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目的探讨肠易激综合征(irritable bowel syndrome,IBS)是否存在内脏感知和胆囊收缩功能异常。方法选择2003年2月至2004年2月在中国医科大学附属第一医院消化内科就诊,诊断符合RomeⅡ标准的IBS患者76例,按是否有腹痛症状分为腹痛组40例,非腹痛组36例,按症状类型分为腹泻组18例、便秘组30例、腹泻与便秘交替组28例;以30名健康志愿者为对照组。直肠初始感受容积和紧迫感阈值容积的测定采用直肠水囊容积试验。用实时超声图像检测空腹胆囊和进食后不同时间的胆囊容积。结果与对照组比较,IBS患者直肠容积的初始感受容积和紧迫感阈值容积明显降低。腹泻组、便秘组和腹泻便秘交替组IBS初始感受容积均低于对照组(P<0.01或P<0.05),腹痛组IBS患者的初始感受容积和紧迫感阈值容积明显低于非腹痛组(P<0.01)。IBS患者空腹胆囊容积、进餐后40min、60min和120min胆囊残余容量均高于对照组(均P<0.01)。IBS患者胆囊最大排空百分比显著大于对照组,最大收缩时间显著短于对照组(均P<0.01)。结论IBS患者内脏神经敏感性增加,可能是IBS发病的主要机制之一。IBS患者可能存在胆囊收缩功能异常。
Objective To investigate the presence of visceral perception and abnormal gallbladder contractility in irritable bowel syndrome (IBS). Methods From February 2003 to February 2004, 76 patients with IBS who met the criteria of Rome Ⅱ were enrolled in the Department of Gastroenterology, the First Affiliated Hospital of China Medical University. According to the presence or absence of abdominal pain, they were divided into abdominal pain group (n = 40) and non-abdominal pain group (n = 36) According to the type of symptoms, there were 18 cases of diarrhea group, 30 cases of constipation group, 28 cases of alternating diarrhea and constipation group, and 30 healthy volunteers as control group. Rectal volume and sense of urgency threshold volume determination of rectal water sac volume test. The gallbladder volume of fasting gallbladder and different time after eating were measured by real-time ultrasound images. Results Compared with the control group, the initial sensory volume and the threshold volume of urgency in IBS patients were significantly decreased. The initial sensory volume of IBS in diarrhea group, constipation group and diarrhea constipation group were lower than those in control group (P <0.01 or P <0.05). The threshold volume of initial sensory volume and urgency in abdominal pain group were significantly lower than those in non-abdominal pain group <0.01). The volume of fasting gallbladder in IBS patients, residual capacity of gallbladder after 40min, 60min and 120min after meal were all higher than those in control group (all P <0.01). The maximum percentage of gallbladder emptying in patients with IBS was significantly greater than that of the control group, and the maximum contraction time was significantly shorter than that of the control group (all P <0.01). Conclusion The increased sensitivity of visceral nerves in patients with IBS may be one of the main pathogens of IBS. IBS patients may have abnormal gallbladder contractility.