广州医科大学学报

目的:探讨幽门螺旋杆菌(Hp)对腹泻型肠易激综合征(IBS-D)患者直肠肛门运动及直肠感觉功能的影响。方法:采用14C尿素呼吸试验及病理组织学检测60例IBS-D患者,根据是否有Hp感染分为Hp阳性组与Hp阴性组,采用高分辨多道胃肠功能消化道检测仪检测IBS-D患者肛门直肠运动功能及直肠感觉,以25例健康人作对照。结果:增加腹压时,Hp阳性组与Hp阴性组IBS-D肛门括约肌净增压分别为(3.1±0.9)和(3.0±1.0)kPa,低于正常对照组(3.6±1.6)kPa(P<0.05)。Hp阳性组与Hp阴性组IBS-D直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显低于正常对照组(P<0.05)。直肠静息压、肛门括约肌压力、最大缩窄压、模拟大便时括约肌净减压、增加腹压时,肛门括约肌净增压,Hp阴性组与Hp阳性组差异无统计学竞义(P>0.05)。直肠对容量刺激的最大耐受性Hp阳性组低于Hp阴性组(P<0.05)。结论:IBS-D直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱。Hp感染对IBS-D患者肛门直肠动力无影响,但可能影响IBS-D患者直肠对容量刺激的耐受能力。

Objective;To study the anorectal motility and rectal sensation in patients with diarrhea- predominant irritable bowel syndrome(IBS-D) and the influence of Helicobacter pylori(Hp) infection. Methods;C14-urea breath test and histopathology were performed in 60 patients with IBS-D to detect Hp infection,according to the results of which,patients were divided into Hp infected group and Hp non-infected group.PC-Polygraf HR high-solution multichannel recording system(CTD-SYNECTICS,Sweden) was used to evaluate the anorectal motility and rectal sensation,with 25 healthy taken as controls.Results:When abdominal pressure increased,the increases of anal sphincter pressure were respectively(3.1±0.9) kPa and(3.0±1.0) kpa in Hp infected and non-infected group,both of which were lower than that of controls[(3.6±1.6) kPa,P < 0.05].The lowest volume of sensory threshold,the maximal volume of tolerance and maximal compliance of rectum were respectively in Hp infected group and in Hp non-infective group,all of which were lower than those in controls P <0.05).No significant difference between Hp infected and non-infected groups were found in rectal static pressure,the pressure of anal sphincter,the maximal squeeze pressure of anal sphincter,the net increased pressure of anal sphincter during abdominal pressure increase,and the net decreased pressure of anal sphincter during defecation imitation(P >0.05),while the maximal tolerance volume of rectum in Hp infected group were lower than those in Hp non-infected group(P <0.05).Conclusions:IBS-D patients are with higher sensitivity, lower tolerance and lower compliance of rectum to volume stimulation,and also with weakened automatic control function of anus.Hp infection might not influence the anorectal motility but might affect the volume of tolerance in patients with IBS-D,further studies with larger sample size on which is vet to be done.