食管酸刺激对正常人内脏感觉中枢易化的作用  

The cerebral cortex facilitation of vicerosensation to esophageal acid exposure in normal individuals

作　　者：许树长[1] 郑芳芳[1] 赵小虎[2] 王琛[1] 来立人[1] 陈莹[1] 刘远飞[1] 陈锡美[1] 

机构地区：[1]上海同济大学附属同济医院消化科,200065 [2]上海同济大学附属同济医院医学影像科,200065

出　　处：《中华消化杂志》2009年第1期3-7,共5页Chinese Journal of Digestion

摘　　要：目的利用功能磁共振成像（fMRI）技术观察食管酸灌注刺激相关内脏感觉中枢及活动特点。方法采用改良组块设计模式对15名健康受试者进行食管酸（O．1mmol／L HCl）或0．9％氯化钠溶液刺激，同时行fMRI。具体步骤为：静息期（A期）8min，0．9％氯化钠溶液灌注（B期）8min，酸灌注（C期）8min，0．9％氯化钠溶液再灌注（D期）8min，总时间为32min。每个组块为160个时间点（scans），每个时间点为3S，共采集640个时间点数据。观察受试者反应，并对受试者大脑功能区的改变进行统计学分析。结果15名受试者中，10名刺激后出现咽喉部胀痛、烧心、胸痛等不适表现。初次0．9％氯化钠溶液刺激期（B-A）激活脑区包括中脑、前扣带回、左侧岛叶、两侧杏仁核及海马旁回、两侧前额皮质背外侧。酸灌注刺激期（C—A）及酸灌注后再灌注0．9％氯化钠溶液刺激期（D-A）所激活脑区与辟A期所激活脑区部位一致。同时发现，大部分激活部位强度逐渐增强，激活像素逐渐增多，即B-A期〈C—A期〈D-A期（P〈0．01），D-A期引起的大脑反应强度明显强于BA期（P〈0．01）。结论0．9％氯化钠溶液和酸刺激产生相同的脑激活区，这些脑区均参与食管感觉的调节，滴酸刺激增加食管黏膜的敏感性存在有客观的中枢证据。Objective To elucidate cerebral cortical response to esophageal acid exposure in normal individuals by functional magnetic resonance imaging （fMRI） and the characteristics of activity. Methods Fifteen volunteers were received intraesophageal perfusion with either 0. 9% of sodium chloride or acid （0.1 mmol/L HC1） solutions. The modified block-design model of fMRI scanning was performed simultaneously. All of 32 minutes were needed for resting （A, 8 minutes）, 0. 9% of sodium chloride perfusion （B,8 minutes）, acid perfusion （C,8 minutes） and 0.9% of sodium chloride perfusion again （D,8 minutes）. Each chunk was consisted of 160 scans and every scan contained 3 seconds. Six hundred and forty scans were collected in all. The clinical response to esophageal acid exposure was observed and the changes in the cerebral regions was statistically analyzed. Results After perfusion of 0. 9% of sodium chloride or acid, 10 out of 15 volunteers had chemosensitive complaints, such as pain in pars laryngen pharyngis, heartburn and chest complaint. The initial active domains involved deutocerebrum, anterior part of callosal gyrus, left side of insula, two sides of amygdale and subiculum hippoeampi, two outers of forehead cortex. The provoked regions of acid perfusion （C-A） and 0. 9% of sodium chloride perfusion again （D-A） were as same as that of the activated domains by initial perfusion of 0, 9 G sodium chloride （B-A）. The intensity and amplitude of most provoked regions increased gradually（D-A〉B-A,P〈0.01）. Conclusions The two different stimulations of saline and acid provoke similar cerebral regions that may act in the regulation of esophageal sensitivity. There are the evidences of the central mechanism of esophageal visceral hypersensitivity by acid perfusion.

关 键 词：食管 酸刺激 食管感觉 功能磁共振成像 

分 类 号：R686[医药卫生—骨科学]