Colonic motor response to wakening is blunted in slow transit constipation as detected by wireless motility capsule.
Colonic motor response to wakening is blunted in slow transit constipation as detected by wireless motility capsule.
复制标题
无线运动胶囊检测到，在慢传输型便秘中，结肠运动对唤醒的反应减弱。
DOI：
10.1038/s41424-018-0012-9
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发表时间：
2018
影响因子：
3.6
通讯作者：
Kuo,Braden
中科院分区：
文献类型：
--
作者：
Surjanhata,Brian;Barshop,Kenneth;Staller,Kyle;Semler,Jack;Guay,Laurence;Kuo,Braden
背景：慢性便秘可分为正常转运（NTC）、慢转运（STC）或出口梗阻。结肠觉醒反应是在觉醒时结肠运动的相对增加。结肠测压研究表明STC的尾流反应减弱。我们试图用无线运动胶囊（WMC）评估健康(H)、NTC和STC患者的觉醒反应。方法：回顾性研究来自多中心临床试验和三级胃肠病学诊所的WMC数据。分析醒前1 h和醒后20 min窗口WMC收缩频率（Ct）和收缩曲线下面积（AUC）的运动参数。t检验比较了H、NTC和STC之间的参数。进行线性回归分析以确定出口阻塞是否混淆数据。接收机工作特性曲线显示最佳Ct截止定义钝尾流响应。结果：共分析H组62例，NTC组53例，STC组75例。苏醒后20、40和60 min， STC受试者的平均Ct值显著低于H组（p< 0.001）和NTC组（p< 0.01）。线性回归表明，出口阻塞与尾流响应降低无关（β= 3.94,(CI-3.12-1.00)， P= 0.27）。醒后20分钟的Ct阈值为64，慢性便秘的钝醒反应敏感性为84%，特异性为32%。结论：STC而非NTC患者的觉醒反应受损的发现进一步证明了神经元功能障碍是STC的病因，并确定了药物干预的可能时间靶点。
Background:Chronic constipation may be categorized as normal transit (NTC), slow transit (STC), or outlet obstruction. Colonic wake response is a relative increase in colonic motility upon awakening. Colonic manometry studies have demonstrated attenuated wake response in STC. We sought to evaluate wake response among healthy (H), NTC, and STC patients using wireless motility capsule (WMC).Methods:A retrospective study of WMC data from a multicenter clinical trial and a tertiary gastroenterology clinic was performed. WMC motility parameters of contraction frequency (Ct) and area under the contraction curve (AUC) were analyzed in 20-min windows 1-h before and after awakening. T-tests compared parameters between H, NTC, and STC. Linear regression analysis was performed to determine if outlet obstruction confounded data. A receiver operating characteristic curve demonstrated optimal Ct cut-offs to define blunted wake response.Results:A total of 62 H, 53 NTC and 75 STC subjects were analyzed. At 20, 40, and 60 min after awakening, STC subjects had significantly lower mean Ct when compared to H (p< 0.001) and NTC (p< 0.01). Linear regression demonstrated that outlet obstruction was not associated with a decreased wake response (β= 3.94,(CI-3.12–1.00), P= 0.27). Defined at the Ct threshold of 64 at 20-min post-wake, blunted wake response sensitivity was 84% and specificity was 32% for chronic constipation.Conclusion:Findings of an impaired wake response in subjects with STC and not NTC adds further evidence to neuronal dysfunction as an etiology of STC, and identifies a possible temporal target for pharmacologic intervention.