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目的:探讨幽门螺旋杆菌(Hp)对腹泻型肠易激综合征(IBS-D)患者直肠肛门运动及直肠感觉功能的影响。方法:采用14C尿素呼吸试验及病理组织学检测60例IBS-D患者,根据是否有Hp感染分为Hp阳性组与Hp阴性组,采用高分辨多道胃肠功能消化道检测仪检测IBS-D患者肛门直肠运动功能及直肠感觉,以25例健康人作对照。结果:增加腹压时,Hp阳性组与Hp阴性组IBS-D肛门括约肌净增压分别为(3.1±0.9)和(3.0±1.0)kPa,低于正常对照组(3.6±1.6)kPa(P<0.05)。Hp阳性组与Hp阴性组IBS-D直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显低于正常对照组(P<0.05)。直肠静息压、肛门括约肌压力、最大缩窄压、模拟大便时括约肌净减压、增加腹压时,肛门括约肌净增压,Hp阴性组与Hp阳性组差异无统计学竞义(P>0.05)。直肠对容量刺激的最大耐受性Hp阳性组低于Hp阴性组(P<0.05)。结论:IBS-D直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱。Hp感染对IBS-D患者肛门直肠动力无影响,但可能影响IBS-D患者直肠对容量刺激的耐受能力。
Objective: To investigate the effects of Helicobacter pylori (Hp) on rectal anorectal and rectal sensory function in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Methods: Sixty patients with IBS-D were examined by 14C urea breath test and histopathology. According to whether Hp infection was divided into Hp positive group and Hp negative group, high resolution multi-gastrointestinal gastrointestinal tract analyzer was used to detect IBS-D Patients with anorectal motor function and rectal sensation, 25 healthy people as a control. Results: The net pressures of IBS-D anal sphincter were (3.1 ± 0.9) and (3.0 ± 1.0) kPa in Hp-positive and Hp-negative groups respectively, which were lower than those in control group (3.6 ± 1.6) kPa <0.05). The lowest sensitivity, maximum tolerability and compliance of IBS-D rectum in Hp-positive and Hp-negative groups were significantly lower than those in normal control group (P <0.05). Rectum resting pressure, anal sphincter pressure, maximum systolic pressure, simulated net stool sphincter decompression, increased abdominal pressure, anal sphincter net pressure, Hp negative group and Hp positive group no statistically significant difference (P> 0.05 ). The maximal tolerance of rectum to volume stimulation was lower in Hp positive group than in Hp negative group (P <0.05). CONCLUSIONS: IBS-D rectum is highly sensitive to volumetric stimulation with low tolerance, low compliance and diminished anal self-control. Hp infection has no effect on anorectal motility in patients with IBS-D, but may affect the ability of the rectum to tolerate volume stimulation in patients with IBS-D.