Abstract：
Chronic constipation (CC) may be caused by defecatory disorders (DDs) and associated with reduced rectal sensation. Among patients with type 1 diabetes (T1D) and CC (T1DCC patients), the prevalence of DDs and reduced rectal sensation is unknown. We sought to compare complications of T1D, anorectal dysfunction, and CC symptoms, among T1DCC patients with versus without a DD.
Anorectal pressures at rest and during squeeze and evacuation, as well as rectal sensation and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry in 114 consecutive T1DCC patients.
Thirty-seven patients (32%) had prolonged BET, suggestive of a DD. Complications of T1D included peripheral neuropathy (n = 67, 59%), retinopathy (n = 42, 37%), and nephropathy (n = 26, 23%). Among these complications, only retinopathy was associated with, that is, more prevalent in patients with normal (45%) than prolonged BET (19%). Compared with patients with normal BET, patients with prolonged BET had a lower rectal pressure (mean [SD], 32 [23] mm Hg vs. 23 [19] mm Hg, p = 0.03), greater anal pressure (91 [23] mm Hg vs. 68 [36] mm Hg, p < 0.001), and lower rectoanal gradient (-67 [30] mm Hg vs. -36 [32] mm Hg, p < 0.0001) during evacuation. Anal resting pressure and anal squeeze increment were below normal in 14 (13%) and 32 (29%) of patients and one or more rectal sensory thresholds were above normal in 34 (30%) patients; these abnormalities affected similar proportions in the normal and prolonged BET cohorts.
Among T1DCC patients, 37 (32%) had prolonged BET, which was associated with anorectal pressures indicative of a DD but was not associated with reduced rectal sensation, suggesting that DDs are more likely explained by abdomino-anal dyscoordination than visceral disturbance.
Anorectal pressures at rest and during squeeze and evacuation, as well as rectal sensation and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry in 114 consecutive T1DCC patients.
Thirty-seven patients (32%) had prolonged BET, suggestive of a DD. Complications of T1D included peripheral neuropathy (n = 67, 59%), retinopathy (n = 42, 37%), and nephropathy (n = 26, 23%). Among these complications, only retinopathy was associated with, that is, more prevalent in patients with normal (45%) than prolonged BET (19%). Compared with patients with normal BET, patients with prolonged BET had a lower rectal pressure (mean [SD], 32 [23] mm Hg vs. 23 [19] mm Hg, p = 0.03), greater anal pressure (91 [23] mm Hg vs. 68 [36] mm Hg, p < 0.001), and lower rectoanal gradient (-67 [30] mm Hg vs. -36 [32] mm Hg, p < 0.0001) during evacuation. Anal resting pressure and anal squeeze increment were below normal in 14 (13%) and 32 (29%) of patients and one or more rectal sensory thresholds were above normal in 34 (30%) patients; these abnormalities affected similar proportions in the normal and prolonged BET cohorts.
Among T1DCC patients, 37 (32%) had prolonged BET, which was associated with anorectal pressures indicative of a DD but was not associated with reduced rectal sensation, suggesting that DDs are more likely explained by abdomino-anal dyscoordination than visceral disturbance.
摘要：
目的：慢性便秘（CC）可能由排便障碍（DDs）引起，并伴有直肠感觉降低。在1型糖尿病（T1D）和CC（T1DCC患者）患者中，DDs和直肠感觉降低的患病率未知.我们试图比较T1D的并发症，肛门直肠功能障碍,和CC症状，在有与无DD的T1DCC患者中。
方法：休息时以及挤压和排空过程中的肛门直肠压力，在114例连续的T1DCC患者中，通过高分辨率肛门直肠测压测量了直肠感觉和直肠球囊排出时间（BET）。
结果：37例患者（32%）长期BET，暗示DD。T1D的并发症包括周围神经病变（n=67，59%），视网膜病变（n=42，37%），和肾病（n=26，23％）。在这些并发症中,只有视网膜病变与，也就是说,在正常的患者中（45％）比长期的BET（19％）更普遍。与BET正常的患者相比,BET延长的患者直肠压较低(平均值[SD]，32[23]mmHgvs.23[19]mmHg,p=0.03),更大的肛门压力（91[23]mmHgvs.68[36]mmHg,p<0.001)，和较低的直肠肛门梯度(-67[30]mmHgvs.-36[32]mmHg,p<0.0001)疏散过程中。14例（13％）和32例（29％）患者的肛门静息压力和肛门挤压增量低于正常水平，34例（30％）患者的一个或多个直肠感觉阈值高于正常水平；这些异常在正常和长期BET队列中影响相似的比例。
结论：在T1DCC患者中，37人(32%)的BET延长，与指示DD的肛门直肠压力相关，但与直肠感觉降低无关，这表明与内脏紊乱相比，DDs更有可能由腹部-肛门协调失调来解释。
方法：休息时以及挤压和排空过程中的肛门直肠压力，在114例连续的T1DCC患者中，通过高分辨率肛门直肠测压测量了直肠感觉和直肠球囊排出时间（BET）。
结果：37例患者（32%）长期BET，暗示DD。T1D的并发症包括周围神经病变（n=67，59%），视网膜病变（n=42，37%），和肾病（n=26，23％）。在这些并发症中,只有视网膜病变与，也就是说,在正常的患者中（45％）比长期的BET（19％）更普遍。与BET正常的患者相比,BET延长的患者直肠压较低(平均值[SD]，32[23]mmHgvs.23[19]mmHg,p=0.03),更大的肛门压力（91[23]mmHgvs.68[36]mmHg,p<0.001)，和较低的直肠肛门梯度(-67[30]mmHgvs.-36[32]mmHg,p<0.0001)疏散过程中。14例（13％）和32例（29％）患者的肛门静息压力和肛门挤压增量低于正常水平，34例（30％）患者的一个或多个直肠感觉阈值高于正常水平；这些异常在正常和长期BET队列中影响相似的比例。
结论：在T1DCC患者中，37人(32%)的BET延长，与指示DD的肛门直肠压力相关，但与直肠感觉降低无关，这表明与内脏紊乱相比，DDs更有可能由腹部-肛门协调失调来解释。
