功能性消化不良患者症状与病理生理改变的相关性  

Correlation between symptoms and pathophysiological mechanism of patients with functional dyspepsia

作　　者：邸岩[1] 夏志伟[1] 葛颖[1] 王琨[1] 徐志洁[1] 段丽萍[1] 

机构地区：[1]北京大学第三医院消化科,北京100191

出　　处：《解放军医学院学报》2015年第3期208-211,242,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的分析不同亚型功能性消化不良(functional dyspepsia,FD)患者症状与幽门螺杆菌感染(Helicobacter pylori,Hp)和病理生理改变的相关性。方法符合罗马Ⅲ诊断标准的功能性消化不良患者分为上腹痛综合征(epigastric pain syndrome,EPS)组、餐后不适综合征(postprandial distress syndrome,PDS)组及症状重叠(overlapped,OL)组。问卷调查患者的主要症状及严重程度,经胃镜、黏膜病理、5 h不透X线标记物胃排空试验及饮水试验检查。分析不同亚型患者之间Hp感染、胃排空功能和感觉阈值的差异,以及单一症状与上述病理生理改变之间的相关性。结果共纳入108例患者。EPS组的Hp感染率(10/28,35.71%)明显高于PDS组(8/50,16.00%)(P=0.038)和OL组(3/30,10.00%)(P=0.021)。腹胀症状患者的Hp感染率低。PDS患者的胃排空延迟率明显高于EPS组。早饱症状患者的胃排空率明显高于无早饱症状者。腹胀、餐后饱胀患者及嗳气症状者的最大耐受阈值降低。结论不同亚型FD患者Hp感染率不同,但症状及胃排空功能和感觉功能异常与Hp无明显相关性。FD患者的胃排空及感觉功能改变与某些特定症状关系更为密切,治疗中应重视患者的主导症状。Objective To analyze the association between dominant symptoms in different subtypes of functional dyspepsia （FD） and Helicobacter pylori （Hp） infection.Methods Patients matched with FD criterion of RomeⅢwere enrolled in the outpatient service. After investigating the dominant symptoms, they were divided into three subtypes： postprandial distress syndrome （PDS）, epigastric pain syndrome （EPS） and overlapped （OL） group. Main symptoms and degree of their severity in patients were evaluated by 5-H gastric emptying test and drinking load test. The differences between Hp infection, gastric emptying and visceral perceptive threshold of different subtypes of patients, and the association between single symptom and pathophysiologic changes mentioned above were analyzed. ResultsThere were 108 patients enrolled in this study. The Hp infection rate in EPS （35.7%, 10/28） was higher than that in PDS （16%, 8/50,P=0.038） and OL （10%, 3/30,P=0.021）. Patients with abdominal distension showed low Hp infection rate. The PDS patients showed slowly gastric emptying, but patients suffered with early satiety showed rapid gastric emptying. The maximum tolerance value of patients suffered from postprandial fullness and belching decreased.Conclusion Different subtypes of FD patients have different Hp infection rate, while the Hp infection is not associated with symptoms and pathophysiological changes. Gastric motility and sensation changes are closely related to some special symptoms, and dominant symptoms of patients should be paid attention to during treatment.

关 键 词：功能性消化不良 胃排空功能 饮水试验 幽门螺杆菌 

分 类 号：R573[医药卫生—消化系统]