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| 1 | 食管内脏高敏感及其相关研究进展显示文摘胃食管反流疾病(gastroesophageal reflux disease,GERD)是一种较普遍的疾病,经常伴随各种不适症状,需要利用健康护理资源.在动物实验与人类实验研究中均表明,各种传入神经的受体在暴露于酸的情况下均可以敏感化,以至于使更多的感觉刺激通过传入神经输入到脊髓背角神经元,导致了这些神经元的阈值降低,使得他们的感受范围增大.这种敏感性增高的初级传入神经被形容为外周敏感化,而随之增加敏感性的脊髓背角神经元被描述为中央敏感化.一旦这些机制建立起来,可以使组织对以前原本无害的刺激发生敏感,并且会保持一个长期的过程.此外,心理压力和机械刺激都已经被证实可以使细胞间隙增宽,因此可能促进外围敏感化.目前,外围与中枢敏感化被认为是食管疼痛和高敏感的重要机制,甚至生理量的酸亦可以导致症状的发生.对于这些患者的治疗目的主要是降低神经的敏感性.本文主要围绕食管内脏感觉高敏感作一简要综述. | 孟庆伟 许树长 | 2012 | 世界华人消化杂志2012，20，7： | 11 |
| 2 | 食管酸刺激对正常人内脏感觉中枢易化的作用显示文摘目的利用功能磁共振成像(fMRI)技术观察食管酸灌注刺激相关内脏感觉中枢及活动特点。方法采用改良组块设计模式对15名健康受试者进行食管酸(O.1mmol/L HCl)或0.9%氯化钠溶液刺激,同时行fMRI。具体步骤为:静息期(A期)8min,0.9%氯化钠溶液灌注(B期)8min,酸灌注(C期)8min,0.9%氯化钠溶液再灌注(D期)8min,总时间为32min。每个组块为160个时间点(scans),每个时间点为3S,共采集640个时间点数据。观察受试者反应,并对受试者大脑功能区的改变进行统计学分析。结果15名受试者中,10名刺激后出现咽喉部胀痛、烧心、胸痛等不适表现。初次0.9%氯化钠溶液刺激期(B-A)激活脑区包括中脑、前扣带回、左侧岛叶、两侧杏仁核及海马旁回、两侧前额皮质背外侧。酸灌注刺激期(C—A)及酸灌注后再灌注0.9%氯化钠溶液刺激期(D-A)所激活脑区与辟A期所激活脑区部位一致。同时发现,大部分激活部位强度逐渐增强,激活像素逐渐增多,即B-A期〈C—A期〈D-A期(P〈0.01),D-A期引起的大脑反应强度明显强于BA期(P〈0.01)。结论0.9%氯化钠溶液和酸刺激产生相同的脑激活区,这些脑区均参与食管感觉的调节,滴酸刺激增加食管黏膜的敏感性存在有客观的中枢证据。 | 许树长 郑芳芳 赵小虎 王琛 来立人 陈莹 刘远飞 陈锡美 | 2009 | 中华消化杂志2009，29，1： | 1 |
| 3 | Proximal and distal esophageal sensitivity is decreased in patients with Barrett’s esophagus显示文摘AIM: To investigate sensations to multimodal pain stimulation in the metaplastic and normal parts of the esophagus in patients with Barrett’s esophagus (BE). METHODS: Fifteen patients with BE and 15 age-matched healthy volunteers were subjected to mechanical, thermal and electrical pain stimuli of the esophagus. Both the metaplastic part and the normal part (4 and 14 cm, respectively, above the esophago-gastric junction) were examined. At sensory thresholds the stimulation intensity, referred pain areas, and evoked brain potentials were recorded. RESULTS: Patients were hyposensitive to heat stimulation both in the metaplastic part [median stimulation time to reach the pain detection threshold: 15 (12-34) s vs 14 (6-23) s in controls; F = 4.5, P = 0.04] and the normal part of the esophagus [median 17 (6-32) s vs 13 (8-20) s in controls; F = 6.2, P = 0.02]. Furthermore, patients were hyposensitive in the metaplastic part of the esophagus to mechanical distension [median volume at moderate pain: 50 (20-50) mL vs 33 (13-50) mL in controls; F = 5.7, P = 0.02]. No indication of central nervous system abnormalities was present, as responses were comparable between groups to electrical pain stimuli in the metaplastic part [median current evoking moderate pain: 13 (6-26) mA vs 12 (9-24) mA in controls; F = 0.1, P = 0.7], and in the normal part of the esophagus [median current evoking moderate pain: 9 (6-16) mA, vs 11 (5-11) mA in controls; F = 3.4, P = 0.07]. Furthermore, no differences were seen for the referred pain areas (P-values all > 0.3) or latencies and amplitudes for the evoked brain potentials (P-values all > 0.1). CONCLUSION: Patients with BE are hyposensitive both in the metaplastic and normal part of esophagus likely as a result of abnormalities affecting peripheral nerve pathways. | Anne L Kraru Sφren S Olesen Peter Funch-Jensen Hans Gregersen Asbjφrn M Drewes | 2011 | World Journal of Gastroenterology2011，17，4： | 0 |
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