功能性便秘患者排便动力学、肛管直肠敏感性及精神心理因素的研究
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摘要
目的:探讨功能性便秘(FC)患者排便动力学与肛门直肠感觉功能的改变,同时结合心理测试来研究FC的病理生理学机制:并探时其治疗2个月后各项指标的变化情况。
方法:纳入符合罗马Ⅲ标准的82例FC和38例健康对照。通过钡条法研究全结肠通过时间。应用肛管直肠测压检测肛管直肠运动功能;通过直肠球囊注气进行容量刺激,评价肛门直肠敏感性。同时采用Zung焦虑自评量表及抑郁自评量表评价精神心理状况。入组的FC组患者分型后,分别予以促动力药、生物反馈和联合两种方法的治疗,评价疗效。
结果:1.FC患者结肠通过时间较对照组明显延长。2.FC患者存在肛门直肠动力学的异常:包括肛门内外括约肌压力异常和肛门括约肌反向矛盾收缩。3.FC患者存在肛门直肠感觉异常:最大耐受容量增大,直肠粘膜对容量刺激的反应性降低。4.FC患者焦虑、抑郁评分明显高于对照组。5.FC患者治疗后与治疗前比较:症状评分明显改善,肛门括约肌最大缩榨压显著升高,直肠敏感性改善,焦虑、抑郁评分明显下降。
结论:结直肠肛门动力异常、肛门直肠敏感性改变和精神心理因素等均参与FC的发病。针对不同病生机制的治疗可明显改善FC患者的症状、肛门直肠动力和敏感性指标,同时患者精神心理状态也明显改善。
[Aims] To investigate the colonic dynamics, anorectal motility, anorectal sensation and psychology in patients who was diagnosed with functional constipation (FC) and explore the possible pathophysiology.
[Materials and Methods] Eight-two patients with FC and 38 healthy controls who was diagnosed by Rome III in Department of Gastroenterology, China-Japan Friendship Hospital, between July 2007 and October 2008 were included in our study. Total and segmental colonic transit times and transit index were assessed using radiopaque markers method, anorectal manometry and rectal sensory function was tested by UPS2020 testing system, and psychological testing was performed by the Zung Self-Rateing Anxiety Scale and Zung Self-Rateing Depression Scale.
[Results] The colonic transit time in patients with FC was significantly prolonged than that controls. Lower anorectal sphincteric resting pressure (P<0.05), lower anorectal sphincteric maximum squeezing pressure (P<0.05), and longer length of anal high pressure zone (P<0.05) were observed in patients with FC. Patients displayed larger minimum relaxation volume, larger first sensitive volume, larger rectal maximum tolerable volume thresholds compared with healthy controls. Compared with the health controls, patients with FC have higher scores not only in anxiety but also in depreesion.(P<0.05). After two months' treatment, patients with FC show higher anorectal sphincteric maximum squeezing pressure, less first sensitive volume, less rectal maximum tolerable volume thresholds compared with that before treatment. Moreover, the scores of SAS and SDS apparently decline after treatment.
[Conclusion] The abnormalities of gut motility, visceral perception and psychological disordrers may be involved in the pathogenesis of constipation. Abnormal psychological statement was often found in patients with FC. The symptoms, parameters of anoretal motility and perception were improved through treatment in patients with FC.
方法:纳入符合罗马Ⅲ标准的82例FC和38例健康对照。通过钡条法研究全结肠通过时间。应用肛管直肠测压检测肛管直肠运动功能;通过直肠球囊注气进行容量刺激,评价肛门直肠敏感性。同时采用Zung焦虑自评量表及抑郁自评量表评价精神心理状况。入组的FC组患者分型后,分别予以促动力药、生物反馈和联合两种方法的治疗,评价疗效。
结果:1.FC患者结肠通过时间较对照组明显延长。2.FC患者存在肛门直肠动力学的异常:包括肛门内外括约肌压力异常和肛门括约肌反向矛盾收缩。3.FC患者存在肛门直肠感觉异常:最大耐受容量增大,直肠粘膜对容量刺激的反应性降低。4.FC患者焦虑、抑郁评分明显高于对照组。5.FC患者治疗后与治疗前比较:症状评分明显改善,肛门括约肌最大缩榨压显著升高,直肠敏感性改善,焦虑、抑郁评分明显下降。
结论:结直肠肛门动力异常、肛门直肠敏感性改变和精神心理因素等均参与FC的发病。针对不同病生机制的治疗可明显改善FC患者的症状、肛门直肠动力和敏感性指标,同时患者精神心理状态也明显改善。
[Aims] To investigate the colonic dynamics, anorectal motility, anorectal sensation and psychology in patients who was diagnosed with functional constipation (FC) and explore the possible pathophysiology.
[Materials and Methods] Eight-two patients with FC and 38 healthy controls who was diagnosed by Rome III in Department of Gastroenterology, China-Japan Friendship Hospital, between July 2007 and October 2008 were included in our study. Total and segmental colonic transit times and transit index were assessed using radiopaque markers method, anorectal manometry and rectal sensory function was tested by UPS2020 testing system, and psychological testing was performed by the Zung Self-Rateing Anxiety Scale and Zung Self-Rateing Depression Scale.
[Results] The colonic transit time in patients with FC was significantly prolonged than that controls. Lower anorectal sphincteric resting pressure (P<0.05), lower anorectal sphincteric maximum squeezing pressure (P<0.05), and longer length of anal high pressure zone (P<0.05) were observed in patients with FC. Patients displayed larger minimum relaxation volume, larger first sensitive volume, larger rectal maximum tolerable volume thresholds compared with healthy controls. Compared with the health controls, patients with FC have higher scores not only in anxiety but also in depreesion.(P<0.05). After two months' treatment, patients with FC show higher anorectal sphincteric maximum squeezing pressure, less first sensitive volume, less rectal maximum tolerable volume thresholds compared with that before treatment. Moreover, the scores of SAS and SDS apparently decline after treatment.
[Conclusion] The abnormalities of gut motility, visceral perception and psychological disordrers may be involved in the pathogenesis of constipation. Abnormal psychological statement was often found in patients with FC. The symptoms, parameters of anoretal motility and perception were improved through treatment in patients with FC.
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