糖尿病性胃轻瘫的动力学研究

A study on motility in patients with diabetic gastroparesis

目的研究糖尿病性胃轻瘫患者胃动力学异常的机制．方法非胰岛素依赖性糖尿病（ｎｏｎｉｎｓｕｌｉｎｄｅｐｅｎｄｅｎｔｄｉａｂｅｔｅｓｍｅｌｉｔｕｓ，ＮＩＤＤＭ）患者３２例，正常人２２例作对照．采用同位素方法测定固体液体胃排空．另外，用胃频谱图机做胃频谱分析．结果ＮＩＤＤＭ患者的固体液体胃半排空时间较正常对照组明显延缓／ｍｉｎ．（９１５±２３７ｖｓ４９２±９２及５９１±１１４ｖｓ３３２±１４８，Ｐ＜００１），固体胃排空延迟主要在排空３０ｍｉｎ以后，液体胃排空延迟主要在６０ｍｉｎ以后；ＮＩＤＤＭ患者中糖尿病性胃轻瘫检出率为５６３％；ＮＩＤＤＭ胃轻瘫患者伴有胃动过速者（４４４％）多于ＮＩＤＤＭ不伴胃轻瘫的患者（７１％，Ｐ＜００５）；ＮＩＤＤＭ患者的胃排空延迟与自主神经病变有关（Ｐ＜００１）；ＮＩＤＤＭ患者的胃排空延迟与外周神经病变、肾脏病变、空腹血糖和病程无关（Ｐ＞００５）．结论ＮＩＤＤＭ患者胃固体液体胃排空延迟，胃轻瘫检出率５６３％，其特点：固体液体胃排空延迟和胃节律紊乱．自主神经病变是引起糖尿病性胃轻瘫的重要因素．

AIM To study the mechanism of motility abnormality in patients with diabetic gastroparesis. METHODS Thirty two patients with non insulin dependent diabetes mellitus (NIDDM) and 22 normal subjects as controls were studied. The solid and liquid gastric emptying was examined by isotopic method. The electrogastrogram was performed in patients with NIDDM. RESULTS The solid and liquid gastric emptying half time (in minutes) in NIDDM patients was significantly slower than that in normal controls (91 5±23 7 vs 49 2±9 2, 59 1±11 4 vs 33 2±14 8, P <0 01), and solid and liquid gastric emptying was delayed after 30 min and 60 min of emptying, respectively. The incidence of diabetic gastroparesis in 32 NIDDM patients was 56 3%; the incidence of tackygastria in patients with diabetic gastroparesis was higher than in patients without diabetic gastroparesis ( P <0 05); in NIDDM, a significant correlation was found between delayed gastric emptying and autonomic neuropathy (44 4% vs 7 1%, P <0 01). There were no correlations between delayed gastric emptying and peripheral neuropathy, blood glucose levels, duration of disease ( P >0 05, respectively). CONCLUSION The incidence of diabetic gastroparesis in 32 patients with NIDDM is 56 3%. The motility characters of diabetic gastroparesis are delayed gastric emptying of solid and liquid food. Autonomic neuropathy is an important factor in diabetic gastroparesis.