中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2013年
7期
562-566
,共5页
袁作辉%王琨%段丽萍%樊东升%徐志洁%夏志伟%葛颖
袁作輝%王琨%段麗萍%樊東升%徐誌潔%夏誌偉%葛穎
원작휘%왕곤%단려평%번동승%서지길%하지위%갈영
帕金森病%功能性便秘%直肠肛门测压
帕金森病%功能性便祕%直腸肛門測壓
파금삼병%공능성편비%직장항문측압
Parkinson disease%Functional constipation%Anorectal manometry
目的 观察帕金森病(PD)伴便秘患者与功能性便秘(FC)患者的直肠肛门动力和感觉功能及其异同.方法 顺序纳入男性PD伴便秘患者15例及男性FC患者45例,均经全结肠镜或结肠钡灌肠除外肠道器质性疾病.经直肠肛门测压,分析患者直肠肛门动力参数及感觉参数,将排便障碍患者进一步分为排便协同障碍(F3a)及排便推进力不足(F3b)两种亚型.结果 PD伴便秘组年龄(70±11)岁,FC组年龄为(68±11)岁,差异无统计学意义.PD伴便秘组直肠静息压较FC组偏高[9.0(4.0,15.0) mm Hg比6.0(3.0,9.5)mm Hg,1 mm Hg =0.133 kPa],但差异无统计学意义(P=0.082)；两组肛管静息压的差异无统计学意义[(51.2±17.2) mm Hg比(59.7±20.4) mm Hg,P=0.152].缩紧肛门时,PD伴便秘组的肛管最大缩榨压及持续缩榨曲线下面积均显著低于FC组[(136.9 ±43.8)mm Hg比(183.0±62.1)mm Hg,P=0.010;(823.5 ±635.7)mm Hg·s比(1392.4±939.9)mm Hg·s,P=0.033].模拟排便时,PD伴便秘组的直肠力排压及肛管力排剩余压也明显低于FC组[22.0(15.0,30.0)mm Hg比42.0(31.0,55.0) mm Hg,P=0.000;(46.3±23.3)mm Hg比(77.9±35.1)mm Hg,P=0.002]；两组力排时的直肠肛管压差均为负值,异于正常排便压差,但两组间差异无统计学意义.PD伴便秘患者排便障碍以F3b型为主(10/15)；FC组中以F3a型多见[46.7％ (21/45)]；但两组的排便障碍类型构成比的差异无统计学意义(P =0.120).PD伴便秘患者及FC患者的直肠扩张初始感觉阈值分别为(91.3 ±56.9)ml与(67.2 ±38.9)ml,均高于正常参考值,但两组间差异尚无统计学意义(P =0.074).结论 PD伴便秘患者及FC患者均存在直肠肛门动力和感觉异常.与FC患者相比,PD伴便秘患者的缩肛及力排的重要参数值明显降低,且测压分型以F3b型为主,感觉阈值有升高趋势.上述指标可作为PD伴便秘患者直肠肛门测压的特征参数,对PD发病机制的理解及其与相关疾病的鉴别可起重要作用.
目的 觀察帕金森病(PD)伴便祕患者與功能性便祕(FC)患者的直腸肛門動力和感覺功能及其異同.方法 順序納入男性PD伴便祕患者15例及男性FC患者45例,均經全結腸鏡或結腸鋇灌腸除外腸道器質性疾病.經直腸肛門測壓,分析患者直腸肛門動力參數及感覺參數,將排便障礙患者進一步分為排便協同障礙(F3a)及排便推進力不足(F3b)兩種亞型.結果 PD伴便祕組年齡(70±11)歲,FC組年齡為(68±11)歲,差異無統計學意義.PD伴便祕組直腸靜息壓較FC組偏高[9.0(4.0,15.0) mm Hg比6.0(3.0,9.5)mm Hg,1 mm Hg =0.133 kPa],但差異無統計學意義(P=0.082)；兩組肛管靜息壓的差異無統計學意義[(51.2±17.2) mm Hg比(59.7±20.4) mm Hg,P=0.152].縮緊肛門時,PD伴便祕組的肛管最大縮榨壓及持續縮榨麯線下麵積均顯著低于FC組[(136.9 ±43.8)mm Hg比(183.0±62.1)mm Hg,P=0.010;(823.5 ±635.7)mm Hg·s比(1392.4±939.9)mm Hg·s,P=0.033].模擬排便時,PD伴便祕組的直腸力排壓及肛管力排剩餘壓也明顯低于FC組[22.0(15.0,30.0)mm Hg比42.0(31.0,55.0) mm Hg,P=0.000;(46.3±23.3)mm Hg比(77.9±35.1)mm Hg,P=0.002]；兩組力排時的直腸肛管壓差均為負值,異于正常排便壓差,但兩組間差異無統計學意義.PD伴便祕患者排便障礙以F3b型為主(10/15)；FC組中以F3a型多見[46.7％ (21/45)]；但兩組的排便障礙類型構成比的差異無統計學意義(P =0.120).PD伴便祕患者及FC患者的直腸擴張初始感覺閾值分彆為(91.3 ±56.9)ml與(67.2 ±38.9)ml,均高于正常參攷值,但兩組間差異尚無統計學意義(P =0.074).結論 PD伴便祕患者及FC患者均存在直腸肛門動力和感覺異常.與FC患者相比,PD伴便祕患者的縮肛及力排的重要參數值明顯降低,且測壓分型以F3b型為主,感覺閾值有升高趨勢.上述指標可作為PD伴便祕患者直腸肛門測壓的特徵參數,對PD髮病機製的理解及其與相關疾病的鑒彆可起重要作用.
목적 관찰파금삼병(PD)반편비환자여공능성편비(FC)환자적직장항문동력화감각공능급기이동.방법 순서납입남성PD반편비환자15례급남성FC환자45례,균경전결장경혹결장패관장제외장도기질성질병.경직장항문측압,분석환자직장항문동력삼수급감각삼수,장배편장애환자진일보분위배편협동장애(F3a)급배편추진력불족(F3b)량충아형.결과 PD반편비조년령(70±11)세,FC조년령위(68±11)세,차이무통계학의의.PD반편비조직장정식압교FC조편고[9.0(4.0,15.0) mm Hg비6.0(3.0,9.5)mm Hg,1 mm Hg =0.133 kPa],단차이무통계학의의(P=0.082)；량조항관정식압적차이무통계학의의[(51.2±17.2) mm Hg비(59.7±20.4) mm Hg,P=0.152].축긴항문시,PD반편비조적항관최대축자압급지속축자곡선하면적균현저저우FC조[(136.9 ±43.8)mm Hg비(183.0±62.1)mm Hg,P=0.010;(823.5 ±635.7)mm Hg·s비(1392.4±939.9)mm Hg·s,P=0.033].모의배편시,PD반편비조적직장력배압급항관력배잉여압야명현저우FC조[22.0(15.0,30.0)mm Hg비42.0(31.0,55.0) mm Hg,P=0.000;(46.3±23.3)mm Hg비(77.9±35.1)mm Hg,P=0.002]；량조력배시적직장항관압차균위부치,이우정상배편압차,단량조간차이무통계학의의.PD반편비환자배편장애이F3b형위주(10/15)；FC조중이F3a형다견[46.7％ (21/45)]；단량조적배편장애류형구성비적차이무통계학의의(P =0.120).PD반편비환자급FC환자적직장확장초시감각역치분별위(91.3 ±56.9)ml여(67.2 ±38.9)ml,균고우정상삼고치,단량조간차이상무통계학의의(P =0.074).결론 PD반편비환자급FC환자균존재직장항문동력화감각이상.여FC환자상비,PD반편비환자적축항급력배적중요삼수치명현강저,차측압분형이F3b형위주,감각역치유승고추세.상술지표가작위PD반편비환자직장항문측압적특정삼수,대PD발병궤제적리해급기여상관질병적감별가기중요작용.
Objective To investigate the discrepancy of anorectal function in patients of Parkinson's disease (PD) with constipation and functional constipation (FC).Methods Fifteen consecutive male PD patients with constipation and 45 male FC patients were recruited for the study.All subjects underwent colonoscopy or barium enema in order to exclude organic colon diseases.Every patient underwent anorectal manometry and was categorized into subgroups of either dyssynergic defecation (F3a) or inadequate defecatory propulsion (F3b).Results The ages of PD with constipation and FC patients were (70 ± 11) and (68 ± 11) years old respectively.The rectal resting pressure in PD with constipation was higher than that in FC group without statistical significance [9.0 (4.0,15.0) mm Hg vs 6.0 (3.0,9.5) mm Hg,P=0.082,1 mm Hg =0.133 kPa].The anal resting pressure in PD group was not different from FC group [(51.2±17.2) mm Hg vs (59.7 ± 20.4) mm Hg,P =0.152].During anal squeezing,the maximal contraction pressure and area under the squeeze curve in PD with constipation group were both significantly lower than FC patients [maximal contraction pressure:(136.9 ± 43.8) mm Hg vs (183.0 ± 62.1) mm Hg,P=0.010; area under the squeeze curve:(823.5 ±635.7) mm Hg · s vs (1392.4± 939.9) mm Hg · s,P =0.033].During forced defecation,both of the defecation rectal pressure and defecation anal pressure in PD with constipation group were significantly lower than that of FC patients [22.0(15.0,30.0) vs42.0(31.0,55.0)mm Hg,P=0.000; and (46.3 ±23.3) vs (77.9 ±35.1) mm Hg,P =0.002].The proportions of F3a subtype were 10/15 and 46.7％ (21/45) in PD with constipation and FC patients respectively.There was no significant difference in the constituent ratio (P =0.120).Initial rectal sensory volumes were (91.3 ± 56.9) ml and (67.2 ± 38.9) ml in PD with constipation and FC patients respectively.Even both volumes were higher than the normal controls,there was no significant difference between the two groups (P =0.074).Conclusions Both PD with constipation and FC patients have abnormal anorectal motility and sensation comparing to the FC group,the parameters of anal contraction and defecation are significantly lower,F3b is dominant,and rectal sensory threshold is higher in PD with constipation patients.These parameters could possibly characterize the anorectal manometry for PD with constipation patients,which is helpful to understand the pathogenesis of PD and differentiate from other diseases.
