2型糖尿病胃动力障碍的临床研究

[目的]应用胃电图(EGG)研究2型糖尿病(DM)胃动力的变化.[方法]选取2型DM患者60例,正常对照30例,对两组EGG的主频(FP)、振幅(AP)、胃动过缓百分率(B%)的变化与血糖的关系进行研究.[结果]DM组与正常对照组的空腹和餐后FP无统计学意义.两组餐后AP均显著高于空腹(P＜0.05),但两组比较无统计学意义.两组餐前和餐后B%比较,DM组均明显高于正常对照组(P＜0.05).DM空腹血糖(FBG)与餐前、餐后B%呈正相关,随着FBG的升高,B%呈相关升高(P＜0.01).[结论]DM患者存在明显EGG异常,表现为胃动过缓明显增多的胃电节律紊乱.DM患者FBG与餐前、餐后B%呈正相关.     

2型糖尿病合并胃轻瘫患者血糖水平的临床观察

目的观察T2DM合并胃轻瘫(T2DM+胃轻瘫组)患者与单纯T2DM(T2DM组)患者不同时期血糖水平和胃排空率变化,探讨T2DM合并胃轻瘫患者血糖水平变化规律,为临床应用降糖药物提供时间调整依据。方法选取单纯T2DM组50例,T2DM+胃轻瘫组50例,比较两组空腹及进食馒头餐150g后1hPG、2hPG、3hPG及4hPG水平变化。超声胃液体排空功能检查比较两组30、60、90、120及180min胃排空率。结果 T2DM+胃轻瘫组FPG、4hPG高于T2DM组[FPG(12.56±3.48)vs(9.84±2.13)mmol/L;4hPG(15.26±4.87)vs(10.16±1.27)mmol/L](P0.01);T2DM+胃轻瘫组1~3hPG水平低于T2DM组[1hPG(13.16±2.87)vs(16.58±2.64)mmol/L;2hPG(14.27±3.10)vs(19.86±4.34)mmol/L;3hPG(14.89±4.13)vs(16.86±2.17)mmol/L](P均0.01)。T2DM+胃轻瘫组各时间胃排空率低于T2DM组[30min(10.2±1.3)%vs(30.8±3.9)%;60min(17.9±2.3)%vs(38.8±3.5);90min(30.1±4.1)%vs(56.8±6.1)%;120 min(47.9±5.6)%vs(78.9±7.6)%;180min(68.9±8.1)%vs(95.7±9.6)%](P均0.01)。血糖水平与胃排空率呈正相关(r=0.75,P0.05)。结论 T2DM合并胃轻瘫患者胃排空率异常导致血糖水平的明显变化有时相特点,可为临床降糖药物给药时间调整提供理论依据,避免血糖波动过大。     

胃电图和胃排空检测的临床价值评价

目的探讨胃电图(EGG)和胃排空检测的临床价值及胃肌电活动和胃排空异常的相关性.方法170例有消化不良症状者[功能性消化不良(FD)组140例,非胰岛素依赖性糖尿病(NIDD)组30例]和20例正常人分别接受EGG和胃排空(同位素法、Rom's法和超声法)检测.结果70%(21/30)的NIDD患者于餐前、66.7%(20/30)于餐后出现胃电节律紊乱,尤以胃动过速为著(餐前36.7%,餐后33.3%);NIDD患者的餐后主频(DF)(2.60cpm±0.30cpm)、餐后/餐前DF(1.01±0.11)、餐后主功率(DP)(121.45V2.cpm+67.00V2.cpm)及餐后/餐前DP(0.81+-0.07)均较正常对照者显著降低(P＜0.05或P＜0.01).FD患者的餐后DP(210.60V2.cpm±68.40V2.cpm)亦显著低于正常对照者(P＜0.01).FD和NIDD患者用3种方法测得的胃半排空时间均较正常对照者延迟(P＜0.05或P＜0.01).121例空腹胃电节律正常者中,胃排空延迟者占39.7%(48/121);69例空腹胃电节律异常者中,胃电节律过缓者45.9%(17/37)胃排空延迟,胃电节律过速者78.1%(25/32)胃排空延迟.结论EGG及胃排空检测对评价胃肌电活动和胃动力异常有一定临床意义,后两者间的确切关系尚不能被证明,但胃电节律过速与胃排空过缓关系密切.     

2型糖尿病合并胃轻瘫患者的动态血糖谱

目的 探讨2型糖尿病合并胃轻瘫患者的动态血糖特征.方法 对31例2型糖尿病患者以核素扫描评估胃排空,并以7例正常糖调节者作对照;所有入组对象在平衡饮食状态下用动态血糖监测系统(CGMS)进行72 h血糖监测.结果 31例2型糖尿病患者中胃轻瘫占58.1%.胃轻瘫组和非胃轻瘫组在早餐后2 h平均血糖值[(7.82 4-1.42)mmol/L比(9.35 4±2.28)mmol/L]、早餐后血糖最高值[(10.21±2.17)mmol/L比(12.24±2.82 mmol/L)]和2 h平均血糖曲线下面积[(877.62±272.78)min·mmol·L-1比(1028.40±283.98)min·mmol·L-1],差异具有统计学意义(P<0.05).结论 2型糖尿病胃轻瘫患者胃排空延迟可能有助于降低餐后平均血糖.     

西沙必利对糖尿病合并胃轻瘫病人疗效观察

目的 观察服用西沙必利对糖尿病合并胃轻瘫病人的疗效。方法 对30例糖尿病合并胃轻瘫病人进行四周不同剂量西沙必利治疗前后胃镜、胃电图等检查作比较。结果 西沙必利治疗后消化功能异常得到明显好转。结论 糖尿病合并胃轻瘫患有在控制血糖情况下予以10mg西沙必利治疗明显减轻消化道症状，胃排空能力提高。     

胃电图及其在胃动力研究中的应用

胃电图指在上腹部胃体表投影位置记录到的胃生物电。它分为快波和慢波，能准确反映胃肌电的慢波节律和相对功率或振幅变化。适应谱分析方法是胃电参数分析的最新方法。胃餐前、餐后主频以及或振幅的相对变化与胃动力、胃排空有密切联系。胃电图广泛用于胃轻瘫、功能性消化不良等胃动力性疾病的研究。     

肝硬化患者胃动力多因素相关性研究

目的 进一步了解肝硬化患者消化道运动功能紊乱的机理及各因素间的相互关系。 方法 对46例肝硬化患者行血浆血管活性肠肽(VIP)、胃泌素、胃动素(MTL)检测;胃电图、24 h胃内pH监测;同位素核素闪烁法检测胃排空,并与正常组对照。 结果 肝硬化组与正常组,血浆VIP分别为(14.5±4.8)pmol/L和(9.7±3.4)pmol/L,t=5.181,P<0.05;胃泌素分别为(58.6±29.8)pg/ml和(38.1±14.6)pg/ml,t=3.871,P<0.01;MTL分别为(360.0±54.2)pg/ml和(422.0±48.5)pg/ml,t=5.529,P<0.05。胃电图主频、主功率进餐前后均降低,正常慢波节律减少,胃动过缓增加。胃内2 4 h pH监测反流积分增加,胃排空延迟。多元线性回归分析,相互间有显著性相关。 结论 肝硬化患者存在食管胃运动功能紊乱,表现为胃电节律紊乱、胃排空延迟。血浆胃肠激素的异常。肝硬化患者胃内pH异常,存在胃十二指肠反流。     

糖尿病胃轻瘫和非糖尿病患者胃电图检测分析

目的糖尿病胃轻瘫和非糖尿病患者胃电图检测分析。方法于2016年1月—2018年12月选择糖尿病胃轻瘫患者120例,作为研究组;非糖尿病功能性消化不良患者30例,作为对照组。两组分别于空腹和餐后检测胃电图,研究分析胃电图波形主频、波形平均幅值、波形反应面积、餐后/餐前功率比,确定两组间的差异。结果研究组餐后餐前功率比为(1.47±0.82),对照组为(0.51±0.69),差异有统计学意义(t=5.726,P=0.0000.05)。对照组餐前餐后的波形反应面积明显低于研究组,差异有统计学意义(t_(餐前)=4.931,P=0.0010.05;t_(餐后)=4.539,P=0.0030.05),餐前餐后均差异有统计学意义(P0.05)。其他参数在两组间差异无统计学意义(P0.05)。结论糖尿病胃轻瘫和非糖尿病患者在胃电图检测分析可为糖尿病胃轻瘫的诊断和用药提供依据。     

糖尿病胃轻瘫的诊断及发病机制

目的:探讨糖尿病胃轻瘫的早期诊断方法并探讨其可能的发病机制.方法:糖尿病住院患者38例,采用生化及放射免疫方法检测血糖、糖化血红蛋白、胃动素、胃泌素、胰高血糖素水平.以患者卧立位肱动脉收缩压变化检查植物神经功能;并采用标准餐加服小钡条试验,记录排空时间,以胃排空时间＞6 h诊断为胃轻瘫.结果:糖尿病胃排空异常者与胃排空正常者相比其空腹血糖(12.53±4.13 mmol/L vs 7.12±1.37 mmol/L,P＜0.01)、餐后血糖(19.79±5.69 mmol/L vs 14.11±4.21 mmol/L,P＜0.05)及糖化血红蛋白(9.73%±2.39% vs 7.26%±1.96%,P＜0.05)明显升高,同时具有高水平的血清胃动素、胃泌素及胰高血糖素.糖尿病胃排空异常者植物神经功能异常发生率为62%(13/21),而糖尿病胃排空正常者为24%(4/17),糖尿病胃排空异常者胃内小钡条排空时间较正常者明显延长(7.93±1.23 h vs4.35±1.01 h,P＜0.001).结论:采用临床症状评分、血糖及胃肠道激素等监测及影象学检查可诊断糖尿病胃轻瘫,糖尿病胃轻瘫与神经病变、高血糖、血清胃肠激素异常、微血管病变及代谢紊乱有关.     

老年2型糖尿病患者餐后高血糖与胃轻瘫的关系

目的探讨老年2型糖尿病患者餐后高血糖与胃轻瘫的关系,为临床诊断和治疗提供依据。 方法2002年1月至2004年1月浙江大学医学院附属邵逸夫医院采用核素标记试餐发射型计算机断层(SPECT)显像技术检测20例健康体检者(对照组)和80例2型糖尿病患者[按年龄分为两组：<60岁者22例(非老年糖尿病组),≥60岁者58例(老年糖尿病组)]胃半排空时间(T_1/2)并计算延迟率,同时测定糖尿病患者空腹及餐后1,2h和3 h血糖、糖化血红蛋白(HbA_1c)和24 h尿蛋白排泄量。两组间胃T_1/2、空腹血糖、HbA1c、24h尿蛋白排泄量、餐后血糖并采用t检验进行比较。两组间固相延迟率的比较采用χ²检验。 结果非老年病糖尿病组及老年糖尿病组固相胃T_1/2均明显高于对照组(t＝3.56、9.36,P<0.05或0.01),老年糖尿病组固相延迟率明显高于非老年糖尿病组(t＝5.21,P<0.05)。老年糖尿病组胃T_1/2、空腹血糖、HbA_1c及24 h尿蛋白排泄量均明显高于非老年糖尿病组(t＝2.67、3.12、3.43,P<0.05或0.01)。老年糖尿病组空腹血糖明显高于非老年糖尿病组,餐后2 h,3 h血糖显著高于非老年糖尿病患者(t＝3.12、4.68,均P<0.01)。老年糖尿病组餐后血糖高峰出现在餐后3 h。 结论胃轻瘫是2型糖尿病的常见并发症之一,老年2型糖尿病患者胃轻瘫发生率高,餐后血糖的高峰延迟值得临床密切关注。     

Does Grading the Severity of Gastroparesis Based on Scintigraphic Gastric Emptying Predict the Treatment Outcome of Patients with Gastroparesis?

Objectives  

The objectives of this study were as follows: (1) Whether gastric emptying is different between gastroparesis (GP) patients responding or not responding to standard medical therapy; (2) Identifying if mild, moderate, and severe degrees of gastroparesis based on the scintigraphic gastric emptying test (GET) can predict treatment responses for GP of diabetic (DM) and idiopathic (ID) origin.     

Gastric emptying time and the effect of cisapride in cirrhotic patients with autonomic neuropathy

GOALS To investigate the relationships between gastric emptying and autonomic dysfunction in hepatic cirrhosis and to assess the effects of cisapride on gastric emptying in cirrhotic patients.STUDY Twenty-four cirrhotic patients (8 patients in each Child-Pugh classification) and 25 healthy controls were enrolled. All the patients had viral (B or C) hepatitis. Patients with DM, alcoholic cirrhosis, active peptic ulcer, gastric malignancy and pyloric obstruction were excluded by esophagogastroduodenoscopy. Parasympathetic and sympathetic functions were assessed by the criteria set forth by Ewing and Clark. Drugs affecting GI motility and smoking were discontinued 48 hours and 12 hours prior to the study respectively. A solid-phase of gastric emptying study was conducted by scintigraphic method for the calculation of gastric half-emptying time (GET1/2). RESULTS The study revealed that 9 patients with Child-Pugh B and C cirrhosis had autonomic neuropathy and none of Child-Pugh A cirrhosis had autonomic neuropathy. Prolonged GET1/2 was noted in cirrhotics compared with the control group (p < 0.05). However, there was significant difference between 9 patients (Child B-C) with autonomic neuropathy compared with patients 15 patients without autonomic neuropathy. Again there was a significant difference in GET1/2 between Child A cirrhotic and Child B-C cirrhotic whether they had autonomic neuropathy or not. Cisapride decreased GET1/2 significantly in cirrhotic patients (Child B-C cirrhotic). Clearly, patients with autonomic neuropathy in Child B-C cirrhosis had significantly reduced GET1/2 after cisapride administration. Even though cisapride decreased GET1/2 in patients with Child B-C cirrhosis without autonomic neuropathy, this was not significant. CONCLUSION Autonomic neuropathy in advanced cirrhosis from viral hepatitis may cause prolonged gastric emptying. Cisapride can shorten gastric emptying time in such patients.     

Gastric Emptying in Patients with Insulin-Requiring Diabetes Mellitus

Gastric emptying of technetium labeled liquid and solid meals were studied in a group of long-standing, insulin-requiring male diabetics to evaluate the relationship of gastroparesis to symptoms, diabetic control, and diabetic complications. Control subjects and three groups of diabetics were studied: A) no neuropathy; B) peripheral neuropathy; and C) peripheral and autonomic neuropathy. Nine diabetics had gastrointestinal symptoms. Gastric t1/2 liquid emptying was similar in all groups and in controls, but liquid gastric emptying in the first 15 min was significantly more rapid in the diabetics than controls. Solid emptying was prolonged in group C patients. There was a significant correlation between t1/2 solid emptying and the severity of neuropathy. The eight patients with slow solid emptying had more neuropathy and gastrointestinal symptoms than the remaining 22 patients. The type and duration of diabetes, diabetic control, and frequency of retinopathy are independent of gastroparesis. These data indicate that delayed emptying of solids is common (27%) in patients with clinically detectable neuropathy and may often be asymptomatic. Visceral autonomic neuropathy seems the most important underlying factor in diabetic gastroparesis.     

糖尿病大鼠胃血管病变和平滑肌收缩功能与胃动力变化的研究

目的探讨胃平滑肌的收缩功能及胃血管病变与糖尿病胃动力变化之间的关系。方法采用链脲佐菌素腹腔注射建立糖尿病大鼠模型。分别于造模后4周和24周时应用单光子发射断层显像仪(SPECT)技术检测大鼠胃排空时间和速率,观察胃平滑肌的收缩功能及胃血管变化。结果 24周模型组大鼠胃平滑肌的收缩振幅和频率显著下降,4周模型组轻度下降。显微镜下观察,4周模型组,胃黏膜微血管增生,内皮损害较轻,黏膜下及肌层血管轻度纤维化,胃排空加快;24周糖尿病组,胃黏膜微血管数目明显减少,内皮损伤明显,黏膜下及肌层血管纤维化加重,管径/管腔比值明显增加,胃排空减慢。结论胃平滑肌收缩功能的改变和血管病变可能是引起糖尿病胃动力障碍的原因。     

Relationship between the effects of cisapride on gastric emptying and plasma glucose concentrations in diabetic gastroparesis

BACKGROUND/AIMS: The effect of erythromycin on gastric emptying is attenuated during hyperglycaemia. The aim of this study was to determine in patients with diabetic gastroparesis whether the effect of cisapride on gastric emptying of solids and liquids is influenced by the plasma glucose concentration. METHODS: Nineteen patients with type 1 diabetes mellitus, who had delayed gastric emptying of solids and/or liquids, were studied. On 2 separate days, each patient received cisapride (20 mg) or placebo orally 60 min before scintigraphic measurement of gastric emptying of a mixed solid (ground beef) and liquid (dextrose) meal. The plasma glucose concentrations were measured at -5, 30, 60, 90, and 120 min during each gastric emptying measurement. RESULTS: Cisapride accelerated both solid (retention at 100 min 43 +/- 4 vs. 69 +/- 4%, p < 0.001) and liquid (T50 27 +/- 2 vs. 39 +/- 2 min, p < 0.001) gastric emptying. The mean plasma glucose level was not significantly different after placebo when compared with cisapride (19.5 +/- 1.1 vs. 18.2 +/- 1.0 mmol/l). The change in the 50% emptying time (T50) for liquid, but not solid, emptying was related (r = 0.55, p = 0.01) to the change in the plasma glucose AUC from 0 to 30 min between the placebo and cisapride tests, i.e., the acceleration was greater if the plasma glucose concentration was relatively less during the gastric emptying test performed on cisapride. CONCLUSION: The effect of cisapride on gastric emptying, at least that of liquids, in patients with diabetic gastroparesis appears to be dependent on the plasma glucose concentration.     

Gastroparesis in type 2 diabetes mellitus: Prevalence,etiology, diagnosis,and treatment

The worldwide epidemic of type 2 diabetes mellitus (T2DM) is a substantial economic and social burden. Although gastroparesis associated with type 1 diabetes mellitus (T1DM) has been recognized for years, only recently have studies shown that patients with T2DM also have high rates of gastroparesis. Individuals with T2DM constitute 90% to 95% of the diabetic population. Unique characteristics that distinguish this population are obesity, insulin resistance, and associated comorbidities. These features highlight the importance of investigating gastric emptying in individuals with T2DM and upper gastrointestinal symptoms. The purpose of this review is to examine the literature pertaining to diabetes and the effect of diabetes on gastric neuromuscular function, with a focus on T2DM. An understanding of gastric motility in T2DM is important to diagnose gastroparesis, to treat upper gastrointestinal symptoms, and to restore normal gastric motility, which may lead, in turn, to improved glucose control.     

Effects of epalrestat,an aldose reductase inhibitor,on diabetic neuropathy and gastroparesis

OBJECTIVE: Diabetic patients with severe autonomic nervous disorder show delayed gastric emptying accompanied by diabetic gastroparesis, which decreases the electric activity of the stomach associated with gastric motility. It is reported that epalrestat, an aldose reductase inhibitor, is useful for treating diabetic neuropathy. Therefore, we evaluated whether this drug improves the decreased gastric motility in diabetic patients. METHODS: The present study evaluated the electrogastrograms (EGG) and autonomic nervous activity in 15 healthy volunteers (N group), and in 15 diabetic patients before and after the administration of epalrestat (DM group). Autonomic nervous activity was evaluated by spectral analysis of heart rate variability. The EGGs were recorded before and after oral administration of epalrestat (3 months or more) in the DM group. RESULTS: The dominant frequency of EGG was 3 cycles/min (cpm) in the N group. However, these 3 cpm waves disappeared with bradygastria, and postprandial increases in the peak powers of EGG were not observed in the DM group. Both the amplitude of 3 cpm waves and the postprandial peak powers were significantly increased after the administration of epalrestat. The parameters of autonomic nervous activities (LF power, HF power, and the LF/HF ratio) were significantly lower in the DM group before the administration of epalrestat than in the N group. However, these parameters were improved after the administration of epalrestat. CONCLUSION: Since gastroparesis is a form of diabetic dysautonomia, complication by gastroparesis may influence blood sugar control and the absorbance of oral antidiabetics. Epalrestat significantly increased the amplitude of 3 cpm waves on EGG and improved the spectral analytical parameters of heart rate variability. These findings suggest that epalrestat is useful for the treatment of diabetic gastroparesis.     

康复运动与老年2型糖尿病胃排空关系

目的观察康复运动对老年2型糖尿病胃排空的影响。方法将华东医院80例老年糖尿病患者随机分成4组,（康复运动＋口服促动力药组;康复运动组;口服促动力药组及对照组。在人选时及完成2年随访后均给予^99mITc标记的试餐,各测定一次固相胃排空时间。每6个月对患者空腹及餐后血糖进行一次评价。结果（1）第1、2、3组经随访两年后固相GET1／2胃排空时间与随访前相比降低,差异有统计学意义（P〈0．05）。第4组经随访两年后固相GET1／2胃排空时间与试验前相比,差异无统计学意义（P〉0．05）。（2）各组患者空腹血糖均比治疗前有下降,第2组治疗2年时空腹血糖值较治疗前差异有统计学意义（P〈0．05）。第1组经治疗18个月及2年时空腹血糖值较治疗前差异有统计学意义（P〈0．05）。（3）各组患者餐后2h血糖均比治疗前有下降,第2、3组治疗2年后餐后2h血糖值较治疗前差异有统计学意义（P〈0．05）。第1组治疗18个月及2年时餐后2h血糖值较治疗前差异有统计学意义（P〈0．05）。对照前治疗前后差异无统计学意义。结论胃排空与血糖控制互相影响,初步明确合适的康复运动联合促动力药能改善部分老年糖尿病患者胃排空,有利于血糖控制,减少并发症的发生。