肠易激综合征内脏感知异常与临床症状的相关性
姜敏,汤浩,刘峥艳, 张义侠,傅宝玉, 中国医科大学附属第一医院消化内科 辽宁省沈阳市 110001
项目负责人:姜敏, 110001, 辽宁省沈沈阳市和平区南京北街155号, 中国医科大学附属第一医院.jiang-min@163.com
电话: 024-23256666-6199
收稿日期: 2004-12-08 接受日期: 2004-12-28
摘要
目的:探讨肠易激综合征(irritable bowel syndrome，IBS)患者内脏感知异常与临床腹部症状的相关性.
, 百拇医药
方法: 用问卷调查的方式对符合RomeII诊断标准的腹泻、便秘、腹泻与便秘交替三种亚型的IBS患者与内脏感知异常有关的腹部症状进行调查分析;部分患者接受了直肠水囊容积初始阈值和紧迫感阈值的测定.
结果:腹痛是IBS患者内脏感知异常的主要临床表现;与正常对照组比较，IBS患者直肠容积的初始阈值和紧迫感阈值明显降低(腹泻型IBS组初始感觉阈值33±2.02 vs 56±4.04 mL，紧迫感阈值86±4.53 vs 135±3.55 mL，P<0.01;便秘型和腹泻便秘交替型IBS组初始感觉阈值分别为42±3.69 vs 56±4.04，38±3.56 vs 56±4.04 mL，紧迫感阈值分别为96±3.45 vs 135±3.55 mL，102±4.78 vs 135±3.55 mL，P<0.05)，以腹痛为主和以非腹痛为主的IBS患者相比，以腹痛为主的IBS患者的初始阈值和紧迫感阈值明显降低(初始感觉阈值26±2.29 vs 42±3.34ml，P<0.05，紧迫感阈值68±4.20 vs 94±4.37 mL，P<0.01).
, http://www.100md.com
结论:腹痛是内脏感知异常最主要的临床表现，内脏神经敏感性增加即内脏感知异常是IBS的主要发病机制.
姜敏, 汤浩, 刘峥艳, 张义侠, 傅宝玉. 肠易激综合征内脏感知异常与临床症状的相关性. 世界华人消化杂志 2005;13(4):561-564
参考文献1 Menz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is biologicalmarker of patients with
irritable bowel syndrome. Gastroenterology 1995;109:40-50
, http://www.100md.com
2 Drossman DA, Creed FH, Olden KW, Svedlund J, Toner BB, Whitehead WE. Psychosocial aspects of the functional
gastrointestinal disorders. Gut 1999;45 Suppl 2:II25-30
3 Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada: first
population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci
, 百拇医药
2002;47:225-235
4 Di Lorenzo C, Youssef NN, Sigurdsson L, Scharff L, Griffiths J, Wald A. Visceral hyperalgesia in children with functional
abdominal pain. J Pediatr 2001;139:838-843
5 Bouin M, Meunier P, Riberdy-Poitras P. Pain hypersensitivity in patients with functional gastrointestinal disorders: a
gastrointestinal-specific defect or a general systemic condition? Dig Dis Sci 2001;46:2542-2548
, http://www.100md.com
6 Drewes AM, Petersen P, Rossel P, Gao C, Hansen JB, Arendt-Nielsen L. Sensitivity and distensibility of the rectum and
sigmoid colon in patients with irritable bowel syndrome. Scand J Gastroenterol 2001;36:827-832
7 Van Ginkel R, Voskuijl WP, Benninga MA, Taminiau JA, Boeckxstaens GE. Alterations in rectal sensitivity and motility
in childhood irritable bowel syndrom. Gastroenterology 2001;120:31-38
, 百拇医药
8 Simren M, Abrahamsson H, Bjornsson ES. An exaggerated sensory component of the gastrocolonic response in
patients with irritable bowel syndrome. Gut 2001;48:20-27
9 Bouin M, Ploured V, Boivin M, Riberdy M, Lupien F, Laganiere M, Verrier P, Poitras P. Rectal distention testing in
patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds.
, 百拇医药
Gastroenterology 2002;122:1771-1777
10 Poitras P, Riberdy Poitras M, Plourde V, Boivin M, Verrier P. Evolution of visceral sensitivity in patients with irritable
bowel syndrome. Dig Dig Sci 2002;47:914-920
11 Drossman DA. Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome?
Am J Med 1999;107:41-50
, 百拇医药
12 张东伟, 陈锡美, 邹颂海. 胃动素和胆囊收缩素与肠易激综合征的关系. 同济大学学报(医学版)
2001;22:50-51
13 杨云生, 张万岱, 潘德寿, 周殿元, 宋于刚. 肠易激综合征血浆及乙状结肠黏膜中CCK及SP的含量.
新消化病学杂志 1997;5:437-438
14 Gibbs-Gallag N, Palsson OS, Levy RL, Meyer K, Drossman DA, Whiehead WE. Selective call of gastrointestinal-sensation
word: evidence for a cognitivebehavioral contribution to irritable bowel syndrome. Am J Gastroenterol
, http://www.100md.com
2001;96:1133-1138
15 Chang L, Munakata J, Mayer EA, Schulson MJ, Johnson TD, Bernstein CN Saba L, Naliboff B, Anton PA, Matin K.
Perceptual responses in patients with inflammat or and function bowel disease. Gut 2000;50:497-505
16 Wang L, Fang X, Pan G. Intestinal infection and irritable bowel syndrome. Zhonghua Neike Zazhi 2002;41:90-93
17 Bradesi S, Eutamene H, Gracia-Villar R, Fioramonti J, Bueno L. Acute and chronic stress differently affect visceral
, http://www.100md.com
sensitivity to rectal distension in female rats. Neurogastroenterol Motil 2002;14:75-82
18 Monnikes H, Tabbe JJ, Hildebrande M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedeamann B, Heymmann-Monnikes I.
Role of stress functional gastrointestinal disorders. Evidence for stressinduced alterations in gastrointestinal motility
and sensitivity. Dig Dis 2002;19:201-211
, 百拇医药
19 Azpiroz F. Dimensions of gut dysfunction in irritable bowel syndrome: atered sensory function. Can J Gastroenterol
1999; 13 Suppl A:12A-14A
20 姜敏, 张义侠, 傅宝玉, 姜若兰. 大鼠结肠对理化刺激的内脏神经的敏感性. 世界华人消化杂志
2002;11:1278-1281
21 Camilleri M, Coulie B, Tack JK. Viscer hypersensitivity: facts,speculations, and challenges. Gut 2001;48:125-131
, 百拇医药
22 Al-Chaer ED, Kawasaki M, Pasrichs PJ. A new of chronic visceralhypersensitivity in adult rats induced by colon irritation
during postnatal development.Gastroenterology 2000;119:1276-1285
23 肖玉斌, 刘玉兰, 赵利莉. 腹泻型、便秘型肠易激综合征和功能性便秘患者的直肠感觉阈值比较.
世界华人消化杂志 2002;11:1291-1294
24 张义侠, 刘峥艳, 吕淼, 傅宝玉. 慢性便秘的分型和肛门直肠测压表现. 中华消化杂志 2001;21:488-490
, 百拇医药
25 詹丽杏, 邹多武, 许国铭. 功能性便秘和便秘型肠易激综合征的结肠传输试验及直肠感觉阈值比较研究.
中华消化内科杂志2002;22:19-21
26 Wittmann T, Feher A, Rosztoczy A. Effectiveness of pinaveriumbromide therapy on colonic motility disorders in
irritable bowel syndrome. OrvHetil 1999;140:469-473
27 詹丽杏, 李兆申, 邹多武, 许国铭, 尹宁. 匹维溴铵治疗肠易激综合征的临床疗效及改变内脏敏感性研究.
中华消化杂志 2002;22:477-480
编辑 张海宁, 百拇医药( 姜 敏,汤 浩,刘峥艳,张义侠, 傅宝玉)
项目负责人:姜敏, 110001, 辽宁省沈沈阳市和平区南京北街155号, 中国医科大学附属第一医院.jiang-min@163.com
电话: 024-23256666-6199
收稿日期: 2004-12-08 接受日期: 2004-12-28
摘要
目的:探讨肠易激综合征(irritable bowel syndrome，IBS)患者内脏感知异常与临床腹部症状的相关性.
, 百拇医药
方法: 用问卷调查的方式对符合RomeII诊断标准的腹泻、便秘、腹泻与便秘交替三种亚型的IBS患者与内脏感知异常有关的腹部症状进行调查分析;部分患者接受了直肠水囊容积初始阈值和紧迫感阈值的测定.
结果:腹痛是IBS患者内脏感知异常的主要临床表现;与正常对照组比较，IBS患者直肠容积的初始阈值和紧迫感阈值明显降低(腹泻型IBS组初始感觉阈值33±2.02 vs 56±4.04 mL，紧迫感阈值86±4.53 vs 135±3.55 mL，P<0.01;便秘型和腹泻便秘交替型IBS组初始感觉阈值分别为42±3.69 vs 56±4.04，38±3.56 vs 56±4.04 mL，紧迫感阈值分别为96±3.45 vs 135±3.55 mL，102±4.78 vs 135±3.55 mL，P<0.05)，以腹痛为主和以非腹痛为主的IBS患者相比，以腹痛为主的IBS患者的初始阈值和紧迫感阈值明显降低(初始感觉阈值26±2.29 vs 42±3.34ml，P<0.05，紧迫感阈值68±4.20 vs 94±4.37 mL，P<0.01).
, http://www.100md.com
结论:腹痛是内脏感知异常最主要的临床表现，内脏神经敏感性增加即内脏感知异常是IBS的主要发病机制.
姜敏, 汤浩, 刘峥艳, 张义侠, 傅宝玉. 肠易激综合征内脏感知异常与临床症状的相关性. 世界华人消化杂志 2005;13(4):561-564
参考文献1 Menz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is biologicalmarker of patients with
irritable bowel syndrome. Gastroenterology 1995;109:40-50
, http://www.100md.com
2 Drossman DA, Creed FH, Olden KW, Svedlund J, Toner BB, Whitehead WE. Psychosocial aspects of the functional
gastrointestinal disorders. Gut 1999;45 Suppl 2:II25-30
3 Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada: first
population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci
, 百拇医药
2002;47:225-235
4 Di Lorenzo C, Youssef NN, Sigurdsson L, Scharff L, Griffiths J, Wald A. Visceral hyperalgesia in children with functional
abdominal pain. J Pediatr 2001;139:838-843
5 Bouin M, Meunier P, Riberdy-Poitras P. Pain hypersensitivity in patients with functional gastrointestinal disorders: a
gastrointestinal-specific defect or a general systemic condition? Dig Dis Sci 2001;46:2542-2548
, http://www.100md.com
6 Drewes AM, Petersen P, Rossel P, Gao C, Hansen JB, Arendt-Nielsen L. Sensitivity and distensibility of the rectum and
sigmoid colon in patients with irritable bowel syndrome. Scand J Gastroenterol 2001;36:827-832
7 Van Ginkel R, Voskuijl WP, Benninga MA, Taminiau JA, Boeckxstaens GE. Alterations in rectal sensitivity and motility
in childhood irritable bowel syndrom. Gastroenterology 2001;120:31-38
, 百拇医药
8 Simren M, Abrahamsson H, Bjornsson ES. An exaggerated sensory component of the gastrocolonic response in
patients with irritable bowel syndrome. Gut 2001;48:20-27
9 Bouin M, Ploured V, Boivin M, Riberdy M, Lupien F, Laganiere M, Verrier P, Poitras P. Rectal distention testing in
patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds.
, 百拇医药
Gastroenterology 2002;122:1771-1777
10 Poitras P, Riberdy Poitras M, Plourde V, Boivin M, Verrier P. Evolution of visceral sensitivity in patients with irritable
bowel syndrome. Dig Dig Sci 2002;47:914-920
11 Drossman DA. Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome?
Am J Med 1999;107:41-50
, 百拇医药
12 张东伟, 陈锡美, 邹颂海. 胃动素和胆囊收缩素与肠易激综合征的关系. 同济大学学报(医学版)
2001;22:50-51
13 杨云生, 张万岱, 潘德寿, 周殿元, 宋于刚. 肠易激综合征血浆及乙状结肠黏膜中CCK及SP的含量.
新消化病学杂志 1997;5:437-438
14 Gibbs-Gallag N, Palsson OS, Levy RL, Meyer K, Drossman DA, Whiehead WE. Selective call of gastrointestinal-sensation
word: evidence for a cognitivebehavioral contribution to irritable bowel syndrome. Am J Gastroenterol
, http://www.100md.com
2001;96:1133-1138
15 Chang L, Munakata J, Mayer EA, Schulson MJ, Johnson TD, Bernstein CN Saba L, Naliboff B, Anton PA, Matin K.
Perceptual responses in patients with inflammat or and function bowel disease. Gut 2000;50:497-505
16 Wang L, Fang X, Pan G. Intestinal infection and irritable bowel syndrome. Zhonghua Neike Zazhi 2002;41:90-93
17 Bradesi S, Eutamene H, Gracia-Villar R, Fioramonti J, Bueno L. Acute and chronic stress differently affect visceral
, http://www.100md.com
sensitivity to rectal distension in female rats. Neurogastroenterol Motil 2002;14:75-82
18 Monnikes H, Tabbe JJ, Hildebrande M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedeamann B, Heymmann-Monnikes I.
Role of stress functional gastrointestinal disorders. Evidence for stressinduced alterations in gastrointestinal motility
and sensitivity. Dig Dis 2002;19:201-211
, 百拇医药
19 Azpiroz F. Dimensions of gut dysfunction in irritable bowel syndrome: atered sensory function. Can J Gastroenterol
1999; 13 Suppl A:12A-14A
20 姜敏, 张义侠, 傅宝玉, 姜若兰. 大鼠结肠对理化刺激的内脏神经的敏感性. 世界华人消化杂志
2002;11:1278-1281
21 Camilleri M, Coulie B, Tack JK. Viscer hypersensitivity: facts,speculations, and challenges. Gut 2001;48:125-131
, 百拇医药
22 Al-Chaer ED, Kawasaki M, Pasrichs PJ. A new of chronic visceralhypersensitivity in adult rats induced by colon irritation
during postnatal development.Gastroenterology 2000;119:1276-1285
23 肖玉斌, 刘玉兰, 赵利莉. 腹泻型、便秘型肠易激综合征和功能性便秘患者的直肠感觉阈值比较.
世界华人消化杂志 2002;11:1291-1294
24 张义侠, 刘峥艳, 吕淼, 傅宝玉. 慢性便秘的分型和肛门直肠测压表现. 中华消化杂志 2001;21:488-490
, 百拇医药
25 詹丽杏, 邹多武, 许国铭. 功能性便秘和便秘型肠易激综合征的结肠传输试验及直肠感觉阈值比较研究.
中华消化内科杂志2002;22:19-21
26 Wittmann T, Feher A, Rosztoczy A. Effectiveness of pinaveriumbromide therapy on colonic motility disorders in
irritable bowel syndrome. OrvHetil 1999;140:469-473
27 詹丽杏, 李兆申, 邹多武, 许国铭, 尹宁. 匹维溴铵治疗肠易激综合征的临床疗效及改变内脏敏感性研究.
中华消化杂志 2002;22:477-480
编辑 张海宁, 百拇医药( 姜 敏,汤 浩,刘峥艳,张义侠, 傅宝玉)
