功能性消化不良的胆囊排空功能及西沙必利的应用研究.doc

功能性消化不良的胆囊排空功能及西沙必利的应用研究2011-04-03 Gallbladder emptying in patients with functional dyspepsia: improvementof gallbladder motility with cisapride 樊艳华 窦艳玲 戴希真 董恩钰 张 岚 Fan Yanhua, Dou Yanling, Dai Xizhen, et al 【摘要】 目的 研究功能性消化不良(FD)的胆囊排空功能以及西沙必利在此中的作用。 方法 对91例FD患者与30名健康对照者于空腹和试餐后B超检查测算胆囊容积、胃面积和胆 囊排空率(GBEF)。结果 约1/3 FD患者存在胆囊排空功能低下，FD组GBEF明显低于正常组， 且其速度慢，其中GBEFmax分别为64.8%18.2%与77.7%16.1%，P0.001。FD组30例(33.0%) 胆囊排空功能低下者经西沙必利治疗后胆囊排空功能改善，GBEFmax由49.2%19.4%增为 63.3%12.4%，P0.01。治疗后患者症状明显减轻。结论 研究表明约1/3的FD患者胆囊排 空功能低下，西沙必利可改善此类患者的症状及胆囊功能。 【关键词】 消化不良 胆囊排空 西沙必利 Gallbladder emptying in patients with functional dyspepsia: improvement of gallbladder motility with cisapride Fan Yanhua, Dou Yanling, Dai Xizhen, et al. Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029 【Abstract】 Objective To study gallbladder emptying in patients with functional dyspepsia (FD) and to know whether cisapride can improve the emptying. Methods Gastric and gallbladder emptying were evaluated by means of real-time ultrasonography (RUS) in 91 FD patients and in 30 normal subjects. Serial RUS scans were made at fast and every 20 (first hour) or 30 (second hour) minutes after a liquid meal for 2 hours. Cisapride was given to treat the patients with hypokinetic gallbladder emptying for 1 to 2 weeks. Results (1)Gallbladder ejection fraction (GBEF) in FD patients was much lower and slower than that in normal subjects. The GBEFmax was 64.8%18.2% in the FD group and 77.7%16.1% in the normal group (P?.001). Thirty patients (33.0%) were considered to have hypokinetic gallbladder emptying as GBEF60 and GBEFmax in these patients were 2s above the normal group. (2) 25 patients were found with delayed gastric emptying and 11 of them (44.0%) also with hypokinetic gallbladder emptying. The GBEFmax in patients with delayed gastric emptying was slightly lower than those without, but there was no statistical difference between the two groups. (3) Gallbladder emptying was improved in patients with hypokinetic gallbladder emptying treated with cisapride. GBEFmax increased from 49.2%19.4% to 63.3%12.4% (P?.01). After treatment, the symptoms of the patients relieved. There was no statistical correlation between the improvement of gallbladder and gastric emptying. Conclusion About one third of the patients with functional dyspepsia have hypokinetic gallbladder emptying, and cisapride seems to be useful in improving the emptying. 【Key words】 Dyspepsia Gallbladder emptying Cisapride 功能性消化不良(FD)病人常见，几乎占消化科门诊病人的半数。FD病因尚不清，上胃肠 动力障碍、特别是胃排空延迟在发病中所起的重要作用已较公认。国内外有关其胆囊排空功 能的研究均较少，且结果不一致，部分结果显示其胆囊排空功能低下1，或速度减慢2。 消化道促动力剂西沙必利对FD病人胃排空有促进作用，其能否促进胆囊排空功能，目前 国内尚未见报道。我们自1995年5月至1996年5月采用实时超声对照研究了91例FD患者的 胆囊及胃排空功能，并观察了西沙必利对胆囊排空功能的作用。 对象和方法 一、研究对象 91例FD患者中男36例，女55例，年龄2065岁，平均43.3岁，均经化验、B超、胃 镜等检查排除了消化道器质性疾病，无糖尿病等影响消化功能的全身性疾病，亦无腹部手术 史，符合FD的诊断标准。FD组与30名健康对照者在年龄、身高、体重等方面无统计学差异。 二、研究方法 将FD组腹痛、腹胀、早饱等症状根据其严重程度分为03级，其中每1级积1分，并参 考1991年荷兰会议所定标准将FD分为4型。91例中运动障碍型62例，溃疡样型17例，反流 样型4例，复合型8例。胆囊排空功能低下者不论其胃排空功能正常与否予西安杨森制药有限 公司生产的西沙必利(商品名普瑞博思)510 mg，每日3次，治疗12周后复查。 三、胆囊、胃排空功能测定 试餐为250 ml混合奶(250卡)，蛋白质、脂肪与碳水化合物热卡比为12.62。由我院 营养部配制。 胆囊测量取平卧位，于空腹及进餐后每20分钟(第1小时)或30分钟(第2小时)分别测量。 每次B超检查前先确定胆囊最大纵轴图象，测得胆囊长径L和前后径H，然后转动探头90度测 得胆囊最大宽径W。胆囊容积计算公式GBV=LHW/6，胆囊排空率(GBEF)=(GBVf-GBVt)/GBVf， 其中GBVf、GBVt分别为空腹和餐后某一时间的胆囊容积。 胃的测量参照Marzio法3，采用单切面法，于上腹以腹主动脉或肠系膜上静脉为参 照纵形扫查，显示出圆形或椭圆形胃的最大图像，测得其前后径A和上下径B，胃面积计算公 式GS=A