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目的研究非糜烂性胃食管反流病(NERD)患者和正常人食管扩张刺激(OD)-脑诱发电位(CEP)的特征及食管酸灌注后 CEP 的改变,探讨 NERD 患者食管内脏高敏感性的发生机制。方法10例健康志愿者和21例 NERD 患者参与试验;采用 Synectics 内脏刺激器/电子气压泵和带有低顺应性气囊及多个灌注式压力通道的导管给食管以时相性扩张刺激和酸灌注;利用食管气囊扩张术检测受试者食管最大耐受痛阈,用75%最大疼痛耐受容积作为诱发刺激的强度(刺激频率为12次/min,连续64次);采用 OD-CEP 系列技术记录并分析食管酸灌注前后 NERD 患者和正常人 CEP 的变化。组间比较采用 t 检验,多组间比较采用单因素方差分析。结果食管时相性机械扩张刺激诱发出可识别、可重复、多峰的 CEP 波形,以 NP 型为主。正常对照者 N1、P1、N2波潜伏期分别为(246±77)、(388±84)和(502±78)ms,NERD 患者 CEP 波形变异性大,其 N1、P1、N2波潜伏期分别为(192±46)、(293±76)和(440±79)ms,较对照组明显缩短(P 值均<0.05);P1-N2峰间波幅明显增加[(6.2±1.9)μV 比(7.8±3.2)μV,P<0.05]。食管酸灌注能明显缩短 NERD 患者 N1、P1、N2波潜伏期,与酸灌注前相比差异有统计学意义(P 值均<0.05),且酸灌注后 NERD 患者 P1-N2皮层波幅值较酸灌注前显著增加(p<0.05),健康对照组除 CEP 的 N1波潜伏期较对应基线值显著降低(P=0.05)外,其余 CEP 参数均无明显改变。结论 NERD 患者存在食管对机械和酸刺激的高敏感性及食管-中枢内脏感觉传导通路失凋。
Objective To investigate the characteristics of esophageal dilation stimulus (OD) -meta-evoked potential (CEP) in patients with non-erosive gastroesophageal reflux disease (NERD) and normal subjects and the changes of CEP after esophageal acid perfusion in patients with non-erosive gastroesophageal reflux disease (NERD) The mechanism. Methods Ten healthy volunteers and twenty-one patients with NERD were enrolled in the experiment. Synectics visceral stimulator / electropneumatic pump and catheter with low-compliance balloon and multiple perfusion pressure channels were used to induce phagocytic expansion and acid perfusion in the esophagus. Esophageal balloon dilatation was used to detect the maximum esophageal pain threshold, and the maximum pain tolerance volume was used as the stimulus intensity (stimulation frequency was 12 times / min for 64 consecutive times). OD-CEP series technique was used to record The changes of CEP in patients with NERD and normal before and after esophageal acid perfusion were analyzed. The t-test was used to compare the groups, and the one-way ANOVA was used to compare the multiple groups. Results The esophageal phasic mechanical dilatation stimulation induced a CEP wave pattern which could be identified, repeatable and multimodal. The N1, P1, N2 wave latency of normal controls were (246 ± 77), (388 ± 84) and (502 ± 78) ms, respectively. 192 ± 46, 293 ± 76 and 440 ± 79 ms, respectively, which were significantly shorter than those in the control group (P <0.05) 3.2) μV, P <0.05]. The esophageal acid perfusion significantly shortened the latency of N1, P1 and N2 in NERD patients compared with that before acid perfusion (P <0.05), and the amplitude of P1-N2 cortex in patients with NERD after acid perfusion was significantly lower than that of acid (P <0.05). The latency of N1 wave except CEP in healthy control group was significantly lower than the corresponding baseline value (P = 0.05), while the rest CEP parameters had no significant change. Conclusions There is a high sensitivity of esophagus to mechanical and acid stimulation in NERD patients and loss of apoptosis in esophageal-central visceral sensory transduction pathways.