Larsson M H, Simrén M, Thomas E A, Bornstein J C, Lindström E, Sjövall H
Department of Integrative Pharmacology, Gastrointestinal Biology, AstraZeneca R&D, Mölndal, Sweden.
Neurogastroenterol Motil. 2007 Oct;19(10):812-20. doi: 10.1111/j.1365-2982.2007.00941.x.
The pathophysiology of irritable bowel syndrome (IBS) is complex and incompletely known. Very little has been studied regarding the role of submucous neuronal activity. We therefore measured small intestinal transmural potential difference (PD, reflecting mainly electrogenic chloride secretion), and its linkage with fasting motor activity [migrating motor complex (MMC)] in controls (n = 16) and patients with IBS [n = 23, 14 diarrhoea predominant (d-IBS) and nine constipation predominant (c-IBS)]. Transmural-PD and its relation to MMC phase III was measured by modified multilumen manometry for 3 h in the fasting state using one jejunal and one duodenal infusion line as flowing electrodes. The amplitude and duration of motor phase III was similar in controls and IBS patients, but the propagation speed of phase III was higher in IBS patients. In IBS patients, maximal PD during MMC phase III was significantly elevated in both the duodenum and jejunum (P < 0.05) and the PD decline after phase III was significantly prolonged in the jejunum (P < 0.01). The PD elevation was seen in both duodenum and jejunum in d-IBS patients, but only in the jejunum in the c-IBS patients. On the basis of previous modelling studies, we propose that the enhanced secretion may reflect disturbed enteric network behaviour in some patients with IBS.
肠易激综合征(IBS)的病理生理学复杂且尚未完全明确。关于黏膜下神经活动的作用,目前研究甚少。因此,我们测量了对照组(n = 16)和IBS患者 [n = 23,其中14例腹泻型(d-IBS)和9例便秘型(c-IBS)] 的小肠跨壁电位差(PD,主要反映氯的电分泌)及其与空腹运动活动 [移行性运动复合波(MMC)] 的关联。在禁食状态下,使用一条空肠灌注线和一条十二指肠灌注线作为流动电极,通过改良的多腔测压法测量3小时的跨壁PD及其与MMC第三相的关系。对照组和IBS患者的运动第三相的幅度和持续时间相似,但IBS患者的第三相传播速度更高。在IBS患者中,MMC第三相期间十二指肠和空肠的最大PD均显著升高(P < 0.05),空肠中第三相后的PD下降显著延长(P < 0.01)。d-IBS患者的十二指肠和空肠均出现PD升高,但c-IBS患者仅在空肠出现。基于先前的模型研究,我们提出分泌增强可能反映了一些IBS患者肠道神经网络行为的紊乱。
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