液体试餐核素胃排空显像对糖尿病患者胃排空功能的研究

目的应用放射性核素标记的液体试餐行改良的胃排空显像，选择最佳检查体位及胃排空功能评价指标；进而评估糖尿病患者胃轻瘫发生率，并为其诊断及严重程度分级提供依据。方法55名健康志愿者（对照组）和100例2型糖尿病患者（试验组）分别口服99Tcm-DTPA液体试餐后，即刻应用SPECT仪同时行平卧前位、平卧后位动态显像。影像采集结束后，勾画胃区ROI，经计算机处理后获得时间-放射性曲线，分别计算平卧前位、平卧后位胃半排空时间（GET_1/2）及30 min胃排空率（GER_30min）。3 d后服用同等量放射性核素液体试餐后行坐立后位胃排空动态显像，数据采集及处理方式同前。在此基础上，进一步对正常对照组及试验组胃排空显像数据进行t检验。结果正常对照组平卧前位GET_1/2为（12.76±2.22）min，其95%置信区间上限为17.1 min（可作为胃排空功能减退的判断标准）。对照组平卧前位和平卧后位、平卧后位和坐立后位GET_1/2及GER_30min比较，差异均有统计学意义（t=5.35、11.20、-6.37、-9.77，均P < 0.01）；对照组和试验组、试验1组（无消化系统症状糖尿病患者组）和试验2组（有消化系统症状糖尿病患者组）平卧前位GER_30min比较，差异均有统计学意义（t=6.22、3.01，均P < 0.01），其中试验组平卧前位GER_30min较对照组小，试验2组平卧前位GER_30min较试验1组小。统计试验组GET_1/2，41%胃排空功能减退，其中，9%胃排空功能重度受损。结论液体试餐核素胃排空显像是一种简单易行、准确可靠的胃排空功能检测方法。GET_1/2和GER_30min可作为胃排空功能减退程度的指标，并优选平卧前位进行检查，可在临床推广应用。

Research on gastric emptying in diabetic patients using radionuclide-labeled liquid test meal

Objective Gastric emptying scintigraphy was performed with radionuclide-labeled liquid test meal to determine the best position and evaluation index for the clinical examination of gastric emptying.Subsequently,the incidence of gastroparesis in diabetic patients was evaluated,and the basis for its diagnosis and severity index was obtained.Methods A total of 155 participants were divided into the control (n=55) and experimental groups (n=100).The volunteers were made to drink 99Tcm1-DTPA radioactive nuclide liquid test meal and to lie down on an exam table.SPECT was utilized to dynamically and instantaneously image anterior and posterior gastric emptying in the lying position.After image acquisition,the stomach area was highlighted as the ROI.Through computer processing,the time-radioactive change curve was obtained,and then lying anterior and posterior gastric-half emptying time (GET1/2) and gastric emptying rate in 30 minutes (GER30min) were calculated.Three days later,the patients received the same amount of radionuclides in liquid test meal for the dynamic imaging of posterior gastric emptying in the sitting position.Data acquisition and processing were conducted using the previously described protocol for gastric emptying in the lying position.Imaging data from the normal control and experimental groups were compared by using t-test.Results In the control group,the lying anterior GET1/2 was(12.76±2.22) min with an upper limit of 95％ confidence interval of 17.1 min.This parameter could be used as a criterion for the evaluation of gastric emptying function.The GET1/2 and GER30min of the lying anterior and posterior of the normal control group were significantly different (t=5.35,11.20,-6.37,-9.77,all P＜0.05).The lying anterior GER30min of experimental groups 1 (without digestive system symptom diabetes) and 2 (with digestive system symptom diabetes) were significantly different (t =6.22,3.01,both P＜0.05).The lying anterior GER30min of the experimental group was lower than that of the control group,and was lower in experimental group 2 than in experimental group 1.Based on the GET1/2 of the experimental group,41％ of the patients exhibited dysfunctional gastric emptying,whereas 9％ of the patients suffered from severely impaired gastric emptying.Conclusion Radionuclide-labeled liquid test meal gastric emptying imaging is a simple,accurate and reliable detection method.GET1/2 and GER30min can be used as gastric emptying function impairment degree index,and the lying anterior position was selected as a better method of radionuclide-labeled liquid test meal gastric emptying imaging which can be used in clinical extension