非心源性胸痛患者的中枢性致敏:一项临床试验  

Central sensitization in patients with noncardiac chest pain:A clinical experimental study

作　　者：Mohr Drewes A. Pedersen J. Reddy H. 张红凯 

机构地区：[1]Center for Visceral Biomechanics and Pain,Department of Medical Gastroenterology,Aalborg University Hospital,DK-9000 Aalborg,Denmark Dr.

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2006年第12期52-53,共2页Core Journals in Gastroenterology

摘　　要：Objective.Patients with non-cardiac chest pain(NNCP) suffer from unexplained and often intractable pain which can pose a major clinical problem.The aim of this study was to investigate nociceptive processing in NNCP patients and their response to experimentally acid-induced oeso-phageal hyperalgesia using a multimodal stimulation protocol.Material and methods.Ten highly selected patients with NCCP(mean age 43 years,1 M) were compared with an age-and gender-matched group of 20 healthy subjects.After preconditioning,the distal oesophagus was painfully distended with a balloon using “ impedance planimetry”.This method assesses the luminal cross-sectional area of the oesophagus based on the electrical impedance of the fluid inside the balloon.The baseline distensions were done before and after pharmacological relaxation of the smooth muscle with 20 mg butylscopolamine.After baseline distensions,a series of up to 10 mechanical stimuli was performed(temporal summation) .The stimulations were repeated after sensitization of the oesophagus induced by acid perfusion.The sensory intensities were assessed during the stimulations and the referred pain area was mapped.Results.At baseline distensions,no differences were seen between patients and controls before and after relaxation of the smooth muscles.The patients tolerated fewer repeated distensions than controls(4.8± 0.5 versus 9.1± 0.9;p =0.04) and had an increased size of the referred pain areas to the mechanical stimulations(32.9± 6.2 versus 64.9± 18.3 cm2 ;p =0.01) .After sensitization with acid,the patients developed hyperalgesia(p < 0.001) ,whereas no significant changes were seen in controls.Conclusions.NCCP patients showed facilitated central pain mechanisms(temporal summation and visceral hyperalgesia after sensitization) .This could be used in the diagnosis and understanding of the symptoms in these patients.Objective.Patients with non-cardiac chest pain(NNCP) suffer from unexplained and often intractable pain which can pose a major clinical problem.The aim of this study was to investigate nociceptive processing in NNCP patients and their response to experimentally acid-induced oeso-phageal hyperalgesia using a multimodal stimulation protocol.Material and methods.Ten highly selected patients with NCCP(mean age 43 years,1 M) were compared with an age-and gender-matched group of 20 healthy subjects.After preconditioning,the distal oesophagus was painfully distended with a balloon using “ impedance planimetry”.This method assesses the luminal cross-sectional area of the oesophagus based on the electrical impedance of the fluid inside the balloon.The baseline distensions were done before and after pharmacological relaxation of the smooth muscle with 20 mg butylscopolamine.After baseline distensions,a series of up to 10 mechanical stimuli was performed(temporal summation) .The stimulations were repeated after sensitization of the oesophagus induced by acid perfusion.The sensory intensities were assessed during the stimulations and the referred pain area was mapped.Results.At baseline distensions,no differences were seen between patients and controls before and after relaxation of the smooth muscles.The patients tolerated fewer repeated distensions than controls(4.8± 0.5 versus 9.1± 0.9;p =0.04) and had an increased size of the referred pain areas to the mechanical stimulations(32.9± 6.2 versus 64.9± 18.3 cm2 ;p =0.01) .After sensitization with acid,the patients developed hyperalgesia(p < 0.001) ,whereas no significant changes were seen in controls.Conclusions.NCCP patients showed facilitated central pain mechanisms(temporal summation and visceral hyperalgesia after sensitization) .This could be used in the diagnosis and understanding of the symptoms in these patients.

关 键 词：非心源性胸痛 临床试验 中枢性 食管痛 致敏 食管酸灌注 痛觉敏感 健康受试者 刺激法 时间总和 

分 类 号：R571[医药卫生—消化系统]