糖尿病胃轻瘫的早期诊断及发病机制探讨

目的:探讨糖尿病胃轻瘫的早期诊断方法及其发病机制。方法:选取我院收治的糖尿病患者45例,采用生化及放射免疫方法检测血糖、胃泌素、胃动素、胰高血糖素含量。采取以患者卧立位肱动脉收缩压变化检查植物神经功能;同时以标准餐加服小钡条试验检测胃排空时间,以6 h确诊为胃轻瘫。结果:胃排空异常者与胃排空正常者相比,空腹血糖(12.65±3.96 mmol/L7.21±1.43 mmol/L,P0.01)、餐后血糖(20.01±5.36 mmol/L14.23±4.61 mmol/L,P0.05)及糖化血红蛋白(9.81%±2.50%7.16%±2.03%,P0.05)明显升高,同时血清胃动素、胃泌素及胰高血糖素含量较高。胃排空异常者植物神经功能异常发生率为53.5%(15/28),而胃排空正常者仅为29.4%(5/17),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(7.61±1.054.12±0.85,P0.001)。结论:糖尿病胃轻瘫可以综合临床症状评分、血糖及胃肠道激素等监测及影象学检查等方法进行诊断。微血管病变,高血糖、神经病变及血清胃肠激素异常等均与糖尿病胃轻瘫的发病机制密切相关。

Exploration on Early Diagnosis and Pathogenesis of Diabetic Gastroparesis

Objective：To explore the clinical diagnosis and the pathogenic mechanisms of diabetic gastroparesis.Methods：A total num-ber of 45 in-hospital patients with diabetes were chose in this study.Bbiochemical method and radioimmunoassay （RIA）were used to de-tect the 1evels of plasma glucoses,glycosylated hemoglobin （GHG）,gastrin,motilin and glucagons.The autonomic nerve function and barium strip emptying time （〉6h）were used to diagnose the diabetic gastroparesis.Results：The levels of the blood glucose （FBG）, postprandial blood glucose（PBG）and GHG were obvious higher in diabetic patients with abnormal gastric emptying than those with nor-mal gastric emptying（FBG：12.65 ±3.96 mmol/L＆amp;7.21 ±1.43 mmol/L,P 〈0.01;PBG：20.01 ±5.36 mmol/L＆amp;14.23 ±4.61 mmol/L,P 〈0.05;GHG：9.81% ±2.50% ＆amp;7.16% ±2.03%,P 〈0.05）.Meanwhile,higher levels of serum motilin,gastrin,and glucagons were detected in diabetic patients with abnormal gastric emptying.The incidence rate of autonomic nerve function abnormality was 53. 5% （15 /28）in diabetic patients with abnormal gastric emptying,higher than those with normal gastric emptying 53.5%（15 /28）.The barium strip emptying time was obvious prolonged in patients with diabetic gastroparesis （7.61 ±1.05h＆amp;4.12 ±0.85h,P 〈0.001）. Conclusion：Diabetic gastroparesis can be comprehensively diagnosed by grading clinical symptom,examining plasma glucoses,gastrin, motilin and glucagons,evaluating autonomic nerve function and barium emptying time.Hyperglycaemia,gut hormone abnormality,neu-ropathy,and microangiopathy were relevant to the diabetic gastroparesis.