Division of Gastroenterology, Department of Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
J Investig Med. 2023 Dec;71(8):821-829. doi: 10.1177/10815589231196591. Epub 2023 Sep 15.
Cyclic vomiting syndrome (CVS) is an underdiagnosed disorder of the gut-brain interaction. Our understanding of the pathophysiology of CVS is evolving. Here, we tested the hypotheses that: (1) the levels of endocannabinoids and related lipids are altered in CVS, and (2) cephalic-vagal stimulation drive changes in endolipid levels. Ten adult patients with CVS and eight healthy controls were included. Indirect measurements of parasympathetic (RFa) functions were performed with spectral analysis of heart rate variability and respiratory activity. Plasma levels of endocannabinoids and related lipids were measured at baseline and during a sham feeding. Values are reported as mean ± standard error of the mean and compared using -test or ANOVA. CVS patients had a lower parasympathetic tone and response to the Valsalva maneuver and deep breathing than the controls. The baseline 2-Arachidonoylglycerol (2-AG) had a significantly higher concentration in CVS (5.9e-008 ± 3.7e-008 mol/L) than control (3.7e-008 ± 1.3e-008 mol/; p < 0.05). Sham feeding did not change the concentration of 2-AG. 2-oleoylglycerol (2-OG) was significantly higher in CVS than control and did not change with sham feeding. Levels of N-acylethanolamines, including anandamide (AEA), were not different in CVS vs control. After sham feeding, AEA showed a trend toward increasing (p = 0.08) in CVS, but not in control. With sham feeding, palmitoyl ethanolamine significantly increased in both CVS and control groups; oleoyl ethanolamine in CVS only, and stearoyl ethanolamine in the control group. Levels of endocannabinoids and related lipids are altered in CVS patients. Sham feeding affects endogenous signaling lipids in a disease and time-dependent manner.
周期性呕吐综合征（CVS）是一种肠道-大脑相互作用的未被充分诊断的疾病。我们对 CVS 的病理生理学的理解正在不断发展。在这里，我们检验了以下两个假设：（1）CVS 患者的内源性大麻素和相关脂质水平发生改变；（2）头部-迷走神经刺激会引起内脂水平的变化。纳入 10 名 CVS 成年患者和 8 名健康对照者。通过心率变异性和呼吸活动的频谱分析，间接测量副交感神经（RFa）功能。在基线和模拟进食期间测量血浆内源性大麻素和相关脂质水平。值以平均值±标准误差表示，并使用 t 检验或 ANOVA 进行比较。CVS 患者的副交感神经张力和对瓦尔萨尔瓦动作及深呼吸的反应均低于对照组。与对照组相比，CVS 患者的基线 2-花生四烯酸甘油（2-AG）浓度明显更高（5.9e-008±3.7e-008mol/L）（p<0.05）。模拟进食未改变 2-AG 浓度。2-油酰甘油（2-OG）在 CVS 中明显高于对照组，且模拟进食后未发生改变。CVS 与对照组的 N-酰基乙醇胺水平，包括大麻素（AEA），无差异。模拟进食后，CVS 中 AEA 呈增加趋势（p=0.08），但对照组无变化。模拟进食后，棕榈酰乙醇胺在 CVS 和对照组中均显著增加；CVS 中仅增加油酰乙醇胺，对照组中仅增加硬脂酰乙醇胺。CVS 患者的内源性大麻素和相关脂质水平发生改变。模拟进食以疾病和时间依赖的方式影响内源性信号脂质。
