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.
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。