Ⅱ型糖尿病胃排空时间测定及西沙必利对糖尿病性胃轻瘫的疗效

Determination of gastric emptying time in type Ⅱ diabetes mellitus and therapeutic effect of cisapride on diabetic gastroparesis

目的研究Ⅱ型糖尿病（ＤＭ）的胃排空时间和西沙必利对ＤＭ性胃轻瘫的治疗作用。方法采用双核素标记１１３ｍＩｎ液体和９９ｍＴｃ固体试餐，单光子发射计算机断层摄影（ＳＰＥＣＴ）显像技术检测１０７例Ⅱ型糖尿病的胃半排空时间（Ｔ１／２），同时检测空腹血糖和糖基化血红蛋白（ＨｂＡ１Ｃ）。结果（１）５２例患者（４８６％）胃Ｔ１／２正常，４７例（４３９％）胃Ｔ１／２延迟，８例（７５％）胃Ｔ１／２加速。（２）血糖≤７８ｍｍｏｌ／Ｌ的３１例中，无１例胃Ｔ１／２延迟；血糖＞７８ｍｍｏｌ／Ｌ７６例中，４７例（６１８％）胃Ｔ１／２延迟（Ｐ值＜００１）。（３）ＨｂＡ１Ｃ≤７５％２９例中，１例（３４％）胃Ｔ１／２延迟；ＨｂＡ１Ｃ＞７５％７８例中，４６例（５８９％）胃Ｔ１／２延迟（Ｐ值＜００１）。（４）将４７例ＤＭ性胃轻瘫随机分为二组：Ａ组２４例，降糖药加西沙必利３０ｍｇ／ｄ；Ｂ组２３例，单用降糖药。二组疗程均为１个月。Ａ组有效率为９１６％，Ｂ组均无效。二组比较对胃轻瘫、血糖和ＨｂＡ１Ｃ的疗效，Ａ组优于Ｂ组。结论ＤＭ性胃轻瘫与高血糖相关。西沙必利是有力的促进胃动力的药物。

Objective To study gastric emptying time in patients with type Ⅱ diabetic mellitus (DM) and to determine the therapeutic effect of cisapride on diabetic gastroparesis. Methods Gastric emptying time of liquid meals and solid meals, biradiolabelled with 113m In and 99m Tc, was determined with SPECT technique in 107 cases of type Ⅱ DM. Fasting blood glucose and HbA 1C concentration were examined simultaneously. Results (1) 52(48 6%) cases had normal gastric half emptying time (T 1/2 ), 47 cases (43.9%) showed a delay of gastric T 1/2 and 8 cases (7.5%) exhibited accelerated gastric T 1/2 . (2) Among 31 cases with the blood glucose levels ≤7.8 mmol/L, none of them showed delayed gastric T 1/2 ; while among 76 cases with blood glucose levels >7.8 mmol/L, 47 cases (61.8%) had delayed gastric T 1/2 ( P <0.01). (3) In 29 cases with the HbA 1C levels ≤7.5%, only one case (3.4%) had delayed gastric T 1/2 ; while among 78 cases with the HbA 1C levels >7.5%, 46 cases (58 9%) had delayed gastric T 1/2 ( P <0.01). (4) 47 cases with gastroparesis were randomly divided into two groups. 24 cases as group A were treated with hypoglycemic drug and cisapride 30 mg daily by mouth; while 23 cases as group B were treated with hypoglycemic drug alone and served as control. The course of therapy in both groups lasted one month. The rate of efficacy was 91.6% in group A, no efficacy was found in group B. Comparison between the two groups with respect to the therapeutic effect on gastroparesis, blood glucose and HbA 1C levels showed that the efficacy in group A was superior to that of group B. Conclusion There is a close relationship between gastroparesis and hyperglycemia. Cisapride is a potent gastrokinetic drug with favorable effect on diabetic gastroparesis.