【作者】 孔浩；

【导师】 侯晓华；

【作者基本信息】 华中科技大学 ， 内科学， 2011， 博士

【摘要】 目的:探讨不同年龄、性别、摄食习惯健康中国人群结直肠传输时间的变化规律,建立中国健康人群结肠传输时间的正常参考值。方法:目标病例数180例(湖北和河南各90例),按不同年龄段分组,分为18-35岁、36-50岁、51-70岁三个年龄段,每一年龄段各含30例,男女比例为1:1。均测定结肠传输时间和不同时间点钡条排除率。结果:①河南地区正常人群各个时间点钡条排除率均高于湖北地区志愿者,但差异并未发现统计学意义(P〉0.05)。男性志愿者在36、48和72小时钡条排除率明显高于女性(P值分别为0.001、0.001和0.044)。各个时间点钡条排除率在三个年龄组之间均无明显差异。②根据P1计算得出:摄食习惯对结肠传输时间有影响,摄食面食者传输明显快于大米者,差异主要在左半结肠;男性志愿者右半结肠、直乙状结肠和全结肠的传输时间明显快于女性(P=0.042、P=0.018和P=0.002)。三组志愿者在年龄上差异主要集中在SRCTT,总CTT和其他肠段CTT差异不明显。③根据P2计算得出:摄食大米为主者结肠传输明显慢于摄食面食为主者,且差异主要集中在直肠乙状结肠以上;男性志愿者左半结肠、右半结肠、直乙状结肠和全结肠的传输时间明显快于女性(P=0.028、P=0.005、P=0.007和P=0.000);志愿者结肠传输时间在各年龄组之间无明显差异(P>0.05)。④P2计算出的CTT值较P1稍延长,差异无统计学意义(P<0.05)。P2较P1更能反映志愿者结肠尤其是节段结肠传输时间的变化规律。结论:河南地区健康志愿者结肠传输快于湖北地区正常人群;男性结肠传输快于女性;结肠传输在年龄上无显著差异。目的:探讨国人结肠传输时间和钡条排除率的影响因素。方法:测定180名健康志愿者结肠传输时间和不同时间点钡条排除率,探讨其影响因素。结果:(1)吸烟和饮酒均会延长结肠传输时间,降低钡条排除率,使得结肠传输减慢。(2)BMI与志愿者钡条排除率均为显著正相关(P<0.05);与志愿者结肠传输时间均为负相关(P<0.05)。(3)志愿者的平均每日饮水量和钡条排除率、结肠传输时间进行相关性分析,平均每日饮水量志愿者钡条排除率均为显著正相关(P<0.05);与志愿者结肠传输时间均为负相关(P<0.05)。仅左半结肠传输时间与进食量显著负相关(P<0.05)。(4)排便次数与志愿者钡条排除率均为显著正相关(P<0.05);与志愿者结肠传输时间均为负相关(P<0.05)。结论:结肠传输影响因素较多,吸烟和饮酒会延缓结肠传输,BMI越高,结肠传输越快,多喝水可以加快结肠传输。目的:主要目的为以下3个方面:1.便秘患者一般情况和症状学调查;2.功能性便秘与便秘型IBS的结肠传输试验在便秘中应用的情况;3.钡条结肠传输试验诊断的输出梗阻型便秘与直肠肛管测压诊断的差异。方法:对112名慢性便秘(排除器质性疾病和药物因素)的结肠传输时间和直肠肛管压力进行研究,进一步了解改进后结肠传输试验在便秘病人中的应用,同时了解其与直肠肛管测压在反映出口梗阻型便秘检查中的差异。结果:(1)FC和IBS-C患者饮食和排便习惯的调查结果:绝大多数便秘患者(大于70%)每日的液体摄入量均小于2L,活动量偏少,进食量较多。大部分便秘患者有抑制便意和不定时排便的习惯,其中FC患者较IBS-C患者更易出现不定时排便,差异具有统计学意义。IBS-C人群较FC人群更易出现与便秘无关的症状。在上消化道症状调查中,IBS-C患者出现上腹痛、恶心和反酸的几率较FC患者明显升高,差异具有统计学意义(P<0.05);在报警和非特异性症状调查中,IBS-C患者较FD人群更易出现消瘦、肌肉酸痛和口腔异味(P<0.05)。(2)76名FC患者和36名IBS-C患者直肠肛管测压结果进行了比较,其中FC和IBS-C患者排便时肛门括约肌无松弛者分别为34和14名,差别无统计学意义(P<0.05)。(3)FC和IBS-C患者各时间点钡条排除率较正常人群均明显降低。FC患者60和72小时钡条排除率明显高于IBS-C患者(P<0.05),其余时间点无明显差别。与健康志愿者比较,FC与IBS-C患者RCTT、LCTT、RSCTT和CTT明显延长,提示其结肠传输较正常者明显减慢。与FC患者比较,IBS-C患者RCTT明显延长,差异有统计学意义(P<0.05)。(4)排便时肛门内括约肌无松弛导致结肠传输减慢,差异主要在直肠乙状结肠;RSCTT或CTT异常者多存在排便时肛门内括约肌无松弛。结论:FC和IBS-C患者结肠传输较正常人群均明显降低;排便时肛门内括约肌无松弛导致结肠传输减慢;钡条结肠传输试验和直肠肛管测压对于诊断出口梗阻型便秘结果一致。更多还原

【Abstract】 Objective: To investigate the relationship among the colonic transit time(CTT), gender, age and different feeding habits in Chinese healthy volunteers Method: 180 adults were randomly included in our study. 15 men and 15 women in each of the three different age groups were recruited in both of Hubei province (mainly living on rice)and Henan province(mainly living on wheaten food). Every volunteer ingested 20 slender barium marks at the beginning of the experiment; then swallowed 20 round barium marks 12h later; and thereafter every 12h, 20 tubbiness barium markers were taken in separate four times. The abdominal plain film was performed 48hand 72h after the first ingestion of the barium strips. The exclusion ratio of barium strips at the different points, total colon transit time(CTT), right colon transit time(RCTT), left colon transit time(LCTT) and recto-sigmoid colon transit(RSCTT)could be calculated. Result:①The exclusion ratio of barium strips at 36h,48h,60h and 72h in 180 healthy Chinese were 84.00±20.31、92.86±14.14、96.50±9.70 and 97.61±7.43. The exclusion ratio of barium strips at 36h、48h and 72h time point were much higher in male volunteers than in female ones (p<0.05). The difference in 36h and 48h exclusion ratio of barium strips were significant among three age groups(p<0.05).②The RCTT、LCTT、RSCTT and CTT were 8.08±4.66、5.09±6.86、7.73±7.58 and 20.90±12.26in 180 healthy adults. The female volunteers present longer CTT than male volunteers (p<0.05). The upper limit of normal value in Chinese population (Mean+2SD)was 45h(male:39h ;female:50h). However, the difference of transit time in different age group was not significant. The RCTT、LCTT and CTT in healthy volunteers of Hubei province were much slower than those in Henan province (p<0.05)..Conclusion: The colonic transit time is shorter in Chinese healthy adults rather than western countries. Both gender and feeding habit effect CTT, while there were no significant difference in CTT among ages.Objective: To investigate the influencing factors of the colonic transit time in Chinese healthy volunteers. Method: 180 adults were randomly included in our study. The colon transit time and the exclusion ratio of barium strips at different time points were determined in all volunteers. We discussed the influencing factors of colonic transit time. Result:①Smoking and drinking will extend colonic transit time, reduce the exclusion of barium, making slow colonic transit.②The rise in the BMI was directly related to the exclusion ratio of barium strips(P <0.05)and inversely related to the colonic transit time(P<0.05).③The rise in the average daily fluid intake was directly related to the exclusion ratio of barium strip(sP<0.05)and inversely related to the colonic transit time(P<0.05).④Frequency of defecation was directly related to the exclusion ratio of barium strips(P<0.05)and inversely related to the colonic transit time(P<0.05). Conclusion: The colonic transit time was inversely related to the BMI. Smoking and drinking may extend colonic transit time.Objective: The main purpose was the following three aspects: 1. The general symptoms in constipation patients ; 2. the application of the colonic transit test in the cases of constipation patients ; 3. barium colonic transit test in the diagnosis of output obstructive constipation . Method: 112 constipation patients were included in our study. The colon transit time and the exclusion ratio of barium strips at different time points were determined in all patients. Result:①The daily fluid intake in most patients with constipation (more than 70%) were less than 2L; The IBS-C patients were more likely with irregular bowel habits than FC patients, the difference was statistically significant.②The anorectal manometry was done in 76 FC patients and 36 patients with IBS-C ; FC and IBS-C patients with no relaxation of anal sphincter during defecation were 34 and 14, respectively, the difference was not statistically significant (P <0.05).③The exclusion of barium strips at each time points in FC and IBS-C patients were significantly lower than the normal population(P <0.05). Compared with healthy volunteers, RCTT, LCTT, RSCTT and CTT in the FC and IBS-C patients were significantly prolonged, suggesting that the colonic transit were significantly slower than the normal. Compared with FC patients, RCTT in IBS-C patients was significantly longer, the difference was statistically significant (P <0.05).Conclusion: The colonic transit in patients with FC and IBS-C were significantly lower than the normal population; defecation of anal sphincter without relaxation cause slow colonic transit.更多还原