不同时期糖尿病患者自主神经功能及其对近端胃功能的影响

Effect of autonomic nervous function on proximal gastric function in patients with different stages of diabetes

目的:了解不同时期糖尿病患者自主神经功能及其对近端胃功能的影响.方法:44例糖尿病患者,有并发症者24例,初发无并发症者20例,21例健康志愿者,分别行自主神经功能测定和近端胃功能测定.结果:(1)对自主神经功能测定发现多项自主神经功能损害指标均呈现有并发症组>无并发症组>健康对照组的趋势,其中一部分差异有显著性,有并发症糖尿病组自主神经明确累及和严重累及比例明显升高(58.3%);(2)阈值饮水量及饱足饮水量有并发症组(638 mL±311 mL,1000 mL±424 mL)低于无并发症组(870 mL±225 mL,1360 mL±322 mL)及健康对照组(688 mL±225 mL,1235 mL±295 mL),但初发无并发症组反而高于健康对照组.饮水量差值,胃底面积差有并发症组明显低于健康对照组及无并发症组,比较差异有统计学意义(P<0.05);(3)有症状糖尿病组交感神经计分与阈值饮水量、饱足饮水量成负相关(r=-0.51、-0.43,P<0.05).结论:糖尿病患者存在近端胃功能损害,表现为感觉阈值下降,舒张功能降低,并随病程及其他并发症的出现逐渐加重;糖尿病存在自主神经损害,包括交感、副交感神经功能异常;糖尿病近端胃功能损害与交感神经损害有相关关系.

AIM： To assess autonomic nervous function in patients with different stages of diabetes mellitus（DM） and its effect on proximal stomach function.METHODS： Forty-four DM patients（24 with and20 without complications） and 21 healthy volunteers were enrolled. Standard cardiovascular reflex test and water load test were performed to determine the autonomic nervous function and proximal stomach function, respectively. The area and circumference of proximal gastric corpus were measured by ultrasonography.RESULTS： Autonomic nervous function test showed that autonomic nervous dysfunction, was most significant in DM patients with complications, followed by DM patients without complications and normal controls. The per-centage of patients with serious autonomic nervous dysfunction was significantly higher in patients with complications（58.3%）. The threshold and maximum drinking volume were significantly lower in patients with complications than in those without complications and normal controls（638 mL ± 311 mL vs 870 mL ± 225 mL, 688 mL ± 225 mL; 1000 mL ± 424 mL vs 1360 mL ± 322 mL, 1235 mL ± 295 mL; P〈0.05）. The changes in drinking volume and proximal gastric area were significantly lower in patients with complications than in those without complications and normal controls（P〈0.05）. There was a negative correlation between the sympathetic nerve score and satiety threshold and maximum tolerated drinking volume（r =-0.51,-0.43, P〈0.05）.CONCLUSION： Patients with DM have impaired proximal stomach function, which manifests as sensory threshold decline and relax function reduction. Autonomic nervous dysfunction exists in DM patients, including abnormality of the sympathetic nerve and parasympathetic nerve. Proximal stomach dysfunction in DM is related to sympathetic nerve damage.