枳实消痞丸方及其拆方对大鼠胃排空及血浆胃动素的影响

目的 :研究枳实消痞丸及其拆方和不同剂型对大鼠胃排空及血浆胃动素 (MOT)水平的影响。方法 :大鼠分为标准组 ,正常对照组 ,西沙必利组 ,枳实消痞丸方饮片组 (全方 ) ,消法组 ,补法组、和法组 ,全方合煎冲剂组 ,全方分煎冲剂组 ,共 9组 ,分别用 0 .9% Na Cl溶液及各组药物灌胃 4周后利用蛋白胨法测定胃排空 ;另分 5组 ,放免法测定血浆 MOT水平。结果 :除和法组外 ,各用药组的胃排空率均显著快于正常对照组 (P<0 .0 1,<0 .0 5 ) ,而补法组和分煎冲剂组胃排空率又较全方组及西沙必利组为慢 (P<0 .0 5 ) ,其余各组两两间差异无显著性意义。枳实消痞丸方具有促进 MOT释放的作用 ,拆方研究表明方中消法组的药物起主要作用 (P<0 .0 5 )。结论 :枳实消痞丸方能显著促进大鼠胃排空及提高其血浆 MOT水平 ,拆方研究表明其中的消法组药物 (枳实、厚朴、麦芽 )可能起主要作用。未发现冲剂和水煎剂之间的作用差别 ,但分煎冲剂作用较弱。     

通心络胶囊对糖尿病自主神经病变的影响

目的观察通心络胶囊联合甲钴胺片对糖尿病自主神经病变（DAN）患者的影响。方法48例DAN患者均予通心络胶囊4老V次口服,3次／d,甲钴胺片500μg／次口服,3次／d,共2个月。观察服药前后患者心率变异性（HRV）的变化,并记录患者症状的积分情况。结果通心络胶囊治疗后患者多汗、腹泻、便秘、排尿障碍、直立性低血压症状减轻或消失,5项症状的积分均较治疗前减少达50％以上,与治疗前比较差异有统计学意义（P〈0．05）;HRV各指标中低频范围内的功率（LF）降低（32．8±11．4）ms^2,LF／高频范围内的功率（HF）降低（1．8±0．6）ms^2,余指标均增高,差异有统计学意义（P〈0．01）,且未见明显不良反应。结论通心络胶囊联合甲钴胺片对糖尿病自主神经病变有改善交感、迷走神经平衡失调的作用,是治疗DAN安全、有效的药物。     

The Relations Among Serum Ghrelin,Motilin and Gastric Emptying and Autonomic Function in Autoimmune Gastritis

Background

Gastric emptying (GE) of solids is delayed and autonomic dysfunction is detected in autoimmune gastritis (AIG). The goals of this study were to: (1) compare serum levels of ghrelin and motilin in subjects with delayed and normal GE and (2) investigate whether circulating antimyenteric antibodies (CAA), serum ghrelin levels and motilin levels have any effect on autonomic function.

Catecholamines and Diabetic Autonomic Neuropathy

In diabetic patients with autonomic neuropathy plasma noradrenaline concentration, used as an index of sympathetic nervous activity, is low. This decrease is, however, only found in patients with a long duration of diabetes with clinically severe autonomic neuropathy. This apparent insensitivity of plasma catecholamine measurements is not due to changes in the clearance of catecholamines in diabetic autonomic neuropathy. The physiological responses to infused adrenaline and to noradrenaline are enhanced, for noradrenaline mainly cardiovascular responses. Adrenoceptors (alpha and beta adrenoceptors) are not altered in circulating blood cells in diabetic autonomic neuropathy. Thus, a generalized up-regulation of adrenoceptors does not occur in diabetic autonomic neuropathy.     

Gastric Emptying of Indigestible versus Digestible Oils and Solid Fats in Normal Humans

Recent scintigraphic studies indicate thatlipolytic products in the small intestine do not inhibitgastric emptying of fat as potently as previouslysuggested by studies that compared a liquid indigestible oil with a solid digestible fat. The olderstudies left open the confounding possibility that solidfats emptied differently than liquid oil. We studiedeight normal subjects who ingested four meals in which fat was (1) liquid, digestible Criscooil, (2) liquid, indigestible sucrose polyester oil, (3)digestible, solid Crisco, and (4) indigestible, solidolestra. Fats were labeled with iodine-123, and their gastric emptying was followed with agamma camera. Indigestible fats (whether liquid orsolid) emptied consistently faster than digestible fats(P < 0.005), although differences were small. Solid fats emptied about as rapidly as oils in thefirst hour; but more slowly thereafter (P < 0.01). Acomparison of present scintigraphic with older studiessuggested that solid fats were not well tracked by duodenal, marker-perfusion techniques, whichmisled previous investigators.     

Erythromycin Accelerates Gastric Emptying of Indigestible Solids and Transpyloric Migration of the Tip of an Enteral Feeding Tube in Fasting and Fed States

Erythromycin has been shown to initiate gastric interdigestive migrating motor complexes, which are the motor events responsible for gastric emptying of indigestible solids. Hence, erythromycin should also accelerate gastric emptying of indigestible particles and facilitate transpyloric migration of the tip of an enteral feeding tube. Accordingly, we assessed the effect of erythromycin on these events, using a single-blind crossover study. Healthy subjects were nasally intubated with an enteral feeding tube. For fasting studies, the subjects remained fasted; in the fed studies, the subjects were fed a cheeseburger and fries after placement of the feeding tube. Then, ten 1-cm radiopaque plastic segments were swallowed by each subject, followed by an iv infusion of either erythromycin (200 mg over 20 min) or saline. Abdominal x-rays were then taken at regular intervals to document the location of the tube tip and the plastic segments. Erythromycin significantly shortened gastric emptying time of the indigestible particles during both fasting and fed states. Erythromycin also accelerated transpyloric migration of the tip of the feeding tube in both fasting and fed states. Hence, erythromycin can be beneficial when placement of a feeding tube in the small intestine is clinically desired.     

2型糖尿病患者自主神经功能与单纯性运动性高血压

目的探讨2型糖尿病合并自主神经病变患者与单纯性运动性高血压的关系.方法随机选取血压正常的2型糖尿病患者80例,按标准心血管自主神经功能试验(SCANFT)(以下简称神功试验)检查结果分为糖尿病自主神经病变 (DAN) 组(38例)和单纯性糖尿病(SDM)组(42例),与自主神经功能检查阴性的40例健康组作对比分析,并分析其静态血压、运动负荷后血压及动态血压变化.结果三组静态血压无明显差异,DAN组运动负荷后的血压及运动性高血压发生率明显高于SDM组及对照组(均P<0.01).动态血压显示糖尿病患者24 h SBP、d SBP、n SBP均高于对照组(P<0.01),而DAN组的24 h DBP、d DBP、n DBP及心率较SDM组及对照组显著增高(P<0.01),结论自主神经功能异常的糖尿病患者,运动负荷后的血压明显升高,运动性高血压可作为糖尿病患者合并自主性神经病变的预测指标之一.     

QT Interval Length and Diabetic Autonomic Neuropathy

QT interval length was measured in ECG recordings from three groups of age-matched male subjects: 36 normal subjects, 41 diabetic patients without (DAN-ve), and 34 with (DAN+ve) autonomic neuropathy. ECG samples were selected from previously recorded 24-h ECGs on the basis of a clearly defined T wave and a steady RR interval over 2 min of around 750 ms (80 beats min^?1). There were no significant differences in RR interval between the groups. The two diabetic groups had slightly longer QT measurements (normal 365 ± 14 (±SD) ms, DAN-ve 373 ± 18 ms, DAN+ve 375 ± 23 ms, p = 0.05), and corrected QT (QTc) values (normal 423 ± 15 ms, DAN-ve 430 ± 20 ms, DAN+ve 435 ± 24 ms, p = 0.05). Ten diabetic patients fell above our defined upper limit of normal for QTc (>mean + 2SD). There was a significant correlation in the DAN-ve group between the QT indices and 24-h RR counts (QT r = ?0.38, p < 0.01; QTc r = ?0.40, p < 0.01). We conclude that there are some small alterations in QT interval length in the steady state in diabetic autonomic neuropathy. The changes appear to be due to autonomic impairment, rather than diabetes per se.     

糖尿病大鼠胃排空功能与胃组织瘦素的关系

大量文献已证实瘦素可抑制胃排空，胃排空延迟是糖尿病常见的并发症。目的：探讨不同病期糖尿病胃排空延迟与胃组织瘦素的关系。方法：40只Wistar大鼠分为对照1周组（NC1组）、对照4周组（NC2组）、糖尿病病期1周组（DM1组）和糖尿病病期4周组（DM2组）。分别于注射链佐霉素或柠檬酸缓冲液1、4周后检测大鼠胃排空、胃组织瘦素和瘦索受体OB—RbmRNA的表达。结果：与NC1组相比，DM1组大鼠胃排空明显加快（P〈0．01），胃组织瘦素表达显著增加（P〈0．01），OB—RbmRNA的表达无显著差异。与NC2组相比，DM2组大鼠胃排空明显减缓（P〈0．01），瘦素表达显著降低（P〈0．01），OB—RbmRNA的表达无显著差异。结论：随着糖尿病病期的持续，大鼠胃排空由加速转为延迟．胃组织瘦素表达反馈性由增加转为减少。     

脐静脉血浆胃动素浓度测定及其意义

本文测定了４５例足月正常新生儿脐静脉血浆胃动素浓度，并与４５例正常产妇进行比较，结果表明脐静脉血浆平均胃动素浓度为３９６．００±８５．５０ｎｇ／Ｌ，与产妇血浆平均胃动素浓度（３９３．５３±５５．０３ｎｇ／Ｌ）基本相等（Ｐ＞０．０５），但明显高于正常育龄非孕妇女（３６１．１２±９６．２３ｎｇ／Ｌ），Ｐ＜０．０１；不同性别的新生儿，其胃动素浓度无明显差异（Ｐ＞０．０５）。提示新生儿脐静脉血胃动素浓度较高，其意义可能有助于新生儿胃肠道结构和功能的进一步发育和成熟。     

The Effect of Erythromycin in Gastric Emptying of Solids and Hypertonic Liquids in Healthy Subjects

We report our study of the effect of erythromycin on gastric emptying of solid and liquid meals in 10 healthy subjects. On different occasions, subjects consumed either a radiolabeled 50% glucose solution, or a radiolabeled standard solid meal after placebo, and after receiving 200 mg of erythromycin intravenously. Erythromycin accelerated the gastric emptying of the hypertonic liquid meal by significantly decreasing the duration of lag phase ( p < 0.0001), by significantly increasing the emptying rate at the postlag period ( p < 0.001), and by significantly decreasing the duration of the postlag period ( p < 0.0001) and the meal remaining in the stomach at 15 ( p < 0.05), 30 ( p < 0.001), and 60 ( p < 0.01) min postprandially. In addition, erythromycin administration induced a significant plasma fall at 15 ( p < 0.05) and 30 ( p < 0.01) min and a significant increase in pulse rate at 15 and 30 min ( p < 0.01) after consumption of the hypertonic glucose solution, whereas three subjects experienced symptoms suggesting dumping syndrome. Furthermore, erythromycin administration enhanced the gastric emptying of solids by almost abolishing the duration of lag phase ( p < 0.0001) and by reducing the overall t_1/2 of emptying ( p < 0.0001), whereas less food was retained in the stomach at 60 ( p < 0.001) and 120 ( p < 0.0001) min postprandially. Conversely, the postlag t_1/2 of the solid meal emptying was not affected by erythromycin, as compared to placebo. We conclude that erythromycin has gastrokinetic properties, affecting the gastric emptying of both liquids and solids.     

Gastric Emptying Rate of Solids in Patients with Nonulcer Dyspepsia

The underlying role of motility disorders anddelayed gastric emptying in nonulcer dyspepsia is stillquestioned. This study aimed to determine the role ofthe gastric emptying rate of solids in patients with nonulcer dyspepsia. By means of breathtest technology, gastric emptying results of 344consecutive patients with nonulcer dyspepsia werecompared with those of 70 normal healthy volunteers.Although gastric emptying was significantly delayed inpatients with nonulcer dyspepsia compared with normalvolunteers, there was a great overlap between the twogroups. Using 5-95% confidence intervals of the control group in about 30% of the patients withnonulcer dyspepsia gastric emptying was delayed. Nocorrelation was found between gastric emptying rate andage, weight, height, or sex of the subjects in both groups. These findings suggest that, apartfrom gastric emptying, other mechanisms are veryimportant in the etiology of nonulcerdyspepsia.     

Mortality in Diabetic Patients with Cardiovascular Autonomic Neuropathy

Cardiovascular autonomic diabetic neuropathy (CADN) may carry an increased risk of mortality. However, in previous studies the prognosis of patients with CADN seemed to be influenced by life-threatening macro- and microvascular complications which had already been present at the start of the study period. Between 1981 and 1983, 1015 diabetic patients have been examined for CADN (abnormal heart rate variation at rest and during deep respiration) at the Diabetes Research Institute, Düsseldorf. Thirty-five patients (28 with Type 1 diabetes, 7 with Type 2 diabetes) with CADN have been retrospectively recruited and reviewed 8 years later and compared with 35 patients without CADN who were matched for sex, age, and duration of diabetes. Exclusion criteria for entry into the study included severe micro- or macrovascular complications, such as proliferative retinopathy, proteinuria or symptomatic coronary artery disease. During the 8-year observation period, 8 patients with CADN and 1 patient without CADN died. The survival rate estimates steadily declined in patients with CADN over the whole period studied. The 8-year survival rate estimate in patients with CADN was 77 % compared with 97 % in those with normal autonomic function (p < 0.05). Deaths were mainly due to macrovascular diseases (n = 3) and sudden unexpected deaths (n = 3). One patient with CADN died after an episode of severe hypoglycaemia. Among the deceased patients, coefficient of variation of R-R intervals during deep breathing was significantly reduced when compared with those who survived (1.04 ± 0.5 % vs 1.87 ± 1.0 %; p < 0.05), and symptoms of autonomic neuropathy (orthostatic hypotension, gastroparesis, gustatory sweating) were more frequent (7/8 vs 10/27 patients). The mean QTc interval was not different between the groups. These results suggest a relatively poor prognosis of patients with CADN in the absence of clinically detectable micro- and macrovascular complications.     

Prospective Study of Autonomic Nerve Function in Type 1 and Type 2 Diabetic Patients: 24 Hour Heart Rate Variation and Plasma Motilin Levels Disturbed in Parasympathetic Neuropathy

To clarify the impact of autonomic neuropathy in diabetic patients, we have conducted a prospective study of 58 Type 1 and 51 Type 2 diabetic patients (investigated at baseline, after 4, and after 7 years). In Type 1 diabetic patients, the sympathetic nerve function (orthostatic acceleration and brake indices) and in Type 2 patients, parasympathetic nerve function (R-R interval variation; E/I ratio) deteriorated during 7 years of prospective observation. Symptoms of autonomic neuropathy were associated with signs of autonomic neuropathy (low brake indices) in Type 1 but not in Type 2 diabetic patients. In the latest assessment 24 h ECG recording was performed and blood samples assayed for neuropeptide Y (NPY) and motilin were obtained. Type 1 diabetic patients with parasympathetic neuropathy (abnormal E/I ratio) showed significantly lower SD value (less variation in the R-R intervals; 29 [17] vs 50 [16], [mean {interquartile range}]; p = 0.001) and higher postprandial plasma motilin values (70 [20] pmol I^?1 vs 50 [15] pmol I^?1; p< 0.01) than patients with normal parasympathetic nerve function. In Type 2 diabetic patients, sympathetic neuropathy (low brake indices) was associated with an increased frequency of ventricular extra systolic beats during 24 h ECG recording (r_s = 0.65; p<0.01). Postprandial plasma NPY levels were not associated with disturbed autonomic nerve function.     

Gastric Emptying of Solids and Liquids for Evaluation for Gastroparesis

Background  

Gastric emptying scintigraphy (GES) of solids is typically used to evaluate for gastroparesis.     

Autonomic and Peripheral Nerve Function in Early Diabetic Neuropathy

ABSTRACT. Sundkvist G, Lilja B, Rosén I, Agardh C-D (Departments of Internal Medicine and Clinical Physiology, Malmö General Hospital, and Departments of Clinical Neurophysiology and Internal Medicine, University Hospital, University of Lund, Lund, Sweden). Autonomic and peripheral nerve function in early diabetic neuropathy. Possible influence of a novel aldose reductase inhibitor on autonomic function. Acta Med Scand 1987; 221:445–53. Autonomic and peripheral nerve functions as well as the possible short-term effect of a novel aldose reductase inhibitor (ARI) on neuropathy were evaluated in 30 male type I diabetics (age 25–44 years, mean 34; duration of diabetes 10–20 years, mean 34) with neurographic signs of peripheral neuropathy (PN). Autonomic neuropathy (AN) was established by the heart rate reactions to deep breathing (E/I ratio = vagal function) and to tilt (acceleration index = sympathetic and vagal functions; the brake index = vagal function). Twenty-nine patients, 13 with AN, completed the study. Among neurographic variables, only sural nerve function tests correlated with autonomic functions. Patients with AN showed significantly lower mean sensory action potential amplitudes (SAPA) sural, indicating axonal losses, than patients without AN (3.58±0.79 μV vs. 7.34±1.12 μV; p<0.01). PN as measured by neurography did not improve during ARI treatment. On the other hand, vagal function (brake indices) improved (p<0.05) during ARI in AN patients.     

The Splanchnic Circulation and Postural Hypotension in Diabetic Autonomic Neuropathy

Postural hypotension results from sympathetic failure to cause superior peripheral vasoconstriction. The importance of the splanchnic circulation was studied by measuring mesenteric artery blood flow with duplex Doppler scanning. Nine normal and 9 Type 1 diabetic controls were compared to 8 Type 1 patients with autonomic neuropathy whose pressure fell 40–113 mmHg (range) on tilting. Measurements were made supine and after vertical tilt, fasting without insulin and after a 550 kcal meal. Superior mesenteric artery diameter decreased on tilting in normal controls but not in diabetic control or neuropathy groups (supine vs tilted: controls. 6.3 ± 0.9 to 5 ± 0.9 mm, p = 0.004, diabetic controls: 6.0 ± 0.6 to 6.0 ± 1.0 mm, and neuropathy group: 6.4 ± 0.9 to 5.6 ± 0.9 mm), but proportional blood flow changes were similar in all subjects (controls: 407 ± 154 to 255 ± 67 ml min^?1 (-31%, p = 0.03), diabetic controls: 379 ± 140 to 306 ± 149 ml min^?1 (-8%, p = 0.28), neuropathy group: 639 ± 371 to 435 ± 142 ml min^?1 (-23%, p = 0.10). Postprandially supine superior mesenteric artery flow increased in all subjects but this did not affect the degree of systolic blood pressure drop on tilting (fasting vs postprandial blood flow: controls: 407 ± 154 to 775 ± 400 ml min^?1 (p = 0.04), diabetic controls: 379 ± 140 to 691 ± 262 ml min^?1 (p = 0.01), neuropathy group: 639 ± 371 to 943 ± 468 ml min^?1 (p < 0.06)). The similarity of superior mesenteric artery responses to tilting in the three groups, and the lack of exacerbation of postural hypotension in the presence of postprandial hyperaemia indicates that control of splanchnic blood flow is less important in the aetiology of diabetic autonomic postural hypotension than previously thought.     

Postural Hypotension in Diabetic Autonomic Neuropathy: a Review

Postural hypotension is uncommon in diabetes but can occur secondary to autonomic neuropathy. Symptoms are rare and include dizziness, weakness, blurred vision, tiredness, and loss of consciousness. The pathophysiology of postural hypotension is not clear, but changes in intravascular volume, heart rate, cardiac output, and splanchnic vascular resistance are similar in patients and controls. The main factors producing hypotension are a blunted catecholamine response to standing, and failure of lower limb vascular resistance to increase adequately. Treatment for symptomatic postural hypotension includes avoidance of dehydration, adequate salt intake, and fludrocortisone. Other treatments are reviewed but are less helpful. Patients with postural hypotension have intermittent symptoms over the years but rarely become severely disabled. They have a poorer prognosis than patients with symptomatic autonomic neuropathy without postural hypotension.