食管内脏高敏感及其相关研究进展  

Advances in research of esophageal visceral hypersensitivity

作　　者：孟庆伟[1] 许树长[1] 

机构地区：[1]上海市同济大学附属同济医院消化内科,上海市200065

出　　处：《世界华人消化杂志》2012年第7期568-573,共6页World Chinese Journal of Digestology

摘　　要：胃食管反流疾病(gastroesophageal reflux disease,GERD)是一种较普遍的疾病,经常伴随各种不适症状,需要利用健康护理资源.在动物实验与人类实验研究中均表明,各种传入神经的受体在暴露于酸的情况下均可以敏感化,以至于使更多的感觉刺激通过传入神经输入到脊髓背角神经元,导致了这些神经元的阈值降低,使得他们的感受范围增大.这种敏感性增高的初级传入神经被形容为外周敏感化,而随之增加敏感性的脊髓背角神经元被描述为中央敏感化.一旦这些机制建立起来,可以使组织对以前原本无害的刺激发生敏感,并且会保持一个长期的过程.此外,心理压力和机械刺激都已经被证实可以使细胞间隙增宽,因此可能促进外围敏感化.目前,外围与中枢敏感化被认为是食管疼痛和高敏感的重要机制,甚至生理量的酸亦可以导致症状的发生.对于这些患者的治疗目的主要是降低神经的敏感性.本文主要围绕食管内脏感觉高敏感作一简要综述.Gastroesophageal reflux disease （GERD） is a common disorder that is often associated with unpleasant symptoms requiring utilization of health care resource. Both animal and clinical studies suggest that a variety of receptors on afferent nerves sensitized upon exposure to acid increase afferent input to the spinal cord dorsal horn neurons and lead to a reduction in threshold of these neurons together with an increase in their receptive field. This increased sensitivity of primary afferent nerves is described as peripheral sensitization, whereas the consequent increase in sensitivity of the spinal dorsal horn neurons is described as central sensitization. Once these mechanisms have been established, they can cause a long-term increase in sensitivity of tissues to previously innocuous stimuli. Furthermore, psychological stress and mechanical stimulation both have been shown to increase DIS and may therefore facilitate peripheral sensitization. Currently peripheral and central sensitizations are considered to be important mechanisms of esophageal pain hypersensitivity and occurrence of symptoms to even physiological amounts of acid. In these patients treatments aimed at reducing neuronal sensitivity may be effective. This article mainly focuses on the recent advances in research of esophageal visceral hypersensitivity.

关 键 词：胃食管反流病 非糜烂性反流病 食道疼痛过敏 中央敏感 外围敏感 痛觉过敏 皮层诱发电位 

分 类 号：R571[医药卫生—消化系统]