Ladefoged K, Schaffalitzky de Muckadell O B, Jarnum S
Medical Dept. P, Rigshospitalet, Copenhagen, Denmark.
Scand J Gastroenterol. 1987 Sep;22(7):813-20. doi: 10.3109/00365528708991920.
Osmolality, pH, and electrolyte concentrations in faecal fluid were measured in 23 patients referred to our department because of diarrhoeal disorders. The aim of the study was to ascertain whether such measurements could provide valuable diagnostic information in patients with diarrhoea. The patients were studied on a fat-restricted diet (70 g fat/day) and during fasting. Osmolality, pH, and concentrations of electrolytes in faecal water showed wide variations but were within normal ranges in most of the patients. The patients were grouped into secretory and osmotic diarrhoea on the basis of: 1) current assumptions on the pathogenesis of diarrhoea in different disorders; 2) persistence versus resolution of diarrhoea during fasting (resolution = decrease of stool mass to less than 200 g/24 h); and 3) an osmotic gap (measured osmolality -2 X (Na + K]. The accordance between these three ways of grouping was very incomplete. It is concluded that measurements of faecal fluid osmolality and electrolyte concentrations are of little value as diagnostic procedures in chronic diarrhoea. Determination of the osmotic gap and/or of the decrease of stool mass during fasting may help to elucidate the pathogenesis of diarrhoea in different disorders but does not seem diagnostically useful. Three patients turned out to be laxative abusers, and laxative ingestion should always be considered in chronic unsettled diarrhoea.
对因腹泻性疾病转诊至我科的23例患者的粪便液体渗透压、pH值及电解质浓度进行了检测。本研究的目的是确定这些检测是否能为腹泻患者提供有价值的诊断信息。对患者进行了脂肪限制饮食（70克脂肪/天）及禁食研究。粪便水的渗透压、pH值及电解质浓度显示出很大差异，但大多数患者仍在正常范围内。根据以下几点将患者分为分泌性腹泻和渗透性腹泻：1）目前对不同疾病腹泻发病机制的假设；2）禁食期间腹泻持续或缓解情况（缓解=粪便量减少至小于200克/24小时）；3）渗透间隙（测得的渗透压-2×（钠+钾））。这三种分组方法之间的一致性非常不完全。结论是，粪便液体渗透压和电解质浓度检测作为慢性腹泻的诊断方法价值不大。测定渗透间隙和/或禁食期间粪便量的减少可能有助于阐明不同疾病腹泻的发病机制，但似乎在诊断上并无用处。有3例患者被证明是泻药滥用者，对于慢性难治性腹泻应始终考虑泻药摄入的情况。
