高血糖减弱了红霉素在特发性和糖尿病性胃轻瘫中诱导的固相胃排空加速作用。

Hyperglycaemia attenuates erythromycin-induced acceleration of solid-phase gastric emptying in idiopathic and diabetic gastroparesis.

作者信息

Petrakis I E, Vrachassotakis N, Sciacca V, Vassilakis S I, Chalkiadakis G

机构信息

1st Dept. of Surgery, Policlinico Umberto I, University of Rome La Sapienza, Italy.

出版信息

Scand J Gastroenterol. 1999 Apr;34(4):396-403. doi: 10.1080/003655299750026416.

DOI:10.1080/003655299750026416

PMID:10365900

Abstract

BACKGROUND

Erythromycin has recently been found to be a gastrointestinal prokinetic agent in humans. Acute hyperglycaemia has been associated with delayed gastric emptying in both healthy controls and diabetic patients. Our aim was to investigate in gastroparetic patients (diabetics and idiopathics) whether hyperglycaemia, per se, reduces gastric motility during erythromycin-induced acceleration of gastric emptying of solids.

METHODS

In 12 gastroparetic patients, 6 diabetics and 6 idiopathics, gastric emptying of solids was measured scintigraphically after giving placebo in normoglycaemia (5-8.9 mmol/l glucose) or 200 mg erythromycin lactobionate intravenously in normo- or hyperglycaemia (16-19 mmol/l glucose) induced by intravenous glucose infusion in random order on separate days.

RESULTS

Erythromycin in normoglycaemia accelerated solids gastric emptying compared with placebo in all patients by abolishing the lag-phase duration and by decreasing the retained percentage of a meal in the stomach at 120 and 150 min (14.5% +/- 5.3% versus 88.4% +/- 10.6% and 3.5% +/- 2.1% versus 70.1% +/- 15.4%, respectively) (P < 0.001). The retained isotopic percentage in the stomach after erythromycin in induced hyperglycaemia compared with erythromycin in normoglycaemia, at 120 and 150 min, was increased (51.9% +/- 9.8% versus 14.5% +/- 5.3%, and 24.5% +/- 5.9% versus 3.5% +/- 2.1%, respectively) (P < 0.001) but was decreased in comparison with placebo (P < 0.001). A significantly increased percentage of isotope was retained in the stomach of the diabetic patients at 120 and 150 min, compared with the idiopathics, only after giving erythromycin in the hyperglycaemic condition (57.6% +/- 8.7% versus 46.1% +/- 7.6% (P = 0.036) and 27.8% +/- 5.7% versus 21.1 +/- 4.4% (P = 0.040), respectively).

CONCLUSIONS

Hyperglycaemia attenuates erythromycin-induced acceleration of solid-phase gastric emptying in idiopathic and diabetic gastroparesis and increases the retained isotopic meal in the stomach. Hyperglycaemia reduces gastric motility more in the diabetic patients with gastroparesis than in idiopathic patients.

摘要

背景

最近发现红霉素是一种人类胃肠道促动力剂。急性高血糖与健康对照者和糖尿病患者的胃排空延迟有关。我们的目的是研究在胃轻瘫患者（糖尿病患者和特发性患者）中，高血糖本身是否会在红霉素诱导固体胃排空加速期间降低胃动力。

方法

在12例胃轻瘫患者中，6例糖尿病患者和6例特发性患者，在血糖正常（血糖5 - 8.9 mmol/l）时给予安慰剂，或在不同日期随机顺序静脉输注葡萄糖诱导血糖正常或高血糖（血糖16 - 19 mmol/l）时静脉给予200 mg乳糖酸红霉素后，通过闪烁扫描法测量固体胃排空。

结果

与安慰剂相比，血糖正常时的红霉素在所有患者中均通过消除延迟期持续时间并降低120和150分钟时胃内一餐的残留百分比来加速固体胃排空（分别为14.5%±5.3%对88.4%±10.6%和3.5%±2.1%对70.1%±15.4%）（P < 0.001）。与血糖正常时的红霉素相比，诱导高血糖时红霉素给药后120和150分钟时胃内残留同位素百分比增加（分别为51.9%±9.8%对14.5%±5.3%，以及24.5%±5.9%对3.5%±2.1%）（P < 0.001），但与安慰剂相比降低（P < 0.001）。仅在高血糖状态下给予红霉素后，120和150分钟时糖尿病患者胃内保留的同位素百分比显著高于特发性患者（分别为57.6%±8.7%对46.1%±7.6%（P = 0.036）和27.8%±5.7%对21.1±4.4%（P = 0.040））。