Barczyński M, Thor P J, Słowiaczek M, Pitala A
III Katedra i Klinika Chirurgii Ogólnej Collegium Medicum UJ ul. Pradnicka 37, 31-202 Kraków.
Folia Med Cracov. 2000;41(3-4):87-112.
The aim of this study was to determine both the type of gastric mioelectric and emptying disorders in correlation to degree of severity of hyperthyroidism (clinical and thyroid hormones' blood levels) and ANS function estimated in HRV analysis. The study was performed on a group of 50 patients (35 with multinodular toxic goitre and 15 with Graves' disease, 45 females and 5 males, mean age 39.6 years, mean BMI 23.72) with newly diagnosed and so far untreated hyperthyroidism. The control group were 50 healthy volunteers age-, sex-, and BMI-matched to the studied group. Patients were studied twice, within newly diagnosed thyreotoxicosis and after treatment (Metizol) and reaching stable euthyroid state. The study consisted of: a) percutaneous EGG analysis (Synectics): 30 minutes before and after a test meal (ENRICH Liquid 250 ml), b) HRV analysis (ECG POSTER 2002): 10 minutes at rest and during deep breathing test, c) ultrasound measurement of gastric emptying by Bolondi method. Statistical analysis of collected data was performed. In hyperthyroid patients significant both preprandial and postprandial dysrhythmia (33.01% of bradygastria and 16.49% of tachygastria) was found. In some patients decrease of amplitude of EGG signal was marked as a result of antral hypomotility with coexisting significantly prolonged gastric emptying (110 min). Among severe hyperthyroid patients both the antral food distribution (antrum 35% bigger than in a control group) and impaired proximal stomach relaxation were evident. The degree of gastric mioelectric activity and emptying disorders was proportional to the degree of both severity of clinical manifestation of hyperthyroidism in Zgliczynski scale (from I degree to III degrees) and free thyroid hormones' blood levels (positive correlation). In HRV analysis at rest in hyperthyroid patients comparing to a control group the decrease of both the heart rate variability and a total power was found particularly in HF component resulting in relative sympathetic activation. In HRV analysis during deep breathing test the decrease of heart rate variability was present mostly in LF component. It indicates on reduction of vagal regulation (and vagal excitability) of sinus node and gastric pacemaker function. Coexistence of the increase and decrease of a gastric basic electrical rhythm with delay of gastric emptying indicates on a complex mechanism of their formation. Both neurogenic regulation dysfunction and primary miogenic autoregulation disorders as a result of tyreotoxicosis seem to be the possible causes. All the found changes were functional and disappeared after reaching the stable euthyroid state within 3 months of pharmacological treatment.
本研究的目的是确定胃肌电和排空障碍的类型，以及它们与甲状腺功能亢进症的严重程度（临床症状和甲状腺激素血水平）和通过心率变异性分析评估的自主神经系统功能之间的相关性。该研究对一组50例新诊断且未经治疗的甲状腺功能亢进症患者进行（35例多结节毒性甲状腺肿患者和15例格雷夫斯病患者，45名女性和5名男性，平均年龄39.6岁，平均BMI 23.72）。对照组为50名年龄、性别和BMI与研究组匹配的健康志愿者。患者在新诊断甲状腺毒症时和治疗后（服用甲巯咪唑）并达到稳定的甲状腺功能正常状态时进行了两次研究。研究包括：a）经皮胃电图分析（Synectics）：在试餐（250 ml ENRICH液体）前后30分钟；b）心率变异性分析（ECG POSTER 2002）：静息10分钟和深呼吸测试期间；c）通过博隆迪方法进行胃排空的超声测量。对收集的数据进行了统计分析。在甲状腺功能亢进症患者中，发现餐前和餐后均存在明显的心律失常（33.01%的胃缓慢性和16.49%的胃快速性）。在一些患者中，由于胃窦动力不足且胃排空明显延长（110分钟），胃电图信号幅度降低。在严重甲状腺功能亢进症患者中，胃窦食物分布（胃窦比对照组大35%）和近端胃松弛受损均很明显。胃肌电活动和排空障碍的程度与甲状腺功能亢进症临床表现的严重程度（根据兹格利琴斯基量表从I度到III度）和游离甲状腺激素血水平成正比（呈正相关）。在静息状态下的心率变异性分析中，与对照组相比，甲状腺功能亢进症患者的心率变异性和总功率均降低，尤其是高频成分降低，导致相对交感神经激活。在深呼吸测试期间的心率变异性分析中，心率变异性降低主要出现在低频成分中。这表明窦房结和胃起搏器功能的迷走神经调节（和迷走神经兴奋性）降低。胃基本电节律的增加和降低与胃排空延迟并存，表明其形成机制复杂。甲状腺毒症导致的神经源性调节功能障碍和原发性肌源性自动调节障碍似乎都是可能的原因。所有发现的变化都是功能性的，在药物治疗3个月内达到稳定的甲状腺功能正常状态后消失。
