CAJ | 학술논문

目的便秘患儿肛门直肠测压中的抑制反射波形往往不典型，不能反映抑制反射的所有参数，本研究通过分析不典型抑制反射患儿肛门直肠测压基本参数，筛选出相互独立的可能诊断便秘相关疾病的危险因素。方法收集2012年5月至2014年3月在西安交通大学医学院第二附属医院进行肛门直肠测压，表现为不典型抑制反射的患儿共92例，分为正常组36例，先天性巨结肠组24例，巨结肠同源病组32例，采用单因素分析及非条件 Logistic 回归分析评估可能提示诊断便秘相关疾病的危险因素。结果单因素分析结果提示最大抑制反射时程与抑制反射时程比（Ti max ／Tr 0．360±0．053 vs 0.414±0．052，P ＜0．01）、压力变化（0.865±0．069 vs 0．605±0．124，P ＜0．01）是诊断 HD 的危险因素，肛管静息压（P ＝0．034）、抑制反射时程（13．29±5．63 vs 18．25±7．30，P ＜0．05）、Ti max ／Tr （0．360±0.053 vs 0．440±0．091，P ＜0．01）和压力变化（0．865±0．069 vs 0．643±0．124，P ＜0．01）是诊断 HAD 的危险因素。Logistic 回归分析结果显示肛管静息压不能作为诊断 HAD 的危险因素，其他危险因素与单因素分析结果一致。结论直肠肛门测压抑制反射参数中的 Ti max、压力变化是不典型抑制反射便秘患儿诊断 HD 和 HAD 的危险因素，而抑制反射时程延时是诊断 HAD 的独立危险因素。
목적편비환인항문직장측압중적억제반사파형왕왕불전형，불능반영억제반사적소유삼수，본연구통과분석불전형억제반사환인항문직장측압기본삼수，사선출상호독립적가능진단편비상관질병적위험인소。방법수집2012년5월지2014년3월재서안교통대학의학원제이부속의원진행항문직장측압，표현위불전형억제반사적환인공92례，분위정상조36례，선천성거결장조24례，거결장동원병조32례，채용단인소분석급비조건 Logistic 회귀분석평고가능제시진단편비상관질병적위험인소。결과단인소분석결과제시최대억제반사시정여억제반사시정비（Ti max ／Tr 0．360±0．053 vs 0.414±0．052，P ＜0．01）、압력변화（0.865±0．069 vs 0．605±0．124，P ＜0．01）시진단 HD 적위험인소，항관정식압（P ＝0．034）、억제반사시정（13．29±5．63 vs 18．25±7．30，P ＜0．05）、Ti max ／Tr （0．360±0.053 vs 0．440±0．091，P ＜0．01）화압력변화（0．865±0．069 vs 0．643±0．124，P ＜0．01）시진단 HAD 적위험인소。Logistic 회귀분석결과현시항관정식압불능작위진단 HAD 적위험인소，기타위험인소여단인소분석결과일치。결론직장항문측압억제반사삼수중적 Ti max、압력변화시불전형억제반사편비환인진단 HD 화 HAD 적위험인소，이억제반사시정연시시진단 HAD 적독립위험인소。
Objetive The inhibitory curve of the recoanal inhibitory reflex (RAIR)is always atypical in children with constipation,and can not reflect all parameters of RAIR.This study analyses the changes of the basic parameters of anorectal manometry (ARM)in constipated children with non-standard inhibitory curve of RAIR to select potential risk factors for diagnosing the disorders related to constipation. Methods ARM data were collected from May 2012 to March 2014,and there were 92 patients with non-standard inhibitory curve of RAIR (Normal children,n =36,Hirschsprung’s disease,n =24,Hirschsprung’s allied disease,n =32).Hy-pothesis testing and logistic regression were applied to analyze the factors influencing the differential diagnosis of the different disorders related to constipation. Results The results of single factor analysis showed that Ti max /Tr(0.360 ±0.053 vs 0.414 ±0.052,P <0.01 ),maximal inhibitory pressure (0.865 ±0.069 vs 0.605 ±0.124,P <0.01)are the diagnosis risk factors for HD and anal resting pressure (P =0.034),recov-ery time (13.29 ±5.63 vs 18.25 ±7.30,P <0.05),Ti max /Tr(0.360 ±0.053 vs 0.440 ±0.091,P <0.01), maximal inhibitory pressure (0.865 ±0.069 vs 0.643 ±0.124,P <0.01)are the diagnosis risk factors for HAD.Logistic regression analysis indicated that anal resting pressure was not the diagnosis risk factor for HAD,and the other results were similar to those results from hypothesis testing. Conclusion Ti max /Tr,max-imal inhibitory pressure in ARMare both the diagnosis risk factors for HD and HAD.The recovery time is the independent diagnosis risk factor for HAD.