2型糖尿病患者胃排空影响因素分析

目的评估2型糖尿病患者胃排空和病程、血糖、血管病变及血清维生素B12的关系。方法选取2009年10月-2010年5月上海市普陀区中心医院内分泌科住院2型糖尿病患者100名及糖调节正常者40名,口服胃助显剂后超声检测15、30、45、60、759、0 min胃排空率,并计算半排空和全排空时间。每位受试者测空腹及早餐后血糖、糖化血红蛋白、血清维生素B12。分析糖尿病患者胃排空影响因素。结果口服胃助显剂后,病程5年以上糖尿病患者胃半排空和全排空时间较糖调节正常者和病程小于5年患者显著延长;15、30、456、0 min胃排空率明显小于糖调节正常组和5年以下糖尿病患者。大量白蛋白尿患者较尿白蛋白阴性患者45、607、5 min胃排空率下降、全排空时间延长。糖尿病患者胃排空时间与血清维生素B12水平和早餐后2 h血糖负相关。结论超声方法可反映糖尿病患者胃排空。长期高血糖患者胃排空明显减慢。糖尿病胃轻瘫可能与微血管病变及维生素B12缺乏有关。胃排空减慢可能通过延缓糖尿病患者碳水化合物吸收降低餐后血糖波动。

Analysis on Factors Influencing Gastric Emptying in Patients with Type 2 Diabetes Mellitus

Objective To evaluate the correlation between gastric emptying and blood glucose,vascular complications,and serum vitamin B12 level in patients with type 2 diabetes mellitus. Methods One hundred type 2 diabetes mellitus patients hospitalized in Department of Endocrinology,the Central Hospital of Putuo District from October 2009 to May 2010 were selected,and 40 normal individuals were served as controls.Fasting blood samples were collected and blood glucose,HbA1c,vitamin B12 levels were detected.Each subject took gastric developer orally for ultrasonic examination.Then the percentages of gastric emptying were examined every 15 minutes,and the gastric emptying time was calculated. Results Compared with control individuals and short-period patients,those who suffered from diabetes > 5 years exhibited slower gastric emptying.Patients with high-grade albuminuria also had longer emptying time than those without albumin in their urine.Negative correlation was found between patients’ emptying time and serum vitamin B12 levels.Similar result was observed between emptying time and 2-hour postprandial blood glucose. Conclusions Gastric emptying can be well evaluated by ultrasound.Patients with long-period hyperglycemia may have extended gastric emptying.Diabetic gastroparesis probably has some sort of relationship with chronic microvascular disease and vitamin B12 deficiency.Extended gastric emptying may help to reduce glucose fluctuation after meals by postponing carbohydrate absorption.