對動(dòng)力異常程度進(jìn)行定量分析。還有學(xué)者通過MRI進(jìn)行了胃動(dòng)力及胃排空的研究[3],但其價(jià)格昂貴,不便廣泛開展,目前還處于實(shí)驗(yàn)研究階段。故需要一種能定量分析各參數(shù)的檢查方式,來評價(jià)患者的胃腸動(dòng)力改變及改變程度,從而為FD的診斷提供依據(jù)。
胃排空能力是胃腸動(dòng)力檢查的重要指標(biāo),而胃的排空又取決于幽門兩側(cè)的壓力增高,從而使部分胃內(nèi)容物通過幽門進(jìn)入十二指腸,完成一次胃排空,故胃竇的收縮運(yùn)動(dòng)是胃排空的動(dòng)力。影響胃竇收縮運(yùn)動(dòng)的因素多樣,胃內(nèi)食物量、食物成分、胃壁的機(jī)械刺激、胃泌素等[4-5],均可通過壁內(nèi)神經(jīng)反射或迷走-迷走神經(jīng)反射,引起胃運(yùn)動(dòng)的加強(qiáng)。通過對胃竇收縮能力的參數(shù)檢測,便能較好反映胃排空能力,為FD的診斷提供幫助。目前,有學(xué)者用SPECT對健康人飲入造影劑后的胃收縮及胃排空進(jìn)行了研究[6]; Dobó等[7]在膳食中加入標(biāo)記的同位素,以利于胃排空能力的觀察;還有部分學(xué)者嘗試用口服超聲造影檢測不同外在因素對胃竇動(dòng)力學(xué)和胃排空的影響,且獲得成功[8-10]。本試驗(yàn)首次應(yīng)用口服胃腸超聲造影研究伴有上消化道癥狀但無胃器質(zhì)性病變的焦慮癥患者的胃腸動(dòng)力改變。
焦慮癥患者就醫(yī)時(shí),常常主訴嚴(yán)重的腹脹、噯氣、上腹痛等消化不良癥狀[11],而胃鏡等檢查往往無器質(zhì)性的改變。本試驗(yàn)中,入選的焦慮癥患者在服用造影劑后2~3 min內(nèi),胃竇收縮頻率約1次左右,與對照組的差異無統(tǒng)計(jì)學(xué)意義。表明在食物刺激胃初期,兩組胃腸神經(jīng)的調(diào)節(jié)啟動(dòng)功能并無明顯差異,胃竇收縮運(yùn)動(dòng)均能正常啟動(dòng),但在胃竇收縮幅度上,對照組為焦慮癥組2倍以上,即意味著對照組胃竇收縮更為有力,更易于通過其收縮運(yùn)動(dòng),增加胃竇內(nèi)壓力,將更多食糜送入十二指腸,從而促進(jìn)胃排空。MI是檢測胃排空的參數(shù)之一,本試驗(yàn)設(shè)定MI的值為胃竇收縮幅度×3 min內(nèi)收縮次數(shù),故在收縮次數(shù)相似的情況下,收縮幅度決定了其值的大小。本試驗(yàn)中,服用造影劑初期,兩組收縮次數(shù)相似,但焦慮癥患者胃竇收縮幅度小于對照組(圖1、2),故胃竇動(dòng)力指數(shù)低于對照組,提示在進(jìn)食后的早期,焦慮癥患者的胃竇排空能力就低于對照組。在服用造影劑后5~30 min,兩組胃竇收縮幅度、胃竇收縮次數(shù)及MI均逐漸升高,于10 min時(shí)達(dá)到峰值,之后下降。提示無論是否患有焦慮癥,胃腸運(yùn)動(dòng)與時(shí)間關(guān)系的趨勢不變,但就每個(gè)時(shí)間段的值而言,焦慮癥組均明顯低于對照組,表明焦慮癥患者胃竇收縮幅度、胃竇收縮次數(shù)及MI均為其胃腸動(dòng)力異常的因素。本試驗(yàn)中,兩組在口服造影劑后20 min GER顯示出明顯差別,其原因可能與胃排空能力與神經(jīng)調(diào)節(jié)有關(guān)。焦慮癥患者本身就易出現(xiàn)植物神經(jīng)功能紊亂,故常伴有胃腸自主神經(jīng)異常,出現(xiàn)胃腸功能的降低,但其機(jī)制尚未完全明了。Lee等[12]發(fā)現(xiàn),處于焦慮狀態(tài)的小鼠對胃腸道擴(kuò)張的敏感性增加,可能導(dǎo)致功能性消化不良;Carabotti等[13]的研究表明,焦慮癥患者消化道癥狀可能與中樞系統(tǒng)對腦-腸軸的雙向調(diào)節(jié)有關(guān)。Nan等[14]發(fā)現(xiàn)腦部糖代謝異常與焦慮癥患者的消化不良癥狀存在密切聯(lián)系。Chen等[15]發(fā)現(xiàn)電針刺激小鼠足三里穴位,其胃竇蠕動(dòng)加強(qiáng),可能與SCF/c-kit信號通路有關(guān)。
本試驗(yàn)通過胃腸超聲造影,對焦慮癥患者的胃腸動(dòng)力各參數(shù)進(jìn)行了測量,與健康人進(jìn)行定量對比,為證實(shí)焦慮癥患者的胃腸動(dòng)力異常提供了實(shí)驗(yàn)室證據(jù)。該方法經(jīng)濟(jì)、可操作性強(qiáng),且無創(chuàng)、可重復(fù)性高,能較好地協(xié)助臨床評價(jià)患者胃腸動(dòng)力異常。但本試驗(yàn)由于測定時(shí)間有限,對服用造影劑30 min后的胃腸動(dòng)力參數(shù),有待在后續(xù)試驗(yàn)中進(jìn)一步完善。
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Evaluation of oral gastrointestinal ultrasound contrast agents on gastric motility in patients with anxiety disorder
LiWenyan1,GuPeng1,YueWensheng1,LiuJian1,LiuShudong2△
(1.DepartmentofUltrasound;2.DepartmentNeurology,AffiliatedHospital,NorthSichuanMedicalCollege,Nanchong,Sichuan637000,China)
ObjectiveTo apply the oral gastrointestinal ultrasound contrast agents for evaluating the gastric motility abnormality in the patients with anxiety disorder.MethodsTwenty patients with anxiety disorder complicating upper digestive tract symptoms without organic pathological changes were enrolled as the anxiety disorder group.Twenty healthy volunteers were enrolled as the control group in this study.The two groups orally took gastrointestinal ultrasound contrast agents.The antral contraction frequency,antral contraction amplitude amd MI were measured at each time point.GER was calculated.The the gastric motility parameters in the patients with anxiety disorder were evaluated.ResultsThe antral contraction frequency and MI at initial 2 min had no statistical difference between the anxiety group and the control group.The antral contraction amplitude,antral contraction frequency amd MI at each time point during 5-10 min after contrast in the anxiety disorder group were significantly decreased compared with the control group,and the differences were statistically significant(P<0.05).After 20 min,GER in the control group was significantly higher than that in the anxiety group,the difference was statistically significant(P<0.05).ConclusionOral gastrointestinal ultrasound contrast agents is a economic,strongly operable,non-invasive and highly repeatable method for evaluating the gastric motility.
anxiety;gastrointestinal contrast echocardiography;gastric emptying;functional dyspepsia
李文艷(1982-),住院醫(yī)師,碩士,主要從事胃腸道超聲造影方面的研究。△
,E-mail:147920677@qq.com。
R749.7
A
1671-8348(2016)20-2798-03
2016-01-15
2016-03-22)
論著·臨床研究doi:10.3969/j.issn.1671-8348.2016.20.020