Vagal dysfunction in irritable bowel syndrome assessed by rectal distension and baroreceptor sensitivity
Vagal dysfunction in irritable bowel syndrome assessed by rectal distension and baroreceptor sensitivity
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DOI：
10.1111/j.1365-2982.2007.01042.x
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发表时间：
2008-04-01
影响因子：
3.5
通讯作者：
Kamath, M. V.
中科院分区：
文献类型：
--
作者：
Spaziani, R.;Bayati, A.;Kamath, M. V.
自主神经系统功能障碍与肠易激综合征（IBS）的病理生理学有关。这项研究使用压力感受器敏感性（BRS）（一种自主神经功能的测量方法）来表征IBS患者对直肠扩张的自主反应。对 98 名健康志愿者（34 +/- 12 岁，52 名女性）和 39 名 IBS 患者（39 +/- 11 岁，35 名女性）在直肠扩张之前、期间和之后连续测量直肠袋压力、不适、疼痛、心电图、血压和 BRS。与健康志愿者相比，尽管扩张压力（51 +/- 1.4 vs 54 +/- 2.4 mmHg；ns）和体积（394 +/- 2.4 mmHg；ns）相似，但 IBS 患者在直肠扩张时感到明显更多的不适（69 +/- 2.2% vs 56 +/- 3.6%；P < 0.05），但没有疼痛（9 +/- 1.4% vs 6 +/- 2.4%；ns）。 10.9 与 398 +/- 21.5 纳秒）。随着直肠扩张，健康志愿者（66 +/- 1 至 71 +/- 1 bpm；P < 0.05）和 IBS 患者（66 +/- 2 至 74 +/- 3 bpm；P < 0.05）的心率均增加。与 68 名志愿者相比，健康志愿者（121 +/- 2 至 143 +/- 2 mmHg；P < 0.05）和患者（126 +/- 3 至 153 +/- 4 mmHg（P < 0.05）的收缩压也有所升高，舒张压也升高，为 66 +/- 2 至 80 +/- 2 mmHg（P < 0.05）。 IBS 患者中观察到的收缩压升高幅度为 +/- 3 至 84 +/- 3 mmHg (P < 0.05)，IBS 患者的收缩压升高幅度高于健康志愿者，并且在扩张后阶段仍保持升高状态（139 +/- 3 mmHg vs 129 +/- 2 mmHg；P < 0.05）。 mmHg(-1)) 与健康志愿者相比 (9.4 +/- 0.3; P < 0.05)，在休息和直肠扩张期间，收缩压对直肠扩张的反应更大，并且相关的 BRS 降低表明 IBS 患者的自主神经系统存在损害。
Autonomic nervous system dysfunction has been implicated in the pathophysiology of irritable bowel syndrome (IBS). This study characterized the autonomic response to rectal distension in IBS using baroreceptor sensitivity (BRS), a measure of autonomic function. Rectal bag pressure, discomfort, pain, ECG, blood pressure and BRS were continuously measured before, during and after rectal distension in 98 healthy volunteers (34 +/- 12 years old, 52 females) and 39 IBS patients (39 +/- 11 years old, 35 females). In comparison with the healthy volunteers, IBS patients experienced significantly more discomfort (69 +/- 2.2% vs 56 +/- 3.6%; P < 0.05), but not pain (9 +/- 1.4% vs 6 +/- 2.4%; ns) with rectal distension despite similar distension pressures (51 +/- 1.4 vs 54 +/- 2.4 mmHg; ns) and volumes (394 +/- 10.9 vs 398 +/- 21.5 mL; ns). With rectal distension, heart rate increased in both healthy volunteers (66 +/- 1 to 71 +/- 1 bpm; P < 0.05) and IBS patients (66 +/- 2 to 74 +/- 3 bpm; P < 0.05). Systolic blood pressure also increased in both healthy volunteers (121 +/- 2 to 143 +/- 2 mmHg; P < 0.05) and patients (126 +/- 3 to 153 +/- 4 mmHg (P < 0.05) as did diastolic blood pressure, 66 +/- 2 to 80 +/- 2 mmHg (P < 0.05), compared with 68 +/- 3 to 84 +/- 3 mmHg (P < 0.05) in IBS patients. The systolic blood pressure increase observed in IBS patients was greater than that seen in healthy volunteers and remained elevated in the post distension period (139 +/- 3 mmHg vs 129 +/- 2 mmHg; P < 0.05). IBS patients had lower BRS (7.85 +/- 0.4 ms mmHg(-1)) compared with healthy volunteers (9.4 +/- 0.3; P < 0.05) at rest and throughout rectal distension. Greater systolic blood pressure response to rectal distension and associated diminished BRS suggests a compromise of the autonomic nervous system in IBS patients.