Kuiken S D, Lindeboom R, Tytgat G N, Boeckxstaens G E
Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
Aliment Pharmacol Ther. 2005 Jul 15;22(2):157-64. doi: 10.1111/j.1365-2036.2005.02524.x.
Visceral hypersensitivity is considered an important pathophysiological mechanism in irritable bowel syndrome, yet its relationship to symptoms is unclear.
To detect possible associations between symptoms and the presence of hypersensitivity to rectal distension in patients with irritable bowel syndrome.
Ninety-two irritable bowel syndrome patients and 17 healthy volunteers underwent a rectal barostat study. The association between specific irritable bowel syndrome symptoms and the presence of hypersensitivity was examined using Area under the Receiver Operating Characteristic curves.
Irritable bowel syndrome patients had significantly lower thresholds for discomfort/pain than healthy volunteers: 24 (18-30) and 30 (27-45) mmHg above minimal distending pressure, respectively. Forty-one patients (45%) showed hypersensitivity to rectal distension. Proportions of patients with different predominant bowel habits were similar in hypersensitive and normosensitive subgroups (diarrhoea predominant: 39 and 41%, respectively; alternating type: 27 and 28%, respectively; constipation predominant: 34 and 31%, respectively). Severe abdominal pain was more frequent in hypersensitive, compared with normosensitive patients (88% vs. 67%, P = 0.02), but none of the individual irritable bowel syndrome symptoms could accurately predict the presence of hypersensitivity, as assessed by Area under the Receiver Operating Characteristic curve analysis.
Hypersensitive and normosensitive irritable bowel syndrome patients present with comparable, heterogeneous symptomatology. Therefore, selection based on clinical parameters is unlikely to discriminate individual irritable bowel syndrome patients with visceral hypersensitivity from those with normal visceral sensitivity.
内脏高敏感性被认为是肠易激综合征重要的病理生理机制，但其与症状之间的关系尚不清楚。
检测肠易激综合征患者症状与直肠扩张高敏感性之间的可能关联。
92例肠易激综合征患者和17名健康志愿者接受直肠压力测定研究。采用受试者工作特征曲线下面积检验特定肠易激综合征症状与高敏感性之间的关联。
肠易激综合征患者不适/疼痛阈值显著低于健康志愿者，分别为高于最小扩张压力24（18 - 30）mmHg和30（27 - 45）mmHg。41例患者（45%）对直肠扩张表现出高敏感性。高敏感和正常敏感亚组中不同主要排便习惯的患者比例相似（腹泻为主型：分别为39%和41%；交替型：分别为27%和28%；便秘为主型：分别为34%和31%）。与正常敏感患者相比，高敏感患者中严重腹痛更为常见（88%对67%，P = 0.02），但通过受试者工作特征曲线下面积分析评估，没有一种个体肠易激综合征症状能够准确预测高敏感性的存在。
高敏感和正常敏感的肠易激综合征患者具有相似的、异质性的症状表现。因此，基于临床参数进行选择不太可能区分出具有内脏高敏感性的个体肠易激综合征患者与内脏敏感性正常的患者。
