西沙必利可改善2型糖尿病患者的胆囊排空功能。

Cisapride improves gallbladder emptying in patients with type 2 diabetes mellitus.

作者信息

Dhiman R K, Arke L, Bhansali A, Gupta S, Chawla Y K

机构信息

Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

J Gastroenterol Hepatol. 2001 Sep;16(9):1044-50. doi: 10.1046/j.1440-1746.2001.02586.x.

DOI:10.1046/j.1440-1746.2001.02586.x

PMID:11595071

Abstract

BACKGROUND AND AIMS

Gallbladder motor function is impaired in many patients with diabetes, and may be related to cholinergic nerve damage. Cisapride is a prokinetic drug of the gastrointestinal tract and acts by releasing acetylcholine from cholinergic nerve endings. The aim of this study was to determine the effect of cisapride on gallbladder emptying in patients with type 2 diabetes mellitus (DM).

METHODS

Gallbladder emptying and tests for autonomic neuropathy (AN) were performed in 27 patients with type 2 DM and in 10 healthy subjects. Gallbladder emptying was studied by using real-time ultrasonography after an overnight fast, and after the subjects received a breakfast that contained 2500 J. Gallbladder emptying was repeated after the treatment with cisapride (10 mg t.i.d.) for 1 week in all subjects.

RESULTS

Abnormal gallbladder emptying was present in 14 (51.9%) patients. The residual gallbladder volume (mean +/- SEM) was higher (9.3 +/- 1.0 vs 4.6 +/- 0.6; P = 0.002), and ejection fraction was lower (57.4 +/- 4.0 vs 74.2 +/- 2.4; P = 0.015) in diabetic patients than it was in healthy subjects. Cisapride produced a reduction in fasting and residual volumes (24.6 +/- 2.4 vs 20.0 +/- 1.4; P = 0.034 and 9.3 +/- 1.0 vs 5.9 +/- 1.1; P = 0.00003, respectively), and an improvement in ejection fraction (57.4 +/- 4.0 vs 72.6 +/- 3.8; P = 0.000007). The improvement in gallbladder emptying after cisapride therapy was confined to the patients with AN (n = 13) (57.3 +/- 5.4 vs 80.4 +/- 2.9; P = 0.0017), suggesting denervation supersensitivity with an upregulation of cholinergic receptors. There was no significant change in the ejection fraction in patients without AN (57.5 +/- 6.1 vs 65.4 +/- 6.5; P = NS). Sex, duration of diabetes, peripheral neuropathy, diabetic retinopathy and serum cholesterol level did not influence gallbladder emptying.

CONCLUSION

Impaired gallbladder emptying is common in patients with type 2 DM. Cisapride significantly improves gallbladder emptying in patients with autonomic neuropathy.

摘要

背景与目的

许多糖尿病患者存在胆囊运动功能受损，这可能与胆碱能神经损伤有关。西沙必利是一种胃肠道促动力药物，通过从胆碱能神经末梢释放乙酰胆碱发挥作用。本研究旨在确定西沙必利对2型糖尿病（DM）患者胆囊排空的影响。

方法

对27例2型糖尿病患者和10名健康受试者进行胆囊排空及自主神经病变（AN）检测。在禁食过夜后以及受试者进食一份含2500焦耳热量的早餐后，通过实时超声检查研究胆囊排空情况。所有受试者在用西沙必利（10毫克，每日3次）治疗1周后重复进行胆囊排空检查。

结果

14例（51.9%）患者存在胆囊排空异常。糖尿病患者的残余胆囊体积（均值±标准误）更高（9.3±1.0比4.6±0.6；P = 0.002），射血分数更低（57.4±4.0比74.2±2.4；P = 0.015）。西沙必利使空腹及残余体积减小（分别为24.6±2.4比20.0±1.4；P = 0.034以及9.3±1.0比5.9±1.1；P = 0.00003），射血分数提高（57.4±4.0比72.6±3.8；P = 0.000007）。西沙必利治疗后胆囊排空的改善仅限于存在自主神经病变的患者（n = 13）（57.3±5.4比80.4±2.9；P = 0.0017），提示去神经超敏反应及胆碱能受体上调。无自主神经病变患者的射血分数无显著变化（57.5±6.1比65.4±6.5；P = 无显著性差异）。性别、糖尿病病程、周围神经病变、糖尿病视网膜病变及血清胆固醇水平均不影响胆囊排空。