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目的 观察肾功能不全尿毒症患者透析前后胃排空、体表胃电图 ,对急性肾功能衰竭大鼠肠神经系统 (ENS)进行研究 ,探讨ENS病变与尿毒症胃肠道症状之间的关系。方法 15例有胃肠道症状的尿毒症患者进行透析前后胃排空及胃电图研究比较。建立大鼠急性肾功能衰竭模型 ,光镜下观察ENS神经丛数量及血胃肠激素水平。结果 尿毒症患者透析前存在胃电节律紊乱及胃排空障碍 ,透析后得到改善。急性肾功能衰竭大鼠消化道神经丛一氧化氮合酶 (NOS)阳性数量较正常组明显减少 ,血清胃泌素、血管活性肠肽及血浆胃动素水平分别为 (15 9.1± 5 5 .6 ) μg/L ,(12 1.6± 4 8.9) pg/L及 (6 .32± 3.5 5 ) pmol/L ,与对照组相比 ,差异有显著性 (P值均 <0 .0 5 )。 结论 尿毒症患者存在胃肌电活动异常、胃排空障碍 ,透析后得到改善。急性肾功能衰竭大鼠NOS阳性神经丛数量减少及胃肠激素水平的改变 ,可能与尿毒症代谢产物作用于ENS ,导致ENS病变而出现胃肌电活动异常有关。
Objective To observe the changes of gastric emptying and surface electrogastrogram before and after dialysis, and to study the enteric nervous system (ENS) of acute renal failure rats and to explore the relationship between ENS lesions and gastrointestinal symptoms of uremia . Methods 15 cases of gastrointestinal symptoms of uremic patients before and after dialysis gastric emptying and electrogastrogram study and comparison. Acute renal failure model was established in rats. The number of ENS nerve plexus and the level of blood gut gut hormone were observed under light microscope. Results In patients with uremia, there were disorders of gastric electrical rhythm and gastric emptying before dialysis, which were improved after dialysis. The number of NOS positive cells in the digestive tract plexus of acute renal failure rats was significantly lower than that of the normal control group, the levels of serum gastrin, vasoactive intestinal peptide and plasma motilin were (15 9.1 ± 5.5). 6) μg / L, (12 1.6 ± 8.99) pg / L and (6.32 ± 3.55) pmol / L, respectively. There was significant difference between the two groups (P <0.05). Conclusions Uremic patients have abnormal gastric myoelectrical activity, gastric emptying disorder and improvement after dialysis. Acute renal failure in rats with decreased number of NOS-positive plexus and changes in gastrointestinal hormone levels may be related to the role of uremic metabolites in ENS, leading to ENS lesions appear abnormal gastric myoelectric activity.