Bharucha A E, Camilleri M, Low P A, Zinsmeister A R
Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Gut. 1993 Mar;34(3):397-401. doi: 10.1136/gut.34.3.397.
The records of 113 consecutive patients with a suspected gastrointestinal motility disorder referred between January 1988 and July 1991 were retrospectively reviewed. The aims were to identify the prevalence of autonomic dysfunction in those with or without associated neurological disease and to determine the diagnostic value of testing for autonomic dysfunction. All patients had gastrointestinal manometry (3 hours fasting, 2 hours fed), 94 of 113 underwent testing of sympathetic adrenergic and cholinergic function and cardiovagal cholinergic function. All tests were scored in a standard manner. There was a significant (p < 0.05) but modest (r = 0.28) rank correlation between autonomic and motility scores. This correlation was stronger (r = 0.67, p = 0.01) in diabetic patients. The number of patients in each group with autonomic dysfunction was as follows: irritable bowel syndrome nine of 33, idiopathic upper gastrointestinal dysmotility six of 21, diabetes mellitus nine of 13, identified non-diabetic neurological syndromes six of nine, postvagotomy or abdominal surgery three of 11, and myopathic pseudo-obstruction two of seven. Autonomic testing is useful in the assessment of autonomic involvement outside the gastrointestinal tract. Logistic discriminant analysis showed that autonomic function testing did not add to the diagnostic value of motility tests in distinguishing between patients with and without irritable bowel syndrome, although a slight improvement was indicated for identifying neuropathic dysmotilities. Thus, the aetiological role of general autonomic dysfunction in irritable bowel syndrome and idiopathic and postvagotomy dysmotilities deserves further study. The addition of autonomic function tests does not add substantially to the diagnostic accuracy of clinical, radiological, endoscopic, and manometric techniques in most patients referred for evaluation of a suspected motility disorder.
对1988年1月至1991年7月间转诊的113例疑似胃肠动力障碍患者的记录进行了回顾性研究。目的是确定伴有或不伴有相关神经疾病的患者中自主神经功能障碍的患病率，并确定自主神经功能障碍检测的诊断价值。所有患者均进行了胃肠测压（禁食3小时，进食2小时），113例中有94例接受了交感肾上腺素能和胆碱能功能以及心脏迷走胆碱能功能检测。所有检测均采用标准方式评分。自主神经评分与动力评分之间存在显著（p < 0.05）但适度（r = 0.28）的等级相关性。在糖尿病患者中这种相关性更强（r = 0.67，p = 0.01）。每组中存在自主神经功能障碍的患者数量如下：肠易激综合征33例中有9例，特发性上消化道动力障碍21例中有6例，糖尿病13例中有9例，已确诊的非糖尿病性神经综合征9例中有6例，迷走神经切断术或腹部手术后11例中有3例，肌病性假性肠梗阻7例中有2例。自主神经检测在评估胃肠道外的自主神经受累情况时很有用。逻辑判别分析表明，自主神经功能检测在区分肠易激综合征患者和非患者时，并没有增加动力检测的诊断价值，尽管在识别神经性动力障碍方面有轻微改善。因此，一般自主神经功能障碍在肠易激综合征、特发性和迷走神经切断术后动力障碍中的病因学作用值得进一步研究。对于大多数因疑似动力障碍而转诊评估的患者，增加自主神经功能检测并不能显著提高临床、放射学、内镜和测压技术的诊断准确性。
