Normal Values for High-Resolution Anorectal Manometry in Healthy Women: Effects of Age and Significance of Rectoanal Gradient
Normal Values for High-Resolution Anorectal Manometry in Healthy Women: Effects of Age and Significance of Rectoanal Gradient
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DOI：
10.1038/ajg.2012.221
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发表时间：
2012-10-01
影响因子：
9.8
通讯作者：
Zinsmeister, Alan R.
中科院分区：
文献类型：
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作者：
Noelting, Jessica;Ratuapli, Shiva K.;Zinsmeister, Alan R.
注意事项：高分辨率测压（HRM）在临床实践中用于测量肛门压力，但正常值尚未获得。虽然直肠排空是通过模拟排空过程中的直肠肛门梯度来评估的，但健康人和排便障碍之间存在大量重叠，年龄的影响尚不清楚。我们评估了年龄对健康women.METHODS的肛门直肠压力和直肠气囊排出的影响：肛门直肠压力（HRM），直肠感觉，和气囊排出时间（BET）进行了评估，在62无症状的妇女，年龄范围从21岁到80岁（中位年龄44岁），没有肛门直肠创伤的危险因素。总共有30名女性年龄= 50岁，88（3）（< 50岁），平均值（s.e.m.））而不是挤压压力;模拟排空时直肠压力和直肠肛门梯度较高（r = 0.3，P < 0.05）;直肠BET较短（r =-0.4，P < 0.01）（17（9）s（≥ 50岁）vs. 31（10）s（< 50岁））。只有5名女性的直肠BET延长（>60 s），但52名女性的肛门压力高于直肠压力（即，负梯度）。年轻女性（-41（6）mm Hg）的梯度比老年女性（-12（6）mm Hg）的梯度更负，并且与直肠BET呈负相关（r =-0.51，P < 0.0001），但仅解释了直肠BET变化的16%。无症状妇女年龄的增长与较低的肛门静息压、模拟排空时更正的直肠肛门梯度和更短的BET相关。尽管直肠肛门梯度与直肠BET呈负相关，但即使在大多数无症状女性中，该梯度也为负，这破坏了HRM诊断排便障碍的负梯度的实用性。
OBJECTIVES: High-resolution manometry (HRM) is used to measure anal pressures in clinical practice but normal values have not been available. Although rectal evacuation is assessed by the rectoanal gradient during simulated evacuation, there is substantial overlap between healthy people and defecatory disorders, and the effects of age are unknown. We evaluated the effects of age on anorectal pressures and rectal balloon expulsion in healthy women.METHODS: Anorectal pressures (HRM), rectal sensation, and balloon expulsion time (BET) were evaluated in 62 asymptomatic women ranging in age from 21 to 80 years (median age 44 years) without risk factors for anorectal trauma. In total, 30 women were aged = 50 years), 88 (3) (< 50 years), mean (s.e.m.)) but not squeeze pressures; higher rectal pressure and rectoanal gradient during simulated evacuation (r = 0.3, P < 0.05); and a shorter (r = -0.4, P < 0.01) rectal BET (17 (9) s (>= 50 years) vs. 31 (10) s (< 50 years)). Only 5 women had a prolonged (>60 s) rectal BET but 52 had higher anal than rectal pressures (i.e., negative gradient) during simulated evacuation. The gradient was more negative in younger (-41 (6) mm Hg) than older (-12 (6) mm Hg) women and negatively (r = -0.51, P < 0.0001) correlated with rectal BET but only explained 16 % of the variation in rectal BET.CONCLUSIONS: These observations provide normal values for anorectal pressures by HRM. Increasing age is associated with lower anal resting pressure, a more positive rectoanal gradient during simulated evacuation, and a shorter BET in asymptomatic women. Although the rectoanal gradient is negatively correlated with rectal BET, this gradient is negative even in a majority of asymptomatic women, undermining the utility of a negative gradient for diagnosing defecatory disorders by HRM.