Guelrud M, Bettarello A, Cecconello I, Pinotti W, Mantelmacher H, Velasquez H
Gastroenterology. 1983 Sep;85(3):584-8.
Autonomic denervation is found throughout the entire length of the digestive tract in Chagas' disease. Anatomic evidence of myenteric ganglia reduction in chagasic gallbladders has been noted; however, the sphincter of Oddi has not been studied. The purpose of this study is twofold: first, to determine sphincter of Oddi pressure in 11 patients with chronic Chagas' disease and megaesophagus, and to compare the results with those obtained in 27 control subjects; and second, to evaluate the effect of cholecystokinin-octapeptide on sphincter of Oddi pressure in both groups of patients. Sphincter of Oddi pressure was recorded continuously via an endoscopically placed triple-lumen catheter inserted into the papilla and directed into the common bile duct. Basal sphincter of Oddi pressure was 12.9 +/- 1.1 mmHg in controls as compared with 44.9 +/- 4.7 mmHg in chagasics with megaesophagus. Mean common bile duct/duodenum gradient pressure was 4.1 +/- 2.4 mmHg in controls as compared with 13.1 +/- 2.7 mmHg in chagasics. Amplitude of sphincter of Oddi phasic contractions in the control group was 102.4 +/- 5.5 mmHg as compared with 140.5 +/- 9.2 mmHg in the chagasic group. Pulse dose of intravenous cholecystokinin-octapeptide produced a decrease of basal sphincter of Oddi pressure with inhibition of sphincter of Oddi phasic contractions in both chagasic and control patients. In chagasic patients, a neural abnormality in the sphincter of Oddi segment could explain the observed high basal pressure and high amplitude of phasic contractions. Chagasic patients with sphincter of Oddi pressure abnormalities, demonstrating sphincter of Oddi relaxation after cholecystokinin-octapeptide, may have neural impairment limited to preganglionic fibers, while the postganglionic inhibitory nerves remain at least partially intact.
在恰加斯病中，整个消化道均存在自主神经去神经支配现象。已有研究指出恰加斯病胆囊中肌间神经节减少的解剖学证据；然而，尚未对奥迪括约肌进行研究。本研究有两个目的：其一，测定11例慢性恰加斯病合并巨食管患者的奥迪括约肌压力，并将结果与27例对照受试者的结果进行比较；其二，评估八肽胆囊收缩素对两组患者奥迪括约肌压力的影响。通过在内镜下将三腔导管插入乳头并导入胆总管来连续记录奥迪括约肌压力。对照组的基础奥迪括约肌压力为12.9±1.1 mmHg，而合并巨食管的恰加斯病患者为44.9±4.7 mmHg。对照组的平均胆总管/十二指肠梯度压力为4.1±2.4 mmHg，恰加斯病患者为13.1±2.7 mmHg。对照组奥迪括约肌相性收缩的幅度为102.4±5.5 mmHg，恰加斯病组为140.5±9.2 mmHg。静脉注射脉冲剂量的八肽胆囊收缩素可使恰加斯病患者和对照患者的基础奥迪括约肌压力降低，并抑制奥迪括约肌的相性收缩。在恰加斯病患者中，奥迪括约肌段的神经异常可解释所观察到的高基础压力和高相性收缩幅度。奥迪括约肌压力异常的恰加斯病患者在注射八肽胆囊收缩素后出现奥迪括约肌松弛，可能其神经损伤仅限于节前纤维，而后节抑制神经至少部分保持完整。
