Fatty liver index (FLI) is widely used as a non-invasive tool for identifying hepatic steatosis but performs poorly in lean individuals and leaves a substantial proportion of individuals within an indeterminate range. This cross-sectional study evaluated whether combination strategies could improve identification of hepatic steatosis in a selected referred population with suspected steatotic liver disease (SLD). In a derivation cohort of 1648 subjects with suspected SLD who underwent MRI-PDFF assessment between January 2015 and January 2022, we evaluated five non-invasive indices (FLI, hepatic steatosis index [HSI], liver fat score [LFS], visceral adiposity index [VAI], and triglyceride-glucose index [TyG]). Four FLI-based sequential strategies were developed and further validated in an independent biopsy-based cohort of 426 patients from five tertiary centers in South China. FLI performed best in identifying hepatic steatosis among the five non-invasive indices, with an AUROC of 0.75, but showed a high missed-identification rate exceeding 90

Whether include high-sensitivity C-reactive protein (Hs-CRP) in diagnostic flow remains debatable during the updated definition to metabolic dysfunction-associated steatotic liver disease (MASLD) despite systemic inflammation contributes to the disease development and progression. We aimed to identify values of hs-CRP compared to other inflammatory markers derived from routine blood tests in MASLD. This cross-sectional study included consecutive participants (ultrasound-diagnosed MASLD: 1,006, healthy controls: 582), and 175 patients received liver biopsy., with 733 and 310 patients underwent magnetic resonance imaging proton density fat fraction for liver fat content (LFC) quantification and two-dimensional shear-wave elastography liver stiffness measurements (LSM), respectively. Multiple linear regression analysis revealed a significant positive association between hs-CRP and LFC among overweight/obesity group patients (β 0.19, P = 0.03), and LSM among lean/normal weight group (β 0.30, P < 0.001). For the metabolic dysfunction-associated steatohepatitis (MASH), the hs-CRP and the ratio of monocytes to high-density lipoprotein both performed well in the overweight/obesity group and type 2 diabetes group (Overweight/obesity group, hs-CPR AUC 0.65 and 0.74, P = 0.02), bu no valuable inflammatory indicators were observed in MASH and liver fibrosis. Hs-CRP levels are associated with LFC in overweight/obese MASLD and liver stiffness in lean MASLD patients, yet the reported AUC values suggest weak predictive ability. The study protocol was registered at the Chinese Clinical Trial Registry, (ChiCTR-ChiCTR2000034197), approved by the First Affiliated Hospital of Sun Yat-sen University institutional with the regional medical ethics committees (Approval number: [2020] No. 187), and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Written informed consent was obtained from all the patients.

BACKGROUND:Early detection of colorectal cancer (CRC) is crucial for improving patient survival. This innovative multi-center study aims to develop a non-invasive blood-based assay using cell-free DNA (cfDNA) fragmentomics to differentiate CRC from advanced colorectal adenomas and non-cancerous colorectal and other digestive diseases. METHODS:A total of 167 CRC patients and 227 with benign colorectal conditions were divided into training and validation cohorts (1:1 ratio). Plasma cfDNA underwent Low-depth whole-genome sequencing to profile three fragmentomics features, which were integrated into a stacked ensemble model. The model was validated on 69 CRC patients and 96 benign controls, with an additional cohort of 31 advanced adenoma patients included to assess its performance in differentiating advanced adenomas from benign cases. RESULTS:The model achieved an AUC of 0.926, with sensitivity of 91.3% and specificity of 82.3% in validation. Sensitivities were consistently high across CRC stages (I: 94.4%, II: 86.4%, III: 91.3%, IV: 100%). Notably, the model demonstrated exceptional accuracy in distinguishing advanced adenomas from benign cases, achieving an AUC of 0.846 and sensitivity of 67.7%, outperforming traditional blood tests. CONCLUSIONS:This multi-center study underscores a significant advancement in liquid biopsy technology, offering a highly accurate and non-invasive approach for early CRC detection and differentiation of advanced colorectal adenomas.

ObjectivesThe aim of this study is to derive and validate a reliable indicator for predicting an increased risk of postoperative mortality in elderly patients undergoing curative resection for colorectal cancer (CRC).DesignThis study is of multicentre retrospective design.Setting and participantsA total of 1227 CRC patients undergoing curative resection (age ≥65 years) from three distinct cohorts were retrospective enrolled. Participant cohorts consisted of the derivation (n=845), external validation (n=95) and localised validation (n=287) groups. The carcinoembryonic antigen (CEA) to lymphocyte ratio (CLR) was derived from the derivation cohort and subsequently validated in two additional cohorts. The observed end point was all-cause death during the follow-up period postoperation.ResultsIn the derivation cohort, CLR demonstrated an independent association with all-cause mortality. In the two validation cohorts, CLR also presented a strong discriminatory ability in predicting postoperative all-cause death, with the area under the curve (AUC) of 0.68 in the external cohort and 0.78 in the localised cohort. Survival analyses revealed that CRC patients with CLR ≤2.53 tended to have better overall survival than those with CLR >2.53 (p<0.05 for all cohorts). Multivariate Cox proportional hazard models indicated that CLR ≤2.53 was significantly associated with reduced mortality risk in the derivation (HR: 0.405, p<0.001), external validation (HR: 0.519, p=0.039) and localised validation cohorts (HR: 0.167, p<0.001).ConclusionsPreoperative CLR serves as a reliable predictor of all-cause death following curative resection in elderly patients with CRC. Individuals with CLR exceeding 2.53 are inclined to a lower overall survival probability.

BACKGROUND AND AIMS:Emerging machine learning models show promise in addressing the unmet needs for the non-invasive screening of metabolic dysfunction-associated steatotic liver disease (MASLD) but lack extensive validation. We aimed to identify the most effective model for MASLD detection. METHODS:This study enrolled five cohorts: the epidemiological survey for MASLD in South China (January 2020 to March 2022), the UK Biobank database (April 2007 to December 2010), the NHANES III database (1988-1994), the NHANES 2017-2020 database and multi-centre databases with liver biopsy data from South China. The diagnosis of hepatic steatosis was established using the vibration-controlled transient elastography, magnetic resonance imaging-based proton density fat fraction, ultrasonography and biopsy. A total of 34 methods were analysed, comprising 6 machine learning models and 28 traditional scores. Survival analysis was conducted to assess the predictive value of these indicators for MASLD prognosis. RESULTS:The final analysis included a total of 24,861 subjects. The area under the receiver operating characteristic curve (AUROC) for the extreme gradient boosting (XGB) model in detecting MASLD exceeded 0.8 across all five databases. In the subgroup of lean individuals, the combination of the triglyceride-glucose index and waist circumference yielded an AUROC ranging from 0.60 to 0.88. In the NHANES databases, the overall survival rate for the MASLD group was significantly lower than that of the non-MASLD group (p < 0.001). Additionally, the logistic regression model demonstrated strong predictive ability for overall survival in MASLD subjects. CONCLUSIONS:The XGB model exhibited superiority over traditional non-invasive methods in detecting MASLD. TRIAL REGISTRATION:The research was registered in the Chinese Clinical Trial Register (ChiCTR2000034197).

Pancreatic ductal adenocarcinoma (PDAC) is characterised by immune evasion that contribute to poor prognosis. Cancer-associated fibroblasts (CAFs) play a pivotal role in orchestrating the PDAC tumour microenvironment. We investigated the role of CAF-derived extracellular vesicle (EV)-packaged long non-coding RNAs (lncRNAs) in immune evasion and explored gene therapy using engineered EVs loading small interfering RNAs (siRNAs) as a potential therapeutic strategy. Our findings highlight the significance of EV-packaged lncRNA RP11-161H23.5 from CAF in promoting PDAC immune evasion by downregulating HLA-A expression, a key component of antigen presentation. Mechanistically, RP11-161H23.5 forms a complex with CNOT4, a subunit of the mRNA deadenylase CCR4-NOT complex, enhancing the degradation of HLA-A mRNA by shortening its poly(A) tail. This immune evasion mechanism compromises the anti-tumour immune response. To combat this, we propose an innovative approach utilising engineered EVs as natural and biocompatible nanocarriers for siRNA-based gene therapy and this strategy holds promise for enhancing the effectiveness of immunotherapy in PDAC. Overall, our study sheds light on the critical role of CAF-derived EV-packaged lncRNA RP11-161H23.5/CNOT4/HLA-A axis in PDAC immune evasion and presents a novel avenue for therapeutic intervention.

Background: It is unclear whether serum calcium on admission is associated with clinical outcomes in dilated cardiomyopathy (DCM). In this study, we conducted a retrospective study spanning a decade to investigate the prognostic value of baseline calcium in elderly patients with DCM. Methods: A total of 1,089 consecutive elderly patients (age ≥60 years) diagnosed with DCM were retrospectively enrolled from January 2010 to December 2019. Univariate and multivariate analyses were performed to investigate the association of serum calcium with their clinical outcomes. Results: In this study, the average age of the subjects was 68.36 ± 6.31 years. Receiver operating characteristic (ROC) curve analysis showed that serum calcium level had a great sensitivity and specificity for predicting in-hospital death, with an AUC of 0.732. Kaplan–Meier survival analysis showed that patients with a serum calcium >8.62 mg/dL had a better prognosis than those with a serum calcium ≤8.62 mg/dL (log-rank χ2 40.84, p < 0.001). After adjusting for several common risk factors, a serum calcium ≤8.62 mg/dL was related to a higher risk of long-term mortality (HR: 1.449; 95% CI: 1.115~1.882; p = 0.005). Conclusions: Serum calcium level could be served as a simple and affordable tool to evaluate patients’ prognosis in DCM.

BACKGROUND:Various biomarkers associated with sarcopenia have been identified. However, there is a scarcity of studies exploring and validating biomarkers in individuals with age-related sarcopenia. AIMS:This study aimed to investigate the proteome and identify potential biomarkers for age-related sarcopenia. METHODS:Proteomic analysis and experimental validation were conducted using plasma from hospitalized older adults. Sarcopenia diagnosis was based on the Asian Working Group for Sarcopenia 2019 criteria. Data-independent acquisition-based proteomics was performed on plasma from 60 participants, with 30 diagnosed with sarcopenia and 30 without sarcopenia. Differentially expressed proteins (DEPs) were selected and evaluated by Receiver Operating Characteristic (ROC) analysis. Biomarker candidates were further quantitatively validated by enzyme-linked immunosorbent assay (ELISA) utilizing plasma from 6 participants with sarcopenia and 6 without sarcopenia. RESULTS:A total of 39 DEPs were identified and 12 DEPs were selected for ROC analysis. 8 DEPs were included for ELISA validation based on their predictive performance. Paraoxonase-3 (PON3) consistently showed down-regulation in the sarcopenic group across both methodologies. Insulin-like growth factor-binding protein-2 (IGFBP2) showed inconsistency in the sarcopenic group, with up-regulation observed in proteomic analysis but down-regulation in ELISA. DISCUSSION:Decline in PON3 may result in an overload of oxidative stress in skeletal muscles and contribute to sarcopenia. Protein modifications of IGFBP2 might exhibit during sarcopenia pathogenesis. CONCLUSIONS:Plasma proteins are implicated in sarcopenia pathogenesis. PON3 is highlighted as a potential biomarker for patients with age-related sarcopenia. Further studies are imperative to gain an in-depth understanding of PON3 and IGFBP2.

The inherent drawbacks of the conventional B-mode ultrasound for metabolic dysfunction-associated steatotic liver disease (MASLD) are poorly understood. We aimed to investigate the impact factors and optimize the screening performance of ultrasound in MASLD. In a prospective pilot cohort recruited from July 2020 to January 2022, subjects who had undergone magnetic resonance imaging-based proton density fat fraction (MRI-PDFF), ultrasound, and laboratory test-based assessments were included in the deprivation cohort. A validation cohort including 426 patients with liver histologic assessments from five medical centers in South China was also recruited. A total of 1489 Chinese subjects were enrolled in the deprivation cohort, and ultrasound misdiagnosed 62.2% of the non-MASLD patients and failed to detect 6.1% of the MASLD patients. The number of metabolic dysfunction components and the alanine aminotransferase (ALT) level were associated with a missed diagnosis by ultrasound (OR = 0.67, 95% CI 0.55–0.82 p < 0.001; OR = 0.50, 95% CI 0.31–0.79, p = 0.003, respectively). Compared with ultrasound alone, the new strategy based on ultrasound, in combination with measurements of the number of metabolic dysfunction components and ALT and uric acid levels, significantly improved the AUROC both in the research cohort and the validation cohort (0.66 vs. 0.84, 0.83 vs. 0.92, respectively). The number of metabolic dysfunction components and ALT and uric acid levels improved the screening efficacy of ultrasound for MASLD.

As microecology research has advanced, the existence of the correlation between microbiota and systemic inflammatory response syndrome (SIRS), has been gradually suggested in recent years. Substantial evidence underscored the critical role of gut microbiota in sepsis and the organ damage brought on by sepsis. New particular metabolites have been found by applications of metabolomics technology, partially filling in the gaps in sepsis prognosis and early warning systems. However, previous study of sepsis with metabolomics were merely used for screening differential metabolites or examining their mechanisms. And the upstream and downstream relationships between the gut microbiota and sepsis were ignored. In this regard, this review suggests combining gut microbiota and metabolites, and exploring the changes and links of “gut microbiota metabolites organism” in the occurrence and development of sepsis, as well as the damage of various organs caused by sepsis. This will jointly provide new possibilities for the diagnosis, prognosis prediction, and individualized treatment of sepsis. Also provide a basis for the treatment of various organ damage caused by sepsis.

Introduction: There is growing evidence of research indicating that the gut microbiota is involved in the development of sarcopenia. Nevertheless, there exists a notable deficiency in comprehension concerning the connection between irregularities in the intestinal microbiome and metabolic processes in older individuals suffering from sarcopenia.Methods: To analyze fecal samples obtained from a cohort of 30 older patients diagnosed with sarcopenia as well as 30 older patients without sarcopenia, this study employed 16S rDNA sequencing and liquid chromatography-mass spectrometry (LC-MS)-based non-targeted metabolomics profiling techniques.Results: As a result, we found that 29 genera and 172 metabolites were significantly altered in the sarcopenic patients. Among them, Blautia, Lachnospiraceae_unclassified, and Subdoligranulum were the bacteria with a potential diagnostic value for sarcopenia diagnosis. Correlation analysis between clinical indices and these gut bacteria suggested that the IL-6 level was negatively correlated with Blautia. Function prediction analysis demonstrated that 17 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways differ significantly between sarcopenic and non-sarcopenic patients. The primary classes of metabolites identified in the study included lipids and lipid-like molecules, organic acids and derivatives, and organoheterocyclic compounds. KEGG enrichment analysis showed that purine metabolism, arginine and proline metabolism, alanine, aspartate, and glutamate metabolism, butanoate metabolism, and histidine metabolism may contribute to the development of sarcopenia. The correlation study on gut microbiota and metabolites found that Lachnospiraceae_unclassified was positively associated with seven metabolites that were more abundant in the non-sarcopenia group and negatively correlated with three metabolites that were more abundant in the sarcopenia group. In addition, Subdoligranulum was positively correlated with seven metabolites that were lacking in sarcopenia and negatively correlated with two metabolites that were enriching in sarcopenia. Moreover, Blautia was positively associated with xanthosine.Discussion: We conducted a study on the intestinal microbiota and metabolic profile of elderly individuals with sarcopenia, offering a comprehensive analysis of the overall ecosystem. Through this investigation, we were able to validate existing research on the gut-muscle axis and further investigate potential pathogenic processes and treatment options for sarcopenia.

Objective:To evaluate modified Lanza score (MLS) of gastric mucosa for predicting the prognosis of geriatric patients with sepsis.Methods:Data of 50 patients with sepsis, who were over 60 years old and underwent gastroscopy for suspected gastrointestinal bleeding in the Department of Geriatric Critical Care Medicine of Guangdong Provincial People's Hospital from January 2019 to April 2022, were retrospectively analyzed. Patients were divided into the death group ( n=32) and the survival group ( n=18) according to their regression within 28 days after gastroscopy. Their gastric mucosa was scored by using MLS system, and the mortality of patients with MLS≥1 was calculated, then the patients were further divided into 2 groups, MLS=0-2 ( n=23, less than 2 regions of lesions ) and MLS=3-5 ( n=27, two or more regions of lesions). The relationship between MLS and acute physiology and chronic health status evaluation (APACHE) Ⅱ score, risk factor of death and mortality in each group were compared. The correlation between MLS and mortality was analyzed. The influence of geriatric sepsis risk factors affecting the prognosis of patients within 28 days were analyzed by using logistic regression. Results:Among the 50 geriatric patients with sepsis, those with gastric mucosal lesions, i.e., MLS ≥1, accounted for 68.00% (34/50), including 84.38% (27/32) patients with MLS≥1 in the death group, which was significantly higher than the 38.89% (7/18) patients with MLS≥1 in the survival group ( χ 2=10.593, P<0.001). Patients with MLS=3-5 had significantly higher APACHE Ⅱ scores (26.09±6.47 VS 18.57±7.66, t=3.527, P=0.001) and higher mortality [85.19% (23/27) VS 39.13% (9/23), χ 2=11.434, P=0.001] compared with MLS=0-2. Correlation analysis showed a significant correlation between MLS and mortality ( r=0.886, P=0.019). Multivariate logistic regression analysis showed that MLS=4-5 was an independent risk factor for death in geriatric patients with sepsis ( OR=17.055, 95% CI: 1.387-209.744, P=0.027). Conclusion:MLS presents high sensitivity in predicting 28-day outcomes for geriatric patients with sepsis. Two or more than 2 regions of gastric mucosal lesions can significantly increase the risk of death in geriatric patients with sepsis.

Abstract Background/aims Nonobese metabolic dysfunction-associated fatty liver disease (MAFLD) is paradoxically associated with improved metabolic and pathological features at diagnosis but similar cardiovascular diseases (CVD) prognosis to obese MAFLD. We aimed to utilize the metabolomics to identify the potential metabolite profiles accounting for this phenomenon. Methods This prospective multicenter cross-sectional study was conducted in China enrolling derivation and validation cohorts. Liquid chromatography coupled with mass spectrometry and gas chromatography-mass spectrometry were applied to perform a metabolomics measurement. Results The study involved 120 MAFLD patients and 60 non-MAFLD controls in the derivation cohort. Controls were divided into two groups according to the presence of carotid atherosclerosis (CAS). The MAFLD group was further divided into nonobese MAFLD with/without CAS groups and obese MAFLD with/without CAS groups. Fifty-six metabolites were statistically significant for discriminating the six groups. Among the top 10 metabolites related to CAS in nonobese MAFLD, only phosphatidylethanolamine (PE 20:2/16:0), phosphatidylglycerol (PG 18:0/20:4) and de novo lipogenesis (16:0/18:2n-6) achieved significant areas under the ROC curve (AUCs, 0.67, p = 0.03; 0.79, p = 0.02; 0.63, p = 0.03, respectively). The combination of these three metabolites and liver stiffness achieved a significantly higher AUC (0.92, p < 0.01). In obese MAFLD patients, cystine was found to be significant with an AUC of 0.69 (p = 0.015), followed by sphingomyelin (SM 16:1/18:1) (0.71, p = 0.004) and de novo lipogenesis (16:0/18:2n-6) (0.73, p = 0.004). The combination of these three metabolites, liver fat content and age attained a significantly higher AUC of 0.91 (p < 0.001). The AUCs of these metabolites remained highly significant in the independent validation cohorts involving 200 MAFLD patients and 90 controls. Conclusions Diagnostic models combining different metabolites according to BMI categories could raise the accuracy of identifying subclinical CAS. Trial registration The study protocol was approved by the local ethics committee and all the participants have provided written informed consent (Approval number: [2014] No. 112, registered at the Chinese Clinical Trial Registry, ChiCTR-ChiCTR2000034197) Graphical Abstract

胃肠动力障碍性疾病是一类由胃肠动力紊乱引起的消化道疾病,是消化科老年患者中常见的疾病,主要包括胃食管反流、功能性消化不良、胃轻瘫、慢性便秘等[1] . 由于老年人胃肠道症状缺乏特异性,常规检查(如内窥镜检查、放射学或血液检查)难以提供动力参数,使该类疾病的管理极具挑战. 本文将重点介绍一系列关于口咽、食管、胃肠道功能的检测技术,并对老年人应用的时机、安全性进行探讨.

消化系统肿瘤具有恶性程度及病死率高的特点,成为老年人群重点预防的疾病.消化系统肿瘤在发生前常存在可被侦测的改变,包括出血及黏膜形态结构异常.然而肿瘤本身以及上述异常病变的精准监测仍存在诸多技术难关,是影响消化道肿瘤早期检出率的关键影响因素.近年随着人工智能(AI)在消化内镜图像分析、生物传感器、新型生物标记物等领域不断取得进展,AI有望让出血、黏膜形态结构异常与肿瘤等老年人消化重点病种的智能识别逐渐成为可能.本文从消化器官与黏膜两个层面、形态与功能两个维度,综述AI在老年人消化重点病种的应用进展,为降低老年人急症及消化道肿瘤的发生率提供参考.

目的 评价住院营养风险筛查量表(NRS2002)预测老年住院患者发生医院感染(nosocomial infections,NIs)的价值.方法 对2020年1月至2020年12月在广东省人民医院老年病学科住院治疗超过48 h的504例老年患者进行回顾性分析,运用多因素Logistics回归建立模型,验证NRS2002的预测价值,通过受试者工作特征(ROC)曲线评价预测的敏感性及特异性.结果 NRS2002评分≥3的患者NIs的发生率(36.8％)明显高于评分<3的患者(1.1％),是NIs发生的独立危险因素.曲线下AUC面积为0.870,模型预测效果良好.结论 NRS2002能有效预测老年住院患者NIs的发生.

Aims Hypoalbuminemia was extensively used to diagnose malnutrition in older adults. Malnutrition was associated with mortality in elderly patients with cardiovascular diseases. The relationship between hypoalbuminemia and clinical outcomes in elderly patients with nonischemic dilated cardiomyopathy (NIDCM) remains unknown. Methods A total of 1058 consecutive patients with NIDCM (age ≥60 years) were retrospectively enrolled from January 2010 to December 2019. Univariate and multivariate analyses were performed to assess the association of hypoalbuminemia with clinical outcomes. Results Patients with hypoalbuminemia were older (69.29 ± 6.67 vs. 67.61 ± 5.90 years, P < 0.001) and had higher prevalence of in-hospital and long-term death than those without (6.9 vs. 1.7%, 50.7 vs. 35.2%, P < 0.001). Logistic regression analysis showed that hypoalbuminemia was significantly related to in-hospital death [odds ratio (OR): 4.334, 95% confidence interval (CI): 2.185–8.597, P < 0.001]. Kaplan–Meier survival analysis showed that patients with hypoalbuminemia had worse prognosis than those with nonhypoalbuminemia (log-rank χ 2 28.96, P < 0.001). After adjusting for age, serum creatinine, HDL-C, AST/ALT hypoalbuminemia, LVEF and diabetes, hypoalbuminemia remained an independent predictor for long-term death (hazard ratio 1.322, 95% CI 0.046–1.670, P = 0.019). Conclusion Hypoalbuminemia was associated with increased risk of in-hospital and long-term mortality in elderly patients with NIDCM.

Purpose: Gastric cancer is a common tumor type associated with nutritional and immune status. The aim of the current study was to investigate the prognostic value of a preoperative prognostic nutritional index (PNI), composed of nutritional factors and immune factors in elderly patients undergoing gastric cancer surgery. Patients and Methods: A total of 454 patients undergoing gastric cancer surgery were divided into two groups based on preoperative PNI scores: <45.1 (n = 307) and >45.1 (n = 147). Survival analysis was performed using the Kaplan-Meier method and Log rank tests. Univariate and multivariate analyses were conducted to identify independent prognostic factors using a Cox proportional hazards model. Results: According to the X-tile program, the optimal cutoff value for predicting overall survival (OS) with the PNI was 45.1. The receiver operating characteristic analysis revealed that PNI exhibited 70.6% sensitivity and 56.5% specificity for predicting death during longterm follow-up. The cumulative incidence of postoperative 4-year mortality indicated that the risk of death increased significantly for PNI <45.1. In multivariate analysis, preoperative PNI was a significant independent predictor of mortality. In the age-stratified subgroup analysis, preoperative PNI was more sensitive for the old elderly subgroup than for the young elderly subgroup. Conclusion: Preoperative PNI is a sensitive and specific prognostic predictor among elderly patients undergoing gastric cancer surgery.

目的 探讨不同性别、年龄、症状的功能型便秘患者肛门直肠测压的特点,指导该技术在临床的应用,辅助临床诊断与治疗.方法 回顾性分析广东省人民医院老年医学研究所胃肠动力室85例功能性便秘排便障碍型患者,分别用三维高分辨直肠测压技术进行测量,并分析不同性别、年龄、不同症状功能性便秘患者肛门直肠压力变化的特点.结果 三维高分辨肛门直肠测压显示,老年患者和非老年患者肛管静息压、肛管最大收缩压、肛门松驰率、肛门直肠压力差差异有统计学意义(P<0.05);非老年男性与非老年女性肛管最大收缩压、直肠压力、肛门松驰率差异有统计学意义(P<0.05);老年男性与老年女性肛管静息压、肛管最大收缩压、肛门直肠压力差差异有统计学意义(P<0.05);根据粪便性性状不同,分为Bristol1-3型和Bristol4-7型,可见测量指标中两者肛门松驰率差异有统计学意义(P<0.05).其他测量指标未见明显差异(P>0.05).结论 老年及非老年功能性便秘患者中均存在直肠推进力不足和盆底肌不协调收缩,老年患者主要表现为直肠推进力不足,而非老年患者则表现为不协调收缩.非老年男性患者表现为肛管矛盾收缩、松驰率低;非老年女性患者表现为盆底肌功能紊乱和直肠压力低.老年男性肛门直肠压力差下降更明显,老年男性直肠压力梯度下降可能是导致便秘的主要原因.三维高分辨肛门直肠测压在功能性便秘排便障碍的诊治过程中具有良好的应用价值,可以临床推广运用.