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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
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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/OL]. 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/OL]. 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 ?
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