Cozzolino D, Salvatore T, Giugliano D, Paolisso G, Landolfi V, Del Genio A, Torella R
Istituto di Medicina Generale, Prima Facoltà di Medicina, Università di Napoli, Italia.
Diabete Metab. 1991 Nov-Dec;17(6):520-4.
To evaluate the status of ano-rectal complex in diabetic patients, 20 patients with no fecal incontinence and/or local ano-rectal disorders and 18 normal subjects underwent to: 1) ano-rectal manometry; 2) defecography; and 3) rectal sensation tests. In all subjects, the five classic cardiovascular reflexes tests were performed to detect autonomic neuropathy. No significant difference between diabetic patients and controls was found in length, maximum resting pressure and strength of phasic external anal sphincter or anal canal at ano-rectal manometry; similarly, no significant difference between diabetic and normal subjects was found by the same technique in threshold and amplitude of ano-rectal inhibitory reflex. Ano-rectal angle of diabetic patients was not significantly different from normals both at resting and during straining at defecographic study. By rectal sensation testing, it was possible to demonstrate a significant difference between diabetic and normal subjects in perception of rectal distension (87.5 +/- 27.5 vs 39.2 +/- 6.5 ml, p less than 0.05; mean +/- SEM) and of stimulus of defecation (147.0 +/- 56.3 vs 52.9 +/- 18.5 ml, p less than 0.001) but not in perception of maximum tolerable volume (343.5 +/- 69.9 vs 322.0 +/- 48.5 ml, p = NS). No relationship was found between these results and the score of autonomic neuropathy and/or duration of diabetic disease. These data suggest that an early involvement of only sensory parasympathetic fibers of ano-rectal complex occurs in diabetic patients without gastrointestinal symptoms.
为评估糖尿病患者肛门直肠复合体的状况，对20例无大便失禁和/或局部肛门直肠疾病的患者及18名正常受试者进行了以下检查：1）肛门直肠测压；2）排粪造影；3）直肠感觉测试。对所有受试者进行了五项经典的心血管反射测试以检测自主神经病变。在肛门直肠测压中，糖尿病患者与对照组在肛管长度、最大静息压力、相位性肛门外括约肌或肛管强度方面未发现显著差异；同样，采用相同技术在肛门直肠抑制反射阈值和幅度方面，糖尿病患者与正常受试者之间也未发现显著差异。在排粪造影研究中，糖尿病患者在静息和用力排便时的直肠肛管角与正常人相比无显著差异。通过直肠感觉测试发现，糖尿病患者与正常受试者在直肠扩张感知（87.5±27.5 vs 39.2±6.5 ml，p<0.05；平均值±标准误）和排便刺激感知（147.0±56.3 vs 52.9±18.5 ml，p<0.001）方面存在显著差异，但在最大耐受容量感知方面无差异（343.5±69.9 vs 322.0±48.5 ml，p=无显著性差异）。这些结果与自主神经病变评分和/或糖尿病病程之间未发现相关性。这些数据表明，在无胃肠道症状的糖尿病患者中，肛门直肠复合体的感觉副交感神经纤维仅早期受累。
