脾气虚证和腹部外科MODS患者胃电图和胃肠激素变化及中药治疗作用研究
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摘要
目的：观察脾气虚证患者胃电图(EGG)和血浆胃肠激素变化并试图探讨它们之间的关系；观察某些中药治疗脾气虚证的疗效，探讨其作用机理。方法：选择53例脾气虚证患者，检测进餐前后EGG及放免测定血浆胃泌素(Gas)、胃动素(MTL)、生长抑素(SS)和血管活性肠肽(VIP)的含量；选取其中34例患者分为2组，分别予以香砂六君子汤或以西沙必利为主的西药治疗2周，观察疗效及治疗前后EGG、血浆Gas、MTL、SS和VIP的变化。结果：脾气虚证患者EGG明显紊乱，以餐后正常节律百分比(N％)降低、胃动过缓百分比(B％)增加、餐后餐前功率比(PR)＜1为特点；血浆Gas、MTL降低，SS、VIP增高；中药、西药均能明显改善脾气虚证患者症状，治疗后EGG的餐后N％增加，血浆MTL增高，SS、VIP降低，Gas有增高趋势；两个治疗组间疗效无明显差别；经计算，血浆SS与EGG中主频率(DF)、N％负相关，与B％正相关，血浆Gas与EGG中B％呈负相关趋势，与N％呈正相关趋势；胃肠激素间，血浆SS与Gas负相关。结论：脾气虚证时EGG明显紊乱，以餐后N％降低、B％增加、PR＜1为特点，血浆Gas、MTL降低、SS、VIP增高。EGG改变的原因可能与血浆中SS、Gas，特别是SS的变化有关，MTL、VIP在脾气虚证中的作用尚需进一步研究。香砂六君子汤和以西沙必利为主的西药在脾气虚证治疗中有一定作用。
Objective: To observe the changes of EGG and four kinds of plasma gastrointestinal hormones in Spleen-Qi Deficiency(SQD) and try to explore the relationship among them. Meanwhile, to observe the role of XiangSha LiuJunZi decoction and some western medicine in the treatment of SQD, the changes of EGG and gastrointestinal hormones in SQD. Method: Fifty three cases of SQD were elected and their EGG and the levels of plasma gastrin( Gas), motilin (MIL), somatostatin (SS) and vasoactive intestinal peptide(VIP) were measured. The thirty four cases were divided into two groups and were chosen for treatment with XiangSha LiuJunZi decoction or some western medicine, of which cisapride is in chief. The efficacy of treatment, changes of EGG and the content of plasma gastrointestinal hormones were also observed after treatment. Result: The EGG of SQD was disordered, which was characterized by decreased postprandial dominant frequency in normal range(N%) and dominant power(DP), increased postprandial percent of bradygast
ria(B%).The levels of Gas and MTL were lower than the normal controls and the levels of SS and VIP were higher. After being treated, the symptoms were efficiently relieved, postprandial N% and the levels of MTL increased and the levels of SS and VIP decreased. There was an increasing tendency in the level of Gas but there was not significance in statistics(P>0. 05). The efficacy was not difference between the two therapies. There was a negative correlation between the level of plasma
SS and Gas, DF, N% of EGG respectively. There was a positive correlation between the level of SS and B% of EGG. Conclusion: In SQD, the EGG was disordered, which is characterized by decreased postprandial N% and power, increased postprandial B%, and the levels of plasma Gas and MTL were decreased and the levels of plasma SS and VIP increased. The reason of EGG alteration is perhaps associated with the changes of levels of plasma SS and Gas, especially the SS. The reason of the alterated plasma level of MTL and VIP in SQD need further study. The two therapies have certain effect in treatment of the disease.
Objective: To observe the changes of EGG and four kinds of plasma gastrointestinal hormones in Spleen-Qi Deficiency(SQD) and try to explore the relationship among them. Meanwhile, to observe the role of XiangSha LiuJunZi decoction and some western medicine in the treatment of SQD, the changes of EGG and gastrointestinal hormones in SQD. Method: Fifty three cases of SQD were elected and their EGG and the levels of plasma gastrin( Gas), motilin (MIL), somatostatin (SS) and vasoactive intestinal peptide(VIP) were measured. The thirty four cases were divided into two groups and were chosen for treatment with XiangSha LiuJunZi decoction or some western medicine, of which cisapride is in chief. The efficacy of treatment, changes of EGG and the content of plasma gastrointestinal hormones were also observed after treatment. Result: The EGG of SQD was disordered, which was characterized by decreased postprandial dominant frequency in normal range(N%) and dominant power(DP), increased postprandial percent of bradygast
ria(B%).The levels of Gas and MTL were lower than the normal controls and the levels of SS and VIP were higher. After being treated, the symptoms were efficiently relieved, postprandial N% and the levels of MTL increased and the levels of SS and VIP decreased. There was an increasing tendency in the level of Gas but there was not significance in statistics(P>0. 05). The efficacy was not difference between the two therapies. There was a negative correlation between the level of plasma
SS and Gas, DF, N% of EGG respectively. There was a positive correlation between the level of SS and B% of EGG. Conclusion: In SQD, the EGG was disordered, which is characterized by decreased postprandial N% and power, increased postprandial B%, and the levels of plasma Gas and MTL were decreased and the levels of plasma SS and VIP increased. The reason of EGG alteration is perhaps associated with the changes of levels of plasma SS and Gas, especially the SS. The reason of the alterated plasma level of MTL and VIP in SQD need further study. The two therapies have certain effect in treatment of the disease.
引文
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3 葛小平，陈华，盛丽先．脾虚型厌食证患儿胃肠激素及胃电图关系探讨．中医研究，2000，13(3)：24-5
4 宋玉洁，庄泽澄．中医脾气虚证的现代研究近况及思考．山东中医药大学学报，2001，25(3)：238-41
5 任平，刘芳，黄熙，等．脾虚大鼠生长抑素、胃动素、胆囊收缩素内分泌细胞的变化．成都中医药大学学报，2001，24(1)：35-8
6 刘传珍，周丽华，水正．胃肠病脾气虚证三方的临床研究．山东中医学院学报，1995，19(2)：111-3
7 柯美云，周吕．胃电图检查及其评判标准(草案)．中华内科杂志，2000，39(3)：211
8 张道杰，吴玉生，彭立义，等．四君子汤治疗脾气虚型胃肠病疗效的评估．中国医药学报，1995，10(1)：49
9 Synectics medical AB. Digitrapper EGG user's manual. Stockholm, 1997:20-23
10 陈艳敏，柯美云，王智凤，等．50名健康人胃电参数及其影响因素的研究．中华消化杂志，2000，20(4)：227-9
11 周吕，柯美云主编．胃肠动力学(基础与临床)(第一版)．北京：科学出版社，1999：177-85
12 EI-Sharkawy TY. IntraceUular electrical activity of canine and human gastric smooth muscle. J Physiol, 1978,279:291-307
13 Hinder RA, Kelly KA. Human gastric pacesetter potential Site of organ, spread and response to gastric transection and proximal gastric vagotomy. Am J Surg, 1978,133:29-33
14 Sarna SK. Gastrointestinal electrical activity: terminology. Gastroenterology, 1975,68:1631-5
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16 绍池．重要信息：美国胃电图临床应用的现状．基础医学与临床，2001，21(增
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17 Chen JD, Lin Z, Pan J, et al. Abnormal gasric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci, 1996,41:1538-46
18 黄坤明，许国铭，邹多武，等．功能性消化不良24小时胃窦运动及胃电图改变．中华消化内科杂志，2001，21(9)：537-9
19 Hadel W, Owyang C. Peptide-induced gastric arrythmia: a new cause of gastroparesis. Regulatory Pep, 1990,2:6-11
20 Stewatt JJ, Wood CD. Effects of motion sickness and antimotion sickness drugs on gastric function. J Clin Pharmacol, 1994,34:635-43
21 Lin X, Mellow MH, Southmayd L, et al. Impaired gastricmyoelectrical activity in patients with chronic renal failure. Dig Dis Sci, 1997,42:898-93
22 Pfaffenbach B, Adamek R J, Kuhn K, et al. Electrogastrography in Health Subjects. Dig Dis Sci, 1995,40:1445-50
23 Mintchev MP., Kingma YJ, Bowes KL. Accuracy of cutaneous recordings of gastric electrical activity. Gastroenterology, 1993,104:1273-80
24 王建华．脾气虚证本质研究的途径及其方向．中医杂志，1998，39(1)：50-2
25 潘志恒，吴伟康．脾虚证研究中的若干问题探讨．南京中医药大学学报，1997，13(5)：266-8
26 任平，黄熙，张莉，等．四君子汤对实验性脾虚大鼠胃排空率的影响．中国中西医结合杂志，2000，20(8)：596-8
27 李常青．唾液淀粉酶活性比值、D—木糖排泄率和胃电图三者合参对脾气虚证的研究．湖南中医学院学报，1998，2：8-9
28 陈健德．胃电图研究的最新动态．基础医学与临床，1995，15(S：S)：1-2
29 吴信受．健脾益气汤治疗手术后“脾气虚”的观察．北京中医杂志，1985，3：26-7
30 聂克，王健华，王如俊．胃泌素与脾虚证关系的研究进展．广州中医药大学学报，1999，2：12-5
31 姚永莉，宋于刚，张万岱．实验脾虚证胃窦及十二指肠粘膜G、D细胞的变化及意义．中国中西医结合脾胃杂志，1999，7(1)：8-10
32 Kwong NK Response of the electrical activity, motor activity and acid secretion of the human stomach to pentagastrin and histamine stimulation. Stand J Gastroenterology, 1971,6:145-9
33 陈元方，钱家鸣，Stephan K，等．胃肠肽类激素基础与临床(第一版)．北京：北医协和联合出版社，1997：257-62
34 Larrson LI, Goltermann N, De Magistris L, et al. Somatostatin cell and processes as pathways for paraerine secretion. Sci Wash DC,1979,205:1393-5
35 Park J, Chiba T, Yamada T. Mechanisms for musearinic for direct inhibition of canine gastric parietal cells by somatostatha. J Biol Chem, 1987,262:14190-6
36 Itoh Z. Interdigestive motor activity of the lower esophageal sphincter in the conscious dogs. Am J Dig Dis, 1978,23:239-43
37 Takahashi I, Honda R, Dodds WJ, et al. Effect of motilin on the opossum upper gastrointestinal tract and sphincter of oddi. Am J Physiol, 1983,245:G476-81
38 Itoh Z. Motilin. Academic Press, New York, 1990,133-53
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2 北京市中医研究所，北京中医医院．有关脾气虚实质的临床观察和实验研究．中华医学杂志，1982，62(1)：22-6
3 葛小平，陈华，盛丽先．脾虚型厌食证患儿胃肠激素及胃电图关系探讨．中医研究，2000，13(3)：24-5
4 宋玉洁，庄泽澄．中医脾气虚证的现代研究近况及思考．山东中医药大学学报，2001，25(3)：238-41
5 任平，刘芳，黄熙，等．脾虚大鼠生长抑素、胃动素、胆囊收缩素内分泌细胞的变化．成都中医药大学学报，2001，24(1)：35-8
6 刘传珍，周丽华，水正．胃肠病脾气虚证三方的临床研究．山东中医学院学报，1995，19(2)：111-3
7 柯美云，周吕．胃电图检查及其评判标准(草案)．中华内科杂志，2000，39(3)：211
8 张道杰，吴玉生，彭立义，等．四君子汤治疗脾气虚型胃肠病疗效的评估．中国医药学报，1995，10(1)：49
9 Synectics medical AB. Digitrapper EGG user's manual. Stockholm, 1997:20-23
10 陈艳敏，柯美云，王智凤，等．50名健康人胃电参数及其影响因素的研究．中华消化杂志，2000，20(4)：227-9
11 周吕，柯美云主编．胃肠动力学(基础与临床)(第一版)．北京：科学出版社，1999：177-85
12 EI-Sharkawy TY. IntraceUular electrical activity of canine and human gastric smooth muscle. J Physiol, 1978,279:291-307
13 Hinder RA, Kelly KA. Human gastric pacesetter potential Site of organ, spread and response to gastric transection and proximal gastric vagotomy. Am J Surg, 1978,133:29-33
14 Sarna SK. Gastrointestinal electrical activity: terminology. Gastroenterology, 1975,68:1631-5
15 柯美云，蓝宇．胃电图基础研究及其临床应用．基础医学与临床，1999，19(2)：6-9
16 绍池．重要信息：美国胃电图临床应用的现状．基础医学与临床，2001，21(增
刊)：113
17 Chen JD, Lin Z, Pan J, et al. Abnormal gasric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci, 1996,41:1538-46
18 黄坤明，许国铭，邹多武，等．功能性消化不良24小时胃窦运动及胃电图改变．中华消化内科杂志，2001，21(9)：537-9
19 Hadel W, Owyang C. Peptide-induced gastric arrythmia: a new cause of gastroparesis. Regulatory Pep, 1990,2:6-11
20 Stewatt JJ, Wood CD. Effects of motion sickness and antimotion sickness drugs on gastric function. J Clin Pharmacol, 1994,34:635-43
21 Lin X, Mellow MH, Southmayd L, et al. Impaired gastricmyoelectrical activity in patients with chronic renal failure. Dig Dis Sci, 1997,42:898-93
22 Pfaffenbach B, Adamek R J, Kuhn K, et al. Electrogastrography in Health Subjects. Dig Dis Sci, 1995,40:1445-50
23 Mintchev MP., Kingma YJ, Bowes KL. Accuracy of cutaneous recordings of gastric electrical activity. Gastroenterology, 1993,104:1273-80
24 王建华．脾气虚证本质研究的途径及其方向．中医杂志，1998，39(1)：50-2
25 潘志恒，吴伟康．脾虚证研究中的若干问题探讨．南京中医药大学学报，1997，13(5)：266-8
26 任平，黄熙，张莉，等．四君子汤对实验性脾虚大鼠胃排空率的影响．中国中西医结合杂志，2000，20(8)：596-8
27 李常青．唾液淀粉酶活性比值、D—木糖排泄率和胃电图三者合参对脾气虚证的研究．湖南中医学院学报，1998，2：8-9
28 陈健德．胃电图研究的最新动态．基础医学与临床，1995，15(S：S)：1-2
29 吴信受．健脾益气汤治疗手术后“脾气虚”的观察．北京中医杂志，1985，3：26-7
30 聂克，王健华，王如俊．胃泌素与脾虚证关系的研究进展．广州中医药大学学报，1999，2：12-5
31 姚永莉，宋于刚，张万岱．实验脾虚证胃窦及十二指肠粘膜G、D细胞的变化及意义．中国中西医结合脾胃杂志，1999，7(1)：8-10
32 Kwong NK Response of the electrical activity, motor activity and acid secretion of the human stomach to pentagastrin and histamine stimulation. Stand J Gastroenterology, 1971,6:145-9
33 陈元方，钱家鸣，Stephan K，等．胃肠肽类激素基础与临床(第一版)．北京：北医协和联合出版社，1997：257-62
34 Larrson LI, Goltermann N, De Magistris L, et al. Somatostatin cell and processes as pathways for paraerine secretion. Sci Wash DC,1979,205:1393-5
35 Park J, Chiba T, Yamada T. Mechanisms for musearinic for direct inhibition of canine gastric parietal cells by somatostatha. J Biol Chem, 1987,262:14190-6
36 Itoh Z. Interdigestive motor activity of the lower esophageal sphincter in the conscious dogs. Am J Dig Dis, 1978,23:239-43
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