糖尿病胃动力障碍和促胃动力药的作用

Disturbance of gastric motility in patients with diabetes mellitus and the therapeutic effect of gastrokinetic agent

目的 研究2型糖尿病(DM)胃动力变化和观察西沙必利对DM胃轻瘫的疗效。方法 对74例2型DM患者以SPECT显像技术用核素标记^(113)In液体试餐、^(99m)Tc固体试餐测定胃半排空时间(GET_(1/2))和进行胃电图(EGG)检查,同时检测空腹血糖(FBG)。结果 (1)22例FBG≤7.8mmol/L的糖尿病患者,未见GET_(1/2)延迟;52例FBG>7.8mmol/L的糖尿病患者,36例(69.2％)固相GET_(1/2)延迟,其中14例伴液相GET_(1/2)延迟(P<0.01)。(2)正常对照组和DM组的空腹和餐后胃电图主频、平均过零频率差异均无显著性,两组餐后振幅均显著高于空腹(P<0.05)。DM组的胃电节律紊乱率较对照组显著增高(P<0.05)。(3)FBG>7.8mmol/L的DM患者,核素胃排空(RGE)与EGG相关。(4)36例DM胃轻瘫分两组:A组降糖药加西沙必利和B组单用降糖药用药4周。A组对胃轻瘫有效率85％,B组无效。结论FBG与DM患者胃排空呈负相关;血糖控制不良的DM患者,RGE与EGG相关;西沙必利对DM胃轻瘫有一定疗效。

Objective To study gastric motility in patients with type 2 diabetes mellitus (DM) and to observe the therapeutic effect of cisapride on diabetic gastroparesis. Methods The gastric half emptying time (CET1/2) of liquid and solid meals radiolabelled with 113mIn and 99mTc respectively were determined by SPECT imaging technique and electrogastrogram (ECC) was performed in 74 patients with type 2 DM. Fasting blood glucose (FBG) was simultaneously measured. Results (1) None of the 22 diabetic patients with FBG >7.8 mmol/L showed delayed GET1/2; while among 52 diabetic patients with FBG > 7.8 mmol/L, 36 patients (69.2%) had delayed solid phase GET1/2 , and among them 14 patients were accompanied with liquid phase GET1/2 delay (P<0.01).(2) There was no significant difference in fasting and postprandial principle frequency, average over-zero frequency between the normal control group and the DM group. Postprandial amplitude was significantly higher than fasting amplitude in the two groups (P<0.05).The arrhythmia rate in the DM group was significantly higher than that of the normal control gruop (P <0.05 ).(3) The radiolabelled gastric emptying (RGE) was related with ECG manifestations when FBG was more than 7. 8 mmol/L. (4) Thirty-six diabetic patients with gastroparesis were divided into 2 groups. Group A was treated with hypoglycemic drugs and cispride while group B with hypoglycemic drugs alone for 4 weeks. Improvement was noted in 85% of the cases in group A, but none in group B. Conclusion (1) In DM patients, there is an inverse relationship between gastric empting and FBG, relationship does exist between RCE and ECG when blood glucose level is controlled poorly. (2) Cisapride shows a favorable effect on diabetic gastroparesis.