Gaur C, Mathur A, Agarwal A, Verma K, Jain R, Swaroop A
Department of Medicine, Jawahar Lal Nehru Hospital, Ajmer.
J Assoc Physicians India. 2000 Jun;48(6):603-5.
The objective of the study was to study gall bladder volume in fasting and 45 minutes post-prandial, by real time ultrasound in healthy controls and diabetic patients with and without autonomic neuropathy and to compare them.
Age, Sex and body mass index (BMI) matched 50 healthy subjects and 10 patients with insulin dependent diabetes mellitus and 40 patients with noninsulin dependent diabetes mellitus were evaluated according to National diabetes Data Group of National Institute of Health (1979) criteria: 1. Fasting (overnight) venous plasma glucose concentration of > 140 mg/dl on two separate occasions. 2. Following ingestion of 75 gms of glucose, venous plasma glucose concentration of > 200 mg/dl at second hour and at one other occasion during two hour test. Autonomic neuropathy was assessed by the presence of symptoms like dysphagia, abdominal fullness, nausea, vomiting, diarrhea +/- nocturnal, faecal incontinence or constipation, dysuria, urinary incontinence, the gustatory sweating, impotence etc. and were confirmed by standing test for orthostatic hypotension, hand grip test, Valsalva test and deep breaths test.
The study showed that: 1. Patients of diabetes mellitus had statistically significant larger fasting gall bladder volumes and these values were highly significant amongst patients with autonomic neuropathy. 2. Patients of diabetes mellitus and statistically significant larger post fatty meal gall bladder volume and these values were highly significant in patients with autonomic neuropathy.
We therefore conclude that impaired gall bladder contraction was found amongst patients of diabetes mellitus with autonomic neuropathy. The mechanism responsible for cholecystoparesis is attributed to vagal neuropathy. Incomplete gall bladder emptying leads to sequestration of cholesterol and nidus formation. Therefore gall bladder functions should be evaluated routinely in such patients and early intervention is recommended.
本研究的目的是通过实时超声检查，研究健康对照者以及患有和未患有自主神经病变的糖尿病患者在空腹和餐后45分钟时的胆囊容积，并进行比较。
根据美国国立卫生研究院国家糖尿病数据组（1979年）的标准，对年龄、性别和体重指数（BMI）相匹配的50名健康受试者、10名胰岛素依赖型糖尿病患者和40名非胰岛素依赖型糖尿病患者进行评估：1. 两次独立测量时，空腹（过夜）静脉血浆葡萄糖浓度>140mg/dl。2. 摄入75克葡萄糖后，在两小时测试中的第二小时及另一时间点，静脉血浆葡萄糖浓度>200mg/dl。通过吞咽困难、腹部饱胀、恶心、呕吐、腹泻+/-夜间腹泻、大便失禁或便秘、排尿困难、尿失禁、味觉性出汗、阳痿等症状评估自主神经病变，并通过直立性低血压站立试验、握力试验、瓦尔萨尔瓦试验和深呼吸试验进行确认。
研究表明：1. 糖尿病患者的空腹胆囊容积在统计学上显著更大，在患有自主神经病变的患者中这些值非常显著。2. 糖尿病患者的餐后胆囊容积在统计学上显著更大，在患有自主神经病变的患者中这些值非常显著。
因此，我们得出结论，在患有自主神经病变的糖尿病患者中发现胆囊收缩受损。胆囊排空迟缓的机制归因于迷走神经病变。胆囊排空不完全导致胆固醇潴留和结石形成。因此，应常规评估此类患者的胆囊功能，并建议早期干预。
