摘要
目的探讨功能性便秘(FC)患者不同体位(坐位和左侧卧位)肛直肠测压(ARM)结果的差异,研究坐位ARM的直肠肛管压力梯度(RAPG)在评价FC患者肛直肠动力障碍中的应用价值。方法2015年3月至2016年7月在浙江省宁波市鄞州人民医院胃肠动力中心连续招募66例18~75岁符合罗马Ⅲ标准的FC患者,记录便秘症状并行便秘症状评分量表(PAC-SYM)和便秘生命质量量表(PAC-QoL)评分,以随机顺序接受左侧卧位和坐位ARM,再行坐位球囊排出试验(BET),比较不同体位的ARM参数差异,分析ARM参数与BET结果,以及便秘症状与生命质量评分的关系。统计学方法采用t检验、Spearman相关性分析和Kappa检验。结果坐位直肠相关压力参数直肠静息压和直肠排便压,以及RAPG均高于左侧卧位测定值[(30.83±7.89)mmHg(1mmHg=0.133kPa)比(10.53±3.94)mmHg,(78.86±22.25)mmHg比(54.92±21.26)mmHg,(17.53±27.40)mmHg比(-7.80±26.88)mmHg],差异均有统计学意义(t=-21.10、-12.35、-8.84,P均<0.01),但肛管相关压力参数差异无统计学意义(P>0.05)。坐位RAPG与BET一致性检验呈高度一致,最高Kappa值为0.643,高于左侧卧位的最高Kappa值0.349。坐位最适RAPG阈值为10mmHg,此时以RAPG预测BET结果的灵敏度为85.71%,特异度为79.17%。以坐位最适RAPG阈值将患者分为高RAPG组与低RAPG组,高RAPG组每周自发排便频率高于低RAPG组[(2.88±2.16)次比(1.66±0.96)次],差异有统计学意义(t=2.65,P=0.01),且高RAPG组患者PAC-QoL的满意度亚表评分低于低RAPG组[(2.05±0.55)分比(2.83±0.78)分],差异有统计学意义(t=-4.72,P<0.01)。结论坐位ARM测定FC患者的直肠压力参数可能更为准确,尤其是坐位RAPG与BET、便秘症状和生命质量评分的相关性更好,在FC患者肛直肠动力评价中可能更具临床应用价值。
Objective To investigate the differences of anorectal manometry (ARM) parameters in different position (left lateral position and seated position) in patients with functional constipation (FC),and the value of rectoanal pressure gradient (RAPG) was assessed in seated position in the evaluation of anorectal motility disorder in patients with FC.Methods From March 2015 to July 2016,at Clinical Gastrointestinal Motility Center of Ningbo Yinzhou People's Hospital,66 consecutive patients with FC aged 18 to 75 who met Rome Ⅲ criteria were recruited.The questionnaires of patient assessment of constipation symptom (PAC-SYM)and patient assessment of constipation quality of life (PAC-QoL) were recorded.Patients randomly underwent ARM examination in left lateral or seated positions,and then followed by a balloon expulsion test (BET) in seated position.The differences of ARM parameters in different positions were compared.The correlation between ARM parameters and BET results,constipation symptoms and quality of life scores were analyzed.T-test,Spearman correlation analysis and Kappa coefficient were performed for statistical analysis.Results ARM parameters including rectal resting pressure,rectal defecation pressure and RAPG in seated position were both higher than those of left lateral position ((30.83 ±7.89) mmHg (1 mmHg =0.133 kPa) vs.(10.53 ± 3.94) mmHg,(78.86±22.25) mmHg vs.(54.92±21.26) mmHg,(17.53 ±27.40) mmHg vs.(-7.80 ±26.88) mmHg),and the differences were statistically significant (t =-21.10,-12.35 and-8.84,all P < 0.01).However,there was no significant difference in anal-related pressure parameters (P > 0.05).The RAPG in seated position was highly consistent with BET,with a maximum Kappa-value of 0.643,which was higher than the maxium Kappa-value of 0.349 in left lateral position.The optimal RAPG threshold of seated position was 10 mmHg,the sensitivity of RAPG in the prediction of BET was 85.71% and the specificity was 79.17%.According to the optimal RAPG threshold in seated position,the patients were div
作者
吴高珏
许丰
龚镭
陈建德
林琳
Wu Gaojue;Xu Feng;Gong Lei;Chen Jiande;Lin Lin(Department of Gastroenterology,Wuxi No. 2 Hospital Affiliated to Nanjing Medical University,Wuxi 214002,China;Department of Gastroenterology,Ningbo Yinzhou People's Hospital,Ningbo 315000,China;Ningbo Pace Translational Medical Research Center,Ningbo 315000,China;Department of Gastroenterology,The First Affiliated Hospital of Nanjing Medical University Nanjing 210029,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2019年第4期223-228,共6页
Chinese Journal of Digestion
基金
无锡市科教强卫工程青年医学重点人才项目(QNRC066)
无锡市科教强卫工程医学重点学科(胃肠病学)项目(ZDXK002).
关键词
功能性便秘
肛直肠测压
球囊排出试验
直肠肛管压力梯度
Functional constipation
Anorectal manometry
Balloon expulsion test
Rectoanal pressure gradient
