Y-F Tang, J-G Chen, H-J An, P Jin, L Yang, Z-F Dai, L-M Huang, J-W Yu, X-Y Yang, R-Y Fan, S-J Li, Y Han, J-H Wang, C P Gyawali, J-Q Sheng
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引用次数: 38
摘要
背景:筛查新生儿先天性巨结肠病(HD)的常规方法(钡灌肠、BE;肛门直肠测压法;直肠抽吸活检(RSB)有局限性和/或侵入性。高分辨率肛门直肠测压(HR-ARM)是一种微创技术，有潜力克服大多数这些局限性，但新生儿的规范数据和性能特征尚未报道。本研究的目的是评估健康和无症状新生儿的肛门直肠括约肌指标，包括静息压(RP)、肛管长度(ACL)和直肠肛门抑制反射(RAIR)，并利用这些正常参数探讨HR-ARM在诊断HD中的作用。方法:所有手术均由一名操作人员使用固态HR-ARM设备(Medical Measurement Systems, Enchede, netherlands)完成。在第一阶段，研究了180例无症状新生儿(足月新生儿95例，早产儿85例)，并测量了肛门RP、ACL和RAIR。在第二阶段，研究了16例有HD临床表现的新生儿(其中9例经组织病理学证实)，并将其参数与无症状新生儿进行比较。关键结果:足月新生儿的规范RP值高于早产儿(p < 0.05)，且与年龄相关。在早产儿和足月新生儿中，肛门括约肌的渐进式成熟随着年龄的增长而明显。所有正常受试者均存在RAIR。使用缺失的RAIR作为HD的指示，与RSB相比，HR-ARM的敏感性为89%，特异性为83%;这些表现特征均优于BE(敏感性78%，特异性17%)，诊断准确率显著高于BE(分别为80% vs 53%， p = 0.009)。结论和推论:肛门直肠括约肌压力在出生后的头几个月随着RP的增加而逐渐成熟。HR-ARM是一种有效和安全的方法，补充了新生儿HD的诊断。
High-resolution anorectal manometry in newborns: normative values and diagnostic utility in Hirschsprung disease.
Background: Conventional methods of screening for Hirschsprung disease (HD) in newborns (barium enema, BE; anorectal manometry, ARM; rectal suction biopsy, RSB) have limitations and/or are invasive. High-resolution anorectal manometry (HR-ARM) is a minimally invasive technique that has potential to overcome most of these limitations, but normative data and performance characteristics have not been reported in newborns. The aims of our study were to assess anorectal sphincter metrics including resting pressure (RP), anal canal length (ACL), and rectoanal inhibitory reflex (RAIR) in healthy and asymptomatic newborns, and to explore the role of HR-ARM in the diagnosis of HD using these normal parameters.
Methods: All procedures were performed using solid state HR-ARM equipment (Medical Measurement Systems, Enchede, The Netherland) by a single operator. In the first phase, 180 asymptomatic newborns (term newborns 95, preterm newborns 85) were studied, and anal RP, ACL, and RAIR were measured. In the second phase, 16 newborns with clinical manifestations of HD were studied (9 of whom had histopathologic confirmation), and parameters compared to asymptomatic newborns.
Key results: Normative RP values were higher in term newborns compared with preterm newborns (p < 0.05), and correlated with age. Progressive maturation of the anal sphincter was evident with chronologic age, both in preterm and term newborns. RAIR was present in all normal subjects. Using absent RAIR as indicative of HD, HR-ARM had a sensitivity 89% and specificity of 83% compared to RSB; these performance characteristics were better than BE (sensitivity 78%, specificity 17%), with significantly higher diagnostic accuracy (80% vs 53%, respectively, p = 0.009).
Conclusions & inferences: Anorectal sphincter pressure progressively matures with incremental increase in RP during the first months of life. HR-ARM is an effective and safe method that complements the diagnosis of HD in newborns.
期刊介绍：
Neurogastroenterology & Motility (NMO) is the official Journal of the European Society of Neurogastroenterology & Motility (ESNM) and the American Neurogastroenterology and Motility Society (ANMS). It is edited by James Galligan, Albert Bredenoord, and Stephen Vanner. The editorial and peer review process is independent of the societies affiliated to the journal and publisher: Neither the ANMS, the ESNM or the Publisher have editorial decision-making power. Whenever these are relevant to the content being considered or published, the editors, journal management committee and editorial board declare their interests and affiliations.
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