van der Sijp J R, Kamm M A, Nightingale J M, Britton K E, Mather S J, Morris G P, Akkermans L M, Lennard-Jones J E
Department of Physiology and Gastroenterology, St Marks's Hospital, London.
Gut. 1993 Mar;34(3):402-8. doi: 10.1136/gut.34.3.402.
Radio-opaque markers have a well established role in distinguishing between patients with normal and those with slow intestinal transit, but in the latter group their accuracy in defining the region of delay has not been established. To study regional colonic transit accurately the transit of a radioisotope labelled meal was determined and findings were compared with those of simultaneously ingested radio-opaque markers. Twelve healthy controls (mean age 33 years) and 12 severely constipated women (mean age 36 years, bowel frequency < once per week) were studied On day 1, a meal containing 10 MBq 111In bound to 0.7 mm resin microspheres was ingested. Subjects also ingested a set of radiologically distinguishable markers on three successive days. Abdominal scans were obtained three times daily for 7 days. Abdominal radiographs were obtained after 72 or 96 hours and again at 144 or 168 hours. Eight 'regions of interest' were created--one for the small bowel, six for the colon, and one for excreted stool. The constipated patients all showed colonic transit outside the normal range, with a variable site of delay demonstrated by time activity curves for each region. To provide a different measure of the effectiveness of colonic transport, the movement of the 'centre of mass' for the radioisotope and for the markers was then determined. The radioisotope and radiopaque marker methods gave similar results. At all times between 24 and 144 hours there was no significant difference for the position of the centre of mass between the radio-opaque and marker methods. At all times, however, the mean difference between the markers and the radioisotopes was positive, indicating that the center of mass of the markers was always head of that of the radioisotope. The mean difference between the methods was never greater than one region of interest, and ranged from 12 to 72% of one region of interest in the colon. The difference between these two methods could reach up to two colonic segments in certain patients at one time. Radioisotope ingestion provides accurate information about the transit through individual colonic regions because of the possibility of frequent observations and the clear delineation of the entire colon. Although these features were not obtained with radio-opaque markers, they are suitable as a screening test for the presence and pattern of colonic delay.
不透射线标记物在区分肠道转运正常和缓慢的患者方面具有明确作用，但在后者中，其在确定延迟区域的准确性尚未得到证实。为了准确研究结肠区域转运，测定了放射性同位素标记餐的转运情况，并将结果与同时摄入的不透射线标记物的结果进行比较。研究了12名健康对照者（平均年龄33岁）和12名严重便秘女性（平均年龄36岁，排便频率<每周一次）。在第1天，摄入含有10 MBq铟-111与0.7毫米树脂微球结合的餐食。受试者还在连续三天内摄入一组放射学上可区分的标记物。连续7天每天进行3次腹部扫描。在72或96小时后以及144或168小时再次进行腹部X光检查。创建了8个“感兴趣区域”——一个用于小肠，六个用于结肠，一个用于排出的粪便。便秘患者均显示结肠转运超出正常范围，每个区域的时间-活性曲线显示出不同的延迟部位。为了提供一种不同的结肠运输有效性测量方法，随后确定了放射性同位素和标记物的“质心”运动。放射性同位素法和不透射线标记物法得出了相似的结果。在24至144小时之间的所有时间，不透射线标记物法和标记物法之间质心位置均无显著差异。然而，在所有时间，标记物和放射性同位素之间的平均差异均为正值，表明标记物的质心始终位于放射性同位素质心的前方。两种方法之间的平均差异从未超过一个感兴趣区域，在结肠中范围为一个感兴趣区域的12%至72%。在某些患者中，这两种方法之间的差异在某一时刻可达两个结肠段。由于可以频繁观察且能清晰勾勒整个结肠，摄入放射性同位素可提供有关通过各个结肠区域转运的准确信息。尽管不透射线标记物无法获得这些特征，但它们适合作为结肠延迟存在和模式的筛查试验。
