切换至 "中华医学电子期刊资源库"
高级检索
中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (04) : 370 -376. doi: 10.3877/cma.j.issn.2095-3224.2019.04.009

所属专题： 经典病例； 文献；

论著

60例成年人直肠电刺激脑诱发电位特点及结果分析
刘艳妮1, 张彩霞2, 张琪3, 张琼4, 何蕾5, 陈正鑫3, 江滨5,†(), 倪敏5,†()   
  1. 1. 721000　宝鸡市中医医院泌尿外科
    2. 211800　南京市浦口区中医院普外科
    3. 210023　南京中医药大学研究生院
    4. 223600　宿迁，沭阳县中医院肛肠科
    5. 210022　南京，南京市中医院肛肠中心
  • 收稿日期:2019-01-18 出版日期:2019-08-25
  • 通信作者: 江滨, 倪敏
  • 基金资助:
    2018年江苏省研究生实践创新计划项目(No.SJCX18_0461); 江苏省青年卫生重点人才项目(No.QNRC2016128); 南京市2018年省级重点研发计划（社会发展）项目(No.BE2018612)

The characters and results of rectal electrical stimulation cerebral evoked potentials in 60 adults

Yanni Liu1, Caixia Zhang2, Qi Zhang3, Qiong Zhang4, Lei He5, Zhengxin Chen3, Bin Jiang5,†(), Min Ni5,†()   

  1. 1. Department of Urology, Baoji Hospital of Traditional Chinese Medicine, Baoji 721000, China
    2. Department of General Surgery, Nanjing Pukou District Hospital, Nanjing 211800, China
    3. Graduate School of Nanjing University of Chinese Medicine, Nanjing 210023, China
    4. Department of Anorectal, Shuyang County Hospital of Traditional Chinese Medicine, Suqian 223600, China
    5. Department of Anorectal Center, Nanjing Traditional Chinese Medicine Hospital, Nanjing 210022, China
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

刘艳妮, 张彩霞, 张琪, 张琼, 何蕾, 陈正鑫, 江滨, 倪敏. 60例成年人直肠电刺激脑诱发电位特点及结果分析[J]. 中华结直肠疾病电子杂志, 2019, 08(04): 370-376.

Yanni Liu, Caixia Zhang, Qi Zhang, Qiong Zhang, Lei He, Zhengxin Chen, Bin Jiang, Min Ni. The characters and results of rectal electrical stimulation cerebral evoked potentials in 60 adults[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(04): 370-376.

目的

探讨正常人直肠电刺激脑诱发电位（CEP）的正常值及波形特征。

方法

检查者将刺激电极经肛置入受试者直肠内，在头顶部Cz点放置记录电极，参考电极置于前额部Fz点，使用英国Oxford公司肌电诱发电位仪采样分析。

结果

所有检测对象均记录有直肠电刺激脑诱发电位，各波参数范围分别是：P1波潜伏期（45.55±3.26）ms，N1波（101.71±15.71）ms，P2波（198.35±27.70）ms，P1/N1波幅（5.62±1.58）μV，N1/P2波幅（8.26±2.48）μV。直肠电刺激脑诱发电位各波潜伏期及波幅在性别、年龄分组间比较，差异无统计学意义。经一般线性回归分析发现，在控制年龄分组、性别后，波幅随BMI增加而降低，BMI每增加1 kg/m2，P1/N1波幅平均下降0.234 μV（P=0.011），N1/P2波幅平均下降0.320 μV（P=0.027）。

结论

直肠电刺激脑诱发电位提供了一种简单、有效的评估直肠到大脑皮层感觉神经通路的方法。本研究对了解功能性胃肠疾病中的脑肠互动作用具有重要价值。本研究的检测结果及其影响因素分析，可供后续临床研究借鉴。

关键词: 直肠, 直肠感觉, 电刺激, 脑诱发电位, 脑-肠轴
Objective

To investigate the normal range and waveform characteristics of rectal electrical stimulation cerebral evoked potential (CEP) in healthy people.

Methods

The examiner placed the stimulus electrode in the rectum of the subjects through the anus, the recording electrode at Cz point on the top of the head, the reference electrode at Fz point on the forehead and sampled by Oxford EMP.

Results

Rectal electrical stimulation cerebral evoked potentials were recorded in all subjects. The waveform parameters are P1 wave latency (45.55±3.26) ms, N1 wave (101.71±15.71) ms, P2 wave (198.35±27.70) ms, P1/N1 amplitude (5.62±1.58) μV, N1/P2 amplitude (8.26±2.48) μV. There was no significant difference in latency and amplitude of the evoked potential waves between sex and age groups. By general linear regression analysis, it was found that the amplitude decreased with the increase of BMI after controlling age group and sex. For each increase of BMI of 1 kg/m2, the amplitude of P1/N1 decreased by 0.234 μV (P=0.011), and the amplitude of N1/P2 decreased by 0.320 μV (P=0.027).

Conclusion

Rectal electrical stimulation cerebral evoked potentials provides a simple and effective method for evaluating the sensory nerve pathway from rectum to cerebral. This study is of great value in understanding the brain-intestinal interaction in functional gastrointestinal diseases. The results of this study and the analysis of its influencing factors can be used for reference in the follow-up clinical research.

Key words: Rectum, Rectal sensation, Electrical stimulation, Cerebral evoked potential, Brain-gut axis
图3 诱发电位各参数示意
图5 正常女性，32岁，直肠电刺激CEP：P1波潜伏期45.6 ms，N1波潜伏期98.7 ms，P2波潜伏期225.3 μV，P1/N1波幅5.5 μV，N1/P2波幅10.2 μV。第3次波形中P1/N1、N1/P2波幅较前两次明显降低，坐标标尺：30 ms/cm
表1 60例受试者基本信息统计结果（±s）
总人数 例数（例） 年龄（岁） 身高（cm） 体重（kg） BMI（kg/m2）
60 42.07±12.63 166.90±8.41 63.57±8.12 22.81±2.35
性别 ? ? ? ? ?
? 男 30 41.90±12.85 172.97±6.92 68.47±7.27 22.92±2.45
? 女 30 42.23±12.63 160.83±4.46 58.67±5.62 22.70±2.28
年龄分组 ? ? ? ? ?
? 年龄Ⅰ组 15 25.80±2.91 169.40±10.38 63.20±8.32 22.00±2.13
? 年龄Ⅱ组 15 37.00±2.78 164.60±8.62 63.27±10.19 23.30±2.93
? 年龄Ⅲ组 14 46.71±2.76 166.93±8.82 66.00±8.43 23.69±2.34
? 年龄Ⅳ组 16 58.00±4.98 166.69±5.42 62.06±5.28 22.34±1.71
表2 60例成年人直肠电刺激CEP结果（±s）
测值 潜伏期（ms） 波幅（μV）
P1 N1 P2 P1/N1 N1/P2
测值范围 38.60~51.60 67.20~134.00 136.80~261.90 2.30~8.60 4.10~14.80
平均数±标准差 45.55±3.26 101.71±15.71 198.35±27.70 5.62±1.58 8.26±2.48
表3 性别、年龄组间比较直肠电刺激CEP结果（例，±s）
组别 例数 潜伏期（ms） 波幅（μV）
P1 N1 P2 P1/N1 N1/P2
男性组 30 44.85±3.51 101.05±17.64 203.77±24.97 5.76±1.63 8.42±2.42
女性组 30 46.25±2.88 102.36±13.79 192.93±29.61 5.48±1.54 8.10±2.57
t值 ? -1.694 -0.319 1.532 0.675 0.497
P值 ? 0.096 0.751 0.131 0.502 0.621
年龄Ⅰ组 15 45.19±3.46 108.31±16.41 198.75±26.21 5.88±1.75 8.63±2.53
年龄Ⅱ组 15 45.32±3.15 99.33±14.07 198.42±26.81 5.78±1.78 8.01±2.84
年龄Ⅲ组 14 46.68±2.57 102.69±16.09 198.35±24.70 5.49±1.28 8.74±2.59
年龄Ⅳ组 16 45.12±3.74 96.87±15.34 197.90±34.30 5.35±1.55 7.73±2.04
F值 ? 0.381 1.249 0.109 0.364 0.571
P值 ? 0.765 0.337 0.939 0.803 0.689
表4 直肠电刺激CEP结果与影响因素分析结果
组别 潜伏期（ms） 波幅（μV）
P1 N1 P2 P1/N1 N1/P2
回归系数 P值 回归系数 P值 回归系数 P值 回归系数 P值 回归系数 P值
男性组 Ref. - Ref. - Ref. - Ref. - Ref. -
女性组 1.133 0.199 -0.633 0.880 -13.616 0.069 -0.356 0.382 -0.332 0.605
年龄Ⅰ组 0.148 0.905 7.658 0.201 -2.969 0.777 -0.234 0.683 0.216 0.812
年龄Ⅱ组 Ref. - Ref. - Ref. - Ref. - Ref. ?
年龄Ⅲ组 1.092 0.386 -0.344 0.954 0.610 0.954 -0.168 0.773 1.047 0.257
年龄Ⅳ组 0.180 0.881 -1.441 0.802 -1.429 0.887 -0.649 0.245 -0.550 0.531
BMI 0.088 0.650 -0.424 0.648 -1.263 0.440 -0.234 0.011* -0.320 0.027*
R-squared 0.050 ? 0.064 ? 0.067 ? 0.135 ? 0.123 ?
F值 0.569 ? 0.743 ? 0.781 ? 1.689 ? 1.509 ?
[1]
彭超，汤颖. 体感诱发电位临床新进展[J/CD]. 中华临床医师杂志(电子版), 2013, 7(22): 10260-10262.
[2]
胡晓晴，唐娜. 体感诱发电位的基本原理[J]. 国外医学(物理医学与康复学分册), 2005, (2): 53-55＋79.
[3]
倪敏，丁义江，丁曙晴. 神经调节在功能性胃肠病发病中的作用及其研究进展[J]. 世界华人消化杂志, 2011, 19(25): 2649-2653.
[4]
王心刚. 神经电生理诊断技术规范(续) [J]. 现代电生理学杂志, 2018, 25(01): 55-62.
[5]
Ridding MC, Ziemann U. Determinants of the induction of cortical plasticity by non-invasive brain stimulation in healthy subjects [J]. J Physiol, 2010, 588(13): 2291-2304.
[6]
刘娟. 脑电图检查在临床规范应用中的若干注意事项[J]. 现代电生理学杂志, 2009, 16(1): 36-38.
[7]
Harris ML, Hobson AR, Hamdy S, et al. Neurophysiological evaluation of healthy human anorectal sensation [J]. American Journal of Physiology Gastrointestinal & Liver Physiology, 2006, 291(5): G950.
[8]
Hobson AR, Aziz Q, Furlong PL, et al. Identification of the optimal parameters for recording cortical evoked potentials to human oesophageal electrical stimulation [J]. Neurogastroenterol Motil, 1998, 10(5): 421-430.
[9]
潘映辐. 临床诱发电位学[M]. 北京: 人民卫生出版社, 1988: 85-87.
[10]
Thiruppathy K, Mason J, Akbari K, et al. A physiological study of the anorectal reflex in patients with functional anorectal and defecation disorders [J]. Journal of Digestive Diseases, 2017, 18(4): 222-228.
[11]
匡荣光，匡彦，左秀丽, 等. 功能性便秘患者直肠扩张脑诱发电位研究[J]. 中国医师杂志, 2008, 10(10): 1380-1381.
[12]
李延青，左秀丽，匡荣光, 等. 肠易激综合征患者直肠扩张后脑诱发电位的研究[J]. 基础医学与临床, 2003, 12(z1): 349-351.
[13]
Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and romeⅣ [J]. Gastroenterology, 2016, 150(6): 1262-1279. e2.
[14]
Grunkemeier DMS, Cassara JE, Dalton CB, et al. The narcotic bowel syndrome: clinical features, pathophysiology, and Management [J]. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 2007, 5(10): 1126-1139.
[15]
Iovino P, Bucci C, Tremolaterra F, et al. Bloating and functional gastro-intestinal disorders: where are we and where are we going? [J]. World Journal of Gastroenterology, 2014, 20(39): 14407.
[16]
Peter H, Aitak F, Hassan AM, et al. Visceral inflammation and immune activation stress the brain [J]. Frontiers in Immunology, 2017, 8: 1613.
[17]
Mertz H. Role of the brain and sensory pathways in gastrointestinal sensory disorders in humans [J]. Gut, 2002, 51(1): 29-33.
[18]
Whitehead WE, Holtkotter B, Enck P, et al. Tolerance for rectosigmoid distention in irritable bowel syndrome [J]. Gastroenterology, 1990, 98(5 Pt 1): 1187.
[19]
蒋晓忠，王邦茂，赵晓志, 等. 直肠内不同温度刺激对肠易激综合征患者内脏敏感性的影响[J]. 胃肠病学和肝病学杂志, 2006, (2): 163-166.
[20]
Su A, Gandhy R, Barlow C, et al. Utility of high-resolution anorectal manometry and wireless motility capsule in the evaluation of patients with Parkinson′s disease and chronic constipation[J]. BMJ Open Gastroenterology, 2016, 3(1): e000118.
[21]
Sinhamahapatra P, Saha SP, Chowdhury A, et al. Visceral afferent hypersensitivity in irritable bowel syndrome--evaluation by cerebral evoked potential after rectal stimulation [J]. American Journal of Gastroenterology, 2001, 96(7): 2150-2157.
[22]
丁曙晴. 肛管直肠测压在排便障碍性疾病中的价值及临床解读[J]. 中华胃肠外科杂志, 2016, (12): 1342-1344.
[23]
Sauter M, Heinrich H, Fox M, et al. Toward more accurate measurements of anorectal motor and sensory function in routine clinical practice: Validation of High-Resolution Anorectal Manometry and Rapid Barostat Bag measurements of rectal function [J]. Neurogastroenterology & Motility, 2014, 26(5): 685-695.
[24]
Gaman A, Kuo B. A review of CNS activation patterns from fMRI studies in IBS patients versus healthy controls [J]. Gastroenterology, 2007, 32: 600-602.
[25]
Dimcevski G, Sami SA, Funch-Jensen P, et al. Pain in Chronic Pancreatitis: The Role of Reorganization in the Central Nervous System [J]. Gastroenterology, 2007, 132(4): 1546-1556.
[26]
Delechenault P, Leroi AM, Bruna T, et al. Cerebral potentials evoked by electrical stimulation of the anal canal [J]. Diseases of the Colon & Rectum, 1993, 36(1): 55.
[27]
Lelic D, Nissen TD, Brock C, et al. Rapid balloon distension as a tool to study cortical processing of visceral sensations and pain [J]. Neurogastroenterology & Motility the Official Journal of the European Gastrointestinal Motility Society, 2015, 27(6): 832-840.
[28]
Haas S, Brock C, Krogh K, et al. Cortical evoked potentials in response to rapid balloon distension of the rectum and anal canal [J]. Neurogastroenterology & Motility, 2014, 26(6): 862-873.
[29]
Hobday DI, Hobson A, Furlong PL, et al. Comparison of cortical potentials evoked by mechanical and electrical stimulation of the rectum. Neurogastroenterol Motil. 2000 Dec; 12(6): 547-554.
[30]
Leroi AM, Ducrotté P, Bouaniche M, et al. Assessment of the reliability of cerebral potentials evoked by electrical stimulation of the anal canal [J]. International Journal of Colorectal Disease, 1997, 12(6): 335-339.
[31]
Remes-Troche JM, Tantiphlachiva K, Attaluri A, et al. A bi-directional assessment of the human brain-anorectal axis [J]. Neurogastroenterology & Motility the Official Journal of the European Gastrointestinal Motility Society, 2011, 23(3): 117-118.
[32]
Vasudevan SP, Scott SM, Gladman MA, et al. Rectal hyposensitivity: evaluation of anal sensation in female patients with refractory constipation with and without faecal incontinence [J]. Neurogastroenterology & Motility, 2007, 19(8): 660-667.
[33]
Gagliardo A, Galli F, Grippo A, et al. Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities [J]. Journal of Neurology, 2007, 254(2): 220-227.
[34]
Delgadoaros S, Locke GR, Camilleri M, et al. Obesity is associated with increased risk of gastrointestinal symptoms: A population-based study [J]. American Journal of Gastroenterology, 2004, 99(9): 1801-1806.
[35]
Delgadoaros S, Camilleri M, Garcia MA, et al. High body mass alters colonic sensory-motor function and transit in humans [J]. American Journal of Physiology Gastrointestinal & Liver Physiology, 2008, 295(2): G382-388.
[36]
Teitelbaum JE, Sinha P, Micale M, et al. Obesity is related to multiple functional abdominal diseases [J]. J Pediatr, 2009, 154(3): 444-446.
[37]
Gudsoorkar VS, Quigley EM. Colorectal sensation and motility [J]. Current Opinion in Gastroenterology, 2014, 30(1): 75-83.
[38]
郭椿，贺平. 脑肠轴及其研究进展[J]. 世界最新医学信息文摘, 2017, 17(95): 89-91.
[39]
Andresen V, Bach DR, Poellinger A, et al. Brain activation responses to subliminal or supraliminal rectal stimuli and to auditory stimuli in irritable bowel syndrome [J]. Neurogastroenterol Motil, 2005, 17(6): 827-837.
[40]
Fenton BW. Limbic associated pelvic pain: A hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain [J]. Medical Hypotheses, 2007, 69(2): 282-286.
[41]
Takano S, Arakawa H. Bilateral posterior tibial nerve stimulation for functional anorectal pain-short term outcome [J]. International Journal of Colorectal Disease, 2016, 31(5): 1053-1054.
[42]
倪敏，丁曙晴，皇甫少华, 等. 功能性排便障碍患者经腰刺激运动诱发电位的研究[J]. 第三军医大学学报, 2013, 35(21): 2292-2294.
[43]
倪敏，丁义江，丁曙晴, 等. 功能性便秘患者经颅磁刺激运动诱发电位的研究[J]. 南京医科大学学报(自然科学版), 2011, 31(11): 1674-1678.
[44]
Geeraerts B, Oudenhove LV, Dupont P, et al. Different regional brain activity during physiological gastric distension compared to balloon distension: a H215O-PET study [J]. Neurogastroenterology & Motility, 2011, 23(6): 533-e203.
[45]
Wang D, Zhang X, Zhang X, et al. Magnetic resonance imaging analysis of brain function in patients with irritable bowel syndrome [J]. BMC Gastroenterology, 2017, 17(1): 148.
[46]
Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research [J]. Clinical Neurophysiology, 2009, 120(12): 2008-2039.
[1] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[2] 王得晨, 杨康, 杨自杰, 归明彬, 屈莲平, 张小凤, 高峰. 结直肠癌微卫星稳定状态和程序性死亡、吲哚胺2,3-双加氧酶关系的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 462-465.
[3] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[4] 张生军, 赵阿静, 李守博, 郝祥宏, 刘敏丽. 高糖通过HGF/c-met通路促进结直肠癌侵袭和迁移的实验研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 21-24.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[7] 王亮, 符谨诚, 许薇, 李彦庆, 郭永波, 邹科见. 直肠成熟囊性畸胎瘤伴直肠阴道瘘一例并文献复习[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 117-118.
[8] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[9] 付振保, 曹万龙, 刘富红. 腹腔镜直肠癌低位前切除术中不同缝合方法的回肠双腔造口术临床效果研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 684-687.
[10] 贺亮, 王松林, 周业江. 两种预防性回肠造口在腹腔镜ISR术治疗超低位直肠癌的效果对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 697-700.
[11] 中国医师协会结直肠肿瘤专业委员会, 中国抗癌协会大肠癌专业委员会, 北京整合医学学会结直肠肿瘤分会. 吲哚菁绿近红外荧光血管成像技术应用于腹腔镜结直肠手术中吻合口血供判断中国专家共识（2023版）[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 441-447.
[12] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[13] 郑秀丽, 倪敏. 功能性便秘患者的直肠肛门抑制反射特征分析100例[J]. 中华临床医师杂志(电子版), 2023, 17(08): 870-875.
[14] 王飞飞, 王光林, 孟泽松, 李保坤, 曹龙飞, 张娟, 周超熙, 丁源一, 王贵英. 敲低IMPDH1对结肠癌SW480、HT29细胞生物功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(08): 884-890.
[15] 孔凡彪, 杨建荣. 肝脏基础疾病与结直肠癌肝转移之间关系的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(07): 818-822.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号