| Background:Parkinson’s disease(PD)is a group of chronic degenerative disease of the nervous system characterized by such motor symptoms as static tremor,myotonia,movement retardation and abnormal postures and gaits.In recent years,with the gradual deepening of the understanding of PD,people have gained a series of new realizations of the non-motor symptoms(NMS)of PD.Constipation is one of the most frequent symptoms among the NMS of PD.It was revealed by domestic and overseas research that in the PD constipation the outlet obstructive constipation(OOC)accounts the most cases.Currently,only the medicines for improving the gastrointestinal dynamics for the treatment of PD constipation;therefore,it is necessary to search for a radical treatment approach with pertinence to the typing of the constipation so as to reduce the miseries of the patients.High Resolution Anorectal Manometry(HRAM)adopts the method of combining statics and dynamics for the research of the various motor modes of the various sections of the intestinal tract and the anal canal(including the pelvic floor)under different states.It can measure the changes in the rectum anal canal pressures of patients under the states of resting,contraction and excretion so as to reflect the functions and coordination functions of the anal canal,rectum,and the various muscle groups of the pelvic floor under these three states.Objective:analyze the characteristics of HRAM for PD constipation patients,and conduct typing of PD constipation based on the results of HRAM so as to explore the mechanism of PD constipation and provide a theoretical basis for the treatments using botulinum toxin and biofeedback.Method:15 cases of PD constipation patients who complied with the diagnostic of UK Brian Bank Criteria and Roman III as the PD constipation group(Parkinson Defecatory Disorder,PDD),24 cases of patients who complied with the diagnostic criteria of Roman III and were excluded from gastrointestinal diseases as the Functional Defecatory Disorder,FDD group.Based on the Hoehn-Yahr phasing,they were further divided into early H-Y 1-2 phase,advanced stage(H-Y 2.5,3.0 phase).The clinical data of the two group of patients were collected,including age,gender,disease courses.Parameter evaluation was conducted on the two groups of patients using HRAM.Through HRAM,it is possible to conduct the following typing on PD constipation:I Rectal dynamics insufficiency:Rectal Pressure Drainage<70mmHg,coupled with(or not)anus contradictory contraction(anal canal relaxation rate<20%).Ⅱ Anus contradictory contraction:Rectal Pressure Drainage ≥ 70mmHg,coupled with anus contradictory contraction(anal canal relaxation rate<20%).SPSS 23.0 statistics software was used for conducting analyses.Normality tests were conducted on the various parameters and the measurement data accorded with the normal distribution and the data were expressed with x±s,and the independent-sample t test was adopted;the counting data were expressed in the number of cases and chi-square test was adopted.When P<0.05,it meant the variations were statistically significant.Result:15 cases in the PD constipation group 15(12 cases of males and 3 cases of females),ages(66.617.3);24 cases in the functional constipation group(17 cases of males and 7 cases of females),ages(70.7±8.9.The differences in the ages,gender and the constipation courses between the two groups of patients were not statistically significant(P>0.05).Among the 15 cases of the PDD group,10 cases were mainly rectal insufficiency(66.7%),4 cases mainly anal contradiction(26.7%),and for 1 case,the measurement of parameters showed no obvious abnormalities(6.7%).Among the 24 cases of the FDD group,4 cases were mainly rectal insufficiency(16.7%),18 cases mainly anal contradiction(75%),and for 2 cases,measurements of parameters showed no obvious abnormalities(8.3%).PDD group was mainly rectal insufficiency type,and FDD group mainly anal contradiction type,with statistical differences between these two(x2=10.207,P<0.05.The Maximum Squeeze Pressure,MSP and rectal pressure drainage and rectal pressure increase of the PDD group were obviously lower than the FDD group,and the variations had statistical significance;the differences in the rectal resting pressure,anal canal resting pressure,durations of contraction,the residual pressure of anal defecation and rectal sensation threshold had no statistical significance(P>0.05).The 15 cases of PDD patients were categorized into the early and advanced stages based on the H-Y phasing,among which 7 cases were the early stage(H-Y 1.02.0),and 8 cases were advanced stages(H-Y 2.5,3.0).There was no statistical significance in the variations in the various parameters of the resting state,contraction state,excretion state and the rectal sensory functions of the early and advanced stages of the PDD group.Conclusion:1.PDD patients were characterized by rectal insufficiency,while those of FDD were mainly anal contradiction;2.The increases of the maximum compression pressure,rectal pressure drainage and rectal pressure in PD constipation patients were obviously reduced in contrast to the functional constipation patients,and the variations had statistical significance;3.The causes for the constipation of the PD constipation patients are rectal insufficiency and pelvic floor contradiction movement;4.There were no obvious differences in the ARM results in the early and advanced stages of PD,indicating that abnormalities of anorectal dynamics may exist in the early stage of PD. |
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