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目的 评估符合罗马Ⅲ标准的功能性消化不良(FD)及其亚型患者的近端胃功能.方法 纳入30例FD患者,其中餐后不适综合征(PDS) 15例,上腹痛综合征(EPS) 15例.另纳入30名健康志愿者作为对照.采用恒压器检查所有受试者,记录最小扩张压(MDP),以及初始感觉和最大感觉时对应的压力和容积.在MDP+2 mmHg(1 mmHg=0.133 kPa)时,记录试餐前30 min平均容积、试餐后60 min平均容积、试餐后最大容积(容受性),并计算容受性舒张容积.观察FD患者的胃部感觉高敏和容受性障碍情况.统计学处理采用Student's t检验或卡方检验.结果 FD组的MDP、初始感觉压力、最大感觉压力、初始感觉容积、最大感觉容积分别为(6.17±1.95) mmHg、(8.44±2.01) mmHg、(14.62±3.72) mmHg、(123.59±53,26) mL、(451.26±140.44) mL,分别低于健康对照组的(9.27±1.99) mmHg、(12.04±2.66) mmHg、(19.74±4.18) mmHg、(168.41±73.06) mL、(556.89±124.07) mL,差异均有统计学意义(t=-6.080、-5.900、5.011、-2.723、-2.995,P均＜0.01).FD组试餐前30 min和试餐后60 min的平均容积分别为(212.19±120.82)、(333.97±121.86) mL,健康对照组分别为(191.69±66.19)、(385.58±83.05) mL,两组分别比较差异均无统计学意义(P均＞0.05).FD组试餐后最大容积和容受性舒张容积分别为(405.10±111.29)、(190.16±97.22) mL,分别低于健康对照组的(461.10±87.60)、(262.83±78.39) mL,差异均有统计学意义(t=-2.599、-3.187,P均＜0.05).FD患者试餐后最大容积出现在试餐后15～20 min,而健康对照者则是在试餐后5～10 min.30例FD患者中,12例(40％)存在胃部感觉高敏,其中PDS组8例,EPS组4例,两组间的比例差异无统计学意义(P＞0.05);9例(30％)存在胃容受性障碍,其中PDS组5例,EPS组4例,两组间的比例差异无统计学意义(P＞0.05).结论 FD患者存在胃部感觉高敏和胃容受性障碍,但在PDS和EPS亚型间无差异.罗马Ⅲ标准的FD分型可能并不能有效区分不同病理生理学机制的FD患者.

Objective To evaluate proximal gastric function in patients with functional dyspepsia (FD) met Rome Ⅲ criteria and its subtypes.Methods Thirty FD patients were enrolled,including 15 patients with postprandial distress syndrome (PDS) and 15 patients with epigastric pain syndrome (EPS).A total of 30 healthy volunteers were recruited as control.All the subjects received barostat examination.Minimal distending pressure (MDP),pressure and volume of thresholds for first sensation and maximal tolerance for gastric sensitivity were recorded.When the pressure level was MDP+2 mmHg (1 mmHg=0.133 kPa),average volume at 30 minutes before meal,averaged volume at 60 minutes after meal and maximum accommodation volume after meal were recorded,and receptive diastolic volume was calculated.The gastric hypersensitivity and impaired accommodation were observed.Student's t test or x2 test was performed for statistical analysis.Results MDP,pressure of first-sensation,maximum sensation pressure,volume of first sensation and maximal sensation volume of FD group were (6.17 ±1.95) mmHg,(8.44±2.01) mmHg,(14.62±3.72) mmHg,(123.59±53.26) mL and (451.26±140.44) mL,respectively; which were lower than those of healthy control group ((9.27±1.99) mmHg,(12.04±2.66) mmHg,(19.74±4.18) mmHg,(168.41±73.06) mL and (556.89±124.07) mL),and the differences were statistically significant (t=-6.080,-5.900,-5.011,-2.723 and-2.995,all P＜0.01).The averaged volume at 30 minutes before meal and 60 minutes after meal was (212.19±120.82) mL and (333.97±121.86) mL while those of healthy control group was (191.69±66.19) mL and (385.58±83.05) mL,and there were no significant differences between the two groups (both P＞0.05).The maximum postprandial accommodation volume and receptive diastolic volume of FD group were (405.10±111.29) mL and (190.16±97.22) mL,which were lower than those of healthy control group ((461.10±87.60) mL and (262.83±78.39) mL),and the differences were statistically significant (t=-2.599 and-3.187,both P＜0.05).The maximum postprandial accommodation volume of FD patients was at 15 to 20 minutes after meal and in healthy control it was at five to ten minutes after meal.Among the 30 FD patients,12 patients (40 ％) had gastric hypersensitivity,including eight PDS patients and four EPS patients,and there was no significant difference in the ratio between two groups (P＞0.05) ;nine patients (30 ％) had impaired accommodation,including five PDS patients and four EPS patients,and there was no significant difference in the ratio between two groups (P＞ 0.05).Conclusions Gastric hypersensitivity and impaired accommodation often appear in FD patients,and there is no significant difference between PDS and EPS subtypes.FD patients with different pathophysiologic mechanisms cannot be efficiently distinguished according to Rome Ⅲ criteria.