糖尿病胃轻瘫患者的胃排空迟缓与血浆胃肠激素变化相关性探讨

对２１例糖尿病胃轻瘫患者进行了空腹血浆胃肠激素水平和胃排空功能检测，结果表明，胃轻瘫患者空腹血浆生长抑素和血管活性肠肽水平均较对照组明显升高，且与胃半排空时间呈显著正相关，Ｐ物质水平明显变化。提示ＳＳ和ＶＩＰ分泌异常是其胃排空迟缓的原因之一，在胃烃瘫的发病机制中起重要作用。     

血糖变化对糖尿病大鼠胃排空功能与胃促生长素表达的影响

目的研究血糖变化对糖尿病大鼠胃排空功能与胃组织胃促生长素（ghrelin）表达的影响，探讨不同病期糖尿病胃排空延迟与胃促生长素表达的关系。方法60只Wistar大鼠随机分为正常对照组（NC组）、糖尿病组（DM组）和胰岛素干预组（INS组）。腹腔注射链脲佐菌素（sTz）制备糖尿病大鼠模型，分别于给药后1和4周用酚红灌胃法检测胃排空；用免疫组化、半定量RT-PCR技术检测大鼠胃组织胃促生长素及其mRNA表达。结果注射STZ1周后，DM组大鼠的胃排空率、胃促生长素积分吸光度及mRNA表达均明显低于NC组和INS组（P〈0．05）。注射STZ4周后，DM组与INS组大鼠的体质量、胃排空率、胃促生长素积分吸光度均明显低于NC组，而胃促生长素mRNA的表达则高于NC组；DM组与INS组之间差异无统计学意义（P〉0．05）。结论短期血糖升高可能通过抑制胃组织胃促生长素表达参与胃排空延迟的发生；而长期高血糖可能通过促进胃促生长素的表达和释放来增加摄食、维持能量平衡。     

三维超声检测糖尿病胃轻瘫患者胃排空功能的研究

目的应用三维超声扫描技术检测2型糖尿病患者胃液体半排空功能的改变,以利于糖尿病性胃轻瘫的诊断和治疗。方法采用三维超声技术检测30例2型糖尿病患者及20例健康志愿者进食液体试餐后胃排空的指标,经计算机拟合出不同时点胃容积的变化,计算出胃半排空时间（T1/2）、胃排空时间（T）及液体胃排空曲线,并与正常对照组比较。结果2型糖尿病胃轻瘫组胃半排空时间及胃排空时间均较正常对照组延长,30名糖尿病患者中有17名患者存在胃排空延迟,约占56．7％。结论应用三维超声技术检测液体胃排空功能,方法简单易行、患者易接受、可多次重复。为临床诊断糖尿病性胃轻瘫提供一种可靠、无创性的检测手段。     

糖尿病胃轻瘫的识别及临床处理

以前认为糖尿病胃排空障碍是一种少见的合并症，现在估计其发病已达50％，但对其发病机制尚了解有限。50年前。Hodges等发现一些糖尿病患的无张力胃与外科迷走神经切除术后在放射线上的表现类似，1958年，Kassander提出了“糖尿病性胃轻瘫”的名称，并推测糖尿病人的胃排空延迟，是由于迷走神经病变所致，其意义相当于自身迷走神经切除术。也有人认为是糖尿性血管病，或肌层受累，但多倾向于前。     

血糖变化对糖尿病大鼠胃排空功能与leptin表达的影响

目的:探讨不同病期糖尿病胃排空延迟与leptin表达的关系.方法:将40只Wistar大鼠随机分为对照饲养1 wk组(NC1组,n=6)、对照饲养4 wk组(NC2组;n=6)、糖尿病造模1 wk组(DM1组,n=14)和糖尿病造模4 wk组(DM2组,n=14).腹腔注射链脲佐菌素(STZ)制备糖尿病大鼠模型,分别于给药1 wk和4 wk后用酚红灌胃法检测胃排空,采用放射免疫法检测大鼠血清及胃组织leptin表达.结果:注射STZ 1 wk后,与NC1组相比,DM1组大鼠的体质量无显著变化,胃排空率显著加快(72.07%±9.67% vs 33.04%±4.07%),血清leptin含量减少(0.6±0.40 μg/L vs 2.9±0.32 μg/L),胃组织leptin含量显著增加(11.041±1.422 μg/L vs 8.529±1.450 μg/L).注射STZ 4 wk后,与NC2组相比,DM2组大鼠的体质量(162.25±19.74 g vs 329.42±11.06 g)和胃排空率显著下降(15.81%±3.55% vs 31.87%±2.87%),血清leptin含量(0.4±0.22 μg/L vs 3.3±0.25 μg/L)和胃组织leptin的表达显著减少(7.772±1.751 μg/L vs 11.433±1.799 μg/L).结论:短期血糖升高可能通过降低血清瘦素水平来增加摄食,加快胃排空以补充热量摄入,维持能量平衡,而胃组织leptin的增加可能是机体反馈性的作用.长期高血糖可能通过抑制血清及胃组织leptin的表达和释放以增加摄食,维持能量平衡.     

红霉素对糖尿病患者胃轻瘫的影响

红霉素对糖尿病患者胃轻瘫的影响张传继，丛培喜，毛学忠，曹洪贤，刘学兰糖尿病患者常伴胃轻瘫［１］，其关键病理生理机制是与胃排空延迟有关的胃动力异常或胃－幽门－十二指肠动力异常。近年研究发现红霉素能与胃肠道平滑肌细胞上的胃动素受体结合，产生促胃动力作用［...     

糖尿病性胃轻瘫

糖尿病性胃轻瘫南京军区南京总医院（２１０００２）王年吉糖尿病系一常见病、多发病，据１９９５年武汉第二届糖尿病防治会议资料，全国２１个省市２５万人口流行病学调查，糖尿病总发病率２．５％左右，比１９７８年的０．７８％升高了近３倍。按上述比例推算。我国糖尿...     

加味半夏泻心汤联合莫沙必利对老年糖尿病性胃轻瘫患者胃肠功能及Ghrelin、IGF-1水平的影响

目的 分析加味半夏泻心汤联合莫沙必利对老年糖尿病性胃轻瘫患者胃肠功能及胃促生长素(Ghrelin)、胰岛素生长因子(IGF)-1的影响。方法 70例符合入组标准的糖尿病性胃轻瘫患者随机分组为对照组和观察组,每组35例。入组后两组均给予常规基础治疗,在此基础上,对照组每日给予莫沙必利口服,观察组给予加味半夏泻心汤联合莫沙必利口服,治疗4 w后对比两组中医证候积分、胃排空率、胃电图、血清Ghrelin、IGF-1、胃泌素(GAS)、胃动素(MOT)、生长抑素(SS)水平及有效率,并监测肝肾功能及不良反应等。结果 治疗后,观察组中医证候评分显著低于对照组(P<0.05);观察组胃排空率、胃电生理指标较对照组明显改善(P<0.05);观察组Ghrelin、IGF-1、GAS、MOT水平较对照组高,SS水平较对照组低,差异有统计学意义(P<0.05);治疗期间,两组均未发生肝肾功能异常及明显不良反应。结论 半夏泻心汤联合莫沙必利治疗糖尿病性胃轻瘫可有效缓解中医证候,增强胃动力,促进胃排空与炎症反应,可上调血清中Ghrelin、IGF-1表达,且安全性高。     

旋复代赭汤治疗糖尿病性胃轻瘫

目的观察旋复代赭汤治疗糖尿病性胃轻瘫的疗效。方法100例糖尿病性胃轻瘫患者分为治疗组60例，对照组40例，治疗组用旋复代赭汤，对照组用吗丁啉（西安杨森制药有限公司生产）。结果治疗组饭后恶心、呕吐、腹部胀满等消化道不良症状总有效率99％，对照组为65％，两组差异有统计学意义（P〈0．05）。结论旋复代赭汤对改善糖尿病性胃轻瘫患者的消化不良症状，促进胃排空有明显疗效。     

Effect of metoclopramide on gastric liquid emptying in patients with diabetic gastroparesis

Metoclopramide tablets have been approved for use in the acute and chronic management of diabetic gastroparesis. Its efficacy as an antiemetic has been well documented. We measured the acute and chronic effects of oral metoclopramide on gastric liquid emptying in 12 diabetic patients with symptoms of stasis using scintiscanning techniques. We found that liquid emptying in these subjects was abnormal, as determined by residue area determination when compared to normal volunteers (P<0.01). Metoclopramide 10 mg orally acutely enhanced emptying, restoring it to control values (P<0.01). In contrast, when gastric emptying was evaluated following one month of chronic liquid metoclopramide use, 10 mg before each meal, the acute effect of the drug on emptying could no longer be demonstrated and residue areas returned to baseline values, suggesting that chronic oral administration of metoclopramide may result in a loss of the gastrokinetic properties of this drug.This work was supported in part by the Wechsler Research Foundation, No. 538475 and the Hunt Foundation. Dr. Van Thiel is the recipient of a Career Development Award from the National Institutes of Mental Health, No. AA00016.     

Effect of motilin on gastric emptying in patients with diabetic gastroparesis.

Erythromycin markedly accelerates gastric emptying, possibly because it acts as a motilin agonist. In the present study, the effect of an equipotent dose of motilin was tested. In six patients with severe diabetic gastroparesis, gastric emptying of liquids and solids was examined scintigraphically after motilin or placebo in a double-blind crossover study. Motilin (10 pmol.kg-1.min-1) or saline was infused over a 90-minute period starting 5 minutes before breakfast. Motilin markedly accelerated emptying. For liquids, the half-emptying time was reduced from 51 +/- 6 to 22 +/- 11 minutes (P less than 0.01) and for solids from 111 +/- 4 to 51 +/- 12 minutes (P less than 0.01). The mean increase in plasma motilin levels was 1315 +/- 342 pg/mL, corresponding to an effective infusion rate of about 4 pmol.kg-1.min-1. In the control experiments, basal motilin levels (173 +/- 17 pg/mL) were within the normal range but increased steadily postprandially, reaching 321 +/- 25 pg/mL at the end of the study period, probably reflecting gastric distension. The postprandial increase in pancreatic polypeptide level was blunted compared with accepted normal values but was more pronounced during motilin infusion, i.e., 650 +/- 217 vs. 279 +/- 66 pg/mL (P less than 0.01), probably because of the improved emptying. Our data show that motilin accelerates gastric emptying in diabetic gastroparesis and support the hypothesis that erythromycin's effect is mediated through motilin receptors.     

高龄糖尿病患者血糖与胃排空的相互关系

目的研究高龄糖尿病(DM)患者胃排空与血糖间的关系。方法将63例2型糖尿病(T2DM)患者根据血糖控制情况分成2组(血糖控制正常组DM1和血糖异常组DM2),均给予99mTc标记的试餐,测定固相胃排空时间,并与30例正常对照组比较,对DM2组中胃排空延迟者给予莫沙比利5 mg,3次/d,服药4 w后再测放射性核素胃排空及血糖。结果DM2组胃半排空时间延迟,平均(106.9±29.5)m in,与正常对照组(78.1±19.6)相比,P<0.05,DM1组胃半排空时间(76.5±17.1)m in,与正常对照组相比,P>0.05。DM2组中17例血糖异常胃排空延迟者服用莫沙比利后,胃半排空时间明显改善,平均为(81.3±15.2)m in;服药后空腹血糖无变化,8例餐后血糖降低,4例上升,平均餐后血糖与服药前相比,变化无显著差异。结论高龄DM患者高血糖时可延迟胃排空;改善胃排空后可降低部分病人的餐后血糖,空腹血糖无变化。     

Ghrelin对糖尿病小鼠胃排空的影响及机制

目的:探讨ghrelin对糖尿病小鼠胃排空的影响及其作用机制.方法:采用四氧嘧啶建立糖尿病小鼠模型,用灌食phenol red的方法研究糖尿病小鼠胃排空的改变,并观察注射不同剂量ghrelin(50,100和200μg/kg)对糖尿病小鼠胃动力的影响.糖尿病小鼠胃底环形平滑肌条安置在恒温灌流肌槽中并用SMUP-E生物信号处理系统记录肌条的自发收缩活动,观察不同浓度ghrelin(0.1,1和10μmol/L)对肌条自发收缩活动的影响,并研究其作用机制.结果:糖尿病小鼠的胃排空率显著低于正常小鼠的胃排空率(22.90%±1.42% vs 28.10%±1.28%,P<0.05).ghrelin能显著提高糖尿病小鼠的胃排空,具有明显的量效关系.Ghrelin在0.1,1和10μmol/L均能显著增加糖尿病小鼠离体胃底环形平滑肌肌条的自发收缩幅度(1.11±0.03,1.22±0.02,1.36±0.04 vs 1.00,均P<0.05),而atropine和L-NAME均能抑制ghrelin增加糖尿病小鼠肌条自发收缩幅度的效应.结论:Ghrelin能提高糖尿病小鼠的胃排空能力,作用机制可能是通过肌间丛神经系统的硝基能神经和胆碱能神经上的受体而起作用.     

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.     

Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: effect of long-term domperidone treatment

We measured gastric emptying and gastric myoelectrical activity with solid-phase gastric-emptying tests and cutaneously recorded electrogastrograms (EGGs), respectively, in six insulin-dependent diabetic patients with nausea and vomiting who did not respond to standard treatments. Baseline solid phase gastric emptying was markedly delayed (78 +/- 8% retained at 120 min) and EGG recordings revealed gastric dysrhythmias; tachygastria (4-9 cpm signals) in one patient, 1- to 2-cpm waves in two patients, and flatline patterns in three patients. No patient had a normal 3-cpm EGG pattern. After 6 months of domperidone treatment, mean upper gastrointestinal symptoms scores decreased from 17.8 to 3.7 (p less than 0.01), and normal 3-cpm EGG frequencies were recorded from each of the six patients. The mean percentage of meal retained at 120 min decreased but did not improve significantly. Thus, establishment of normal 3-cpm gastric myoelectric activity and resolution of dysrhythmias, not normalization of emptying rates, was associated with improvement in upper gastrointestinal symptoms in these diabetic patients.     

Postprandial blood glucose and its relation to diabetic gastroparesis — a comparison of two methods

Delayed gastric emptying is known as an important organic cause for brittle diabetes. We proposed the interval from the start of a meal to the rise in blood glucose, defined as blood glucose latency (T BG) as an index for gastric emptying and a non-invasive test for diabetic gastropathy. In order to validate this test we compared it in 22 type 1 diabetic patients with an established scintigraphic method for the measurement of gastric half-emptying time (T_1/2) and found the following correlation: T BG = 4.4 + 0.162 × T_1/2; r 0.79, P < 0.001. We therefore suggest measuring the blood glucose latency as a simple non-invasive screening method.