糖尿病患者消化间期胃肠运动障碍

Interdigestive gastrointestinal motility disorders in patients with diabetes mellitus

目的:观察糖尿病患者消化间期胃肠运动的特征。方法:于1998-06/2003-06选择首都医科大学附属北京同仁医院消化内科收治2型糖尿病患者243例,为糖尿病组。同期选择健康志愿者20例,为对照组。使用胃肠测压法进行消化间期胃肠运动功能的检测,6个测压孔分别置于胃窦、十二指肠和近端空肠的位置。根据测压管顶端的3个金属标记物在X射线透视下定位或根据移行性复合运动压力波的频率特征定位,一般胃窦收缩频率约3次/min,十二指肠和近端空肠为8～12次/min,测定时间为240～360min。结果:在两组全部受检测人群中发现3种胃肠运动类型:类型1:发生于胃和小肠发生的移行性复合运动,在糖尿病组占23.05%(56/243),对照组占70.00%(14/20),两组比较差异有显著性意义(χ2=20.86,P<0.01);类型2:单纯发生于小肠的移行性复合运动,胃窦缺乏Ⅲ期收缩活动,在糖尿病组占13.58%(33/243),对照组占15.00%(3/20),两组比较差异无显著性意义;类型3:表现为周期性不规则收缩活动,在胃窦和小肠均缺乏Ⅲ期收缩活动,在糖尿病组占57.20%(139/243),在对照组占15.00%(3/20),两组比较差异有显著性意义(χ2=13.24,P<0.01);连续4h的胃肠动力检测中未出现胃、小肠的收缩活动者,在糖尿病组占6.17%(15/243),在对照组0例,两组比较差异无显著性意义(χ2=1.30,P>0.05)。结论:糖尿病患者消化间期胃肠运动功能障碍的主要特征是周期性不规则收缩活动取代了移行性复合运动,其结果可能会延长食物在小肠停留的时间,加重糖尿病的代谢紊乱和并发症。有效地改善和恢复糖尿病患者的胃肠功能是治疗糖尿病及其并发症的一个重要方面。

AIM： To observe the characteristics of interdigestive gastrointestinal motility in patients with diabetes mellitus. METHODS： 243 patients with type 2 diabetes were selected from Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University between June 1998 and June 2003 as the diabetic group. Meanwhile, 20 healthy volunteers were selected as the control group. Their interdigestive gastrointestinal motility was detected by interdigestive gastrointestinal manometry, in which the six manometry poles were put on gastric antrum, duodenum and proximate jejunum according to the X-ray with the three metal markers at the top of manometry tube or the frequency characteristics of the pressure of migrating motor complex. Generally speaking, the contraction frequency of gastric antrum was three times per minute, and that of duodenum and proximate jejunum was eight to twelve times per minute; the detecting time lasted for 240-360 minutes. RESULTS： Three types of movement were found in the two groups. Type 1： gastrointestinal migrating motor complex, which was found in stomach and small intestine, accounted for 23.05% （561243） in the diabetic group, and 70.00% （14/20） in the control group; there were significant differences between the two groups （χ^2=20.86, P 〈 0.01）. Type 2： intestinal migrating motor complex, which only appeared in small intestine, accounted for 13.58% （33/243） in the diabetic group, and 15.00% （3/20） in the control group; there were no obvious differences between the two groups. Type 3： cyclic irregular contraction, in which irregular contraction instead of migrating motor complex was found in stomach and small intestine; there were 57.20% （139/243） in the diabetic group and 15.00% （3/20） in the control group, which had significant differences （χ^2=13.24, P 〈 0.01）. 6.17% （15/243） patients in the diabetic group and 0 in the control group were found without gastrointestinal motility during 4 hours manometry, which had no significant differences （χ^2=1.30, P 〉 0.05）.CONCLUSION：The characteristic of interdigestive gastrointestinal motility disorders in patients with diabetes mellitus refers to the absence of gastrointestinal migrating motor complexi,which is instead by cyclic irregular contraction, this may affect the food transportation through smaliintestine,aggravate the metabolic disorder and complication of diabetes. The effective improvement anc/restoration of gastrointestinal function is important to treat diabetes and its complication.