Johansson U B, Eskils J, Adamson U, Elwin C E, Wredling R, Lins P E
Department of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Scand J Clin Lab Invest. 2003;63(2):159-66.
Previous studies have shown that the relationship between gastrointestinal symptoms and gastric emptying is weak. Therefore the quantitative assessment of gastric emptying with a relatively simple, non-invasive test would be of considerable clinical value in insulin-treated diabetic patients to identify those with disturbed gastric emptying. The aim of this investigation was to evaluate the inter- and intra-subject variability of a paracetamol-pasta test in healthy subjects and in IDDM patients. Eighteen healthy subjects (8 women) with a mean age of 37 years (range 19-68) and 19 IDDM patients (10 women) with a mean age of 48 years (range 25-62) and mean duration of diabetes of 28 years (range 6-52) were studied on two occasions with an interval of 1 to 4 weeks. After an overnight fast the subjects ingested a standardized pasta meal mixed with 2 g paracetamol in a period of 15 min. Blood samples were drawn at regular intervals after meal intake and analysed for paracetamol (P) and blood glucose. The serum levels of P were significantly lower at 15 min in diabetic patients. The intra-subject coefficients of variation (CV%) of the areas under the serum paracetamol concentration-time curve (AUC) were almost identical in healthy and diabetic subjects, while the intra-subject CV of the P-Tmax was considerably lower in diabetic patients as well as markedly lower than the corresponding inter-subject CV. The inter-subject CVs of all parameters calculated were generally higher in diabetic patients. This study indicates that the assessment of paracetamol absorption kinetics during a paracetamol-pasta test is reproducible in healthy as well as in diabetic subjects. Diabetic patients with non-optimal glucose control and without a case history indicating gastroduodenal motor function disturbances achieve lower serum concentration of P at 15 min and generally display a higher inter-individual variability indicative of subclinical disturbances of gastric emptying in this group of patients.
先前的研究表明，胃肠道症状与胃排空之间的关系较弱。因此，对于接受胰岛素治疗的糖尿病患者，采用相对简单、非侵入性的检测方法对胃排空进行定量评估，对于识别胃排空紊乱的患者具有相当大的临床价值。本研究的目的是评估对乙酰氨基酚面食试验在健康受试者和胰岛素依赖型糖尿病（IDDM）患者中的个体间和个体内变异性。18名健康受试者（8名女性），平均年龄37岁（范围19 - 68岁），以及19名IDDM患者（10名女性），平均年龄48岁（范围25 - 62岁），糖尿病平均病程28年（范围6 - 52年），在间隔1至4周的两个时间段进行研究。经过一夜禁食后，受试者在15分钟内摄入一份与2克对乙酰氨基酚混合的标准化面食餐。进食后定期采集血样，分析对乙酰氨基酚（P）和血糖。糖尿病患者在15分钟时P的血清水平显著较低。健康受试者和糖尿病患者血清对乙酰氨基酚浓度 - 时间曲线下面积（AUC）的个体内变异系数（CV%）几乎相同，而糖尿病患者中P - Tmax的个体内CV相当低，且明显低于相应的个体间CV。糖尿病患者中计算出的所有参数的个体间CV一般更高。本研究表明，在对乙酰氨基酚面食试验期间对对乙酰氨基酚吸收动力学的评估在健康受试者和糖尿病受试者中均可重复。血糖控制不佳且无胃十二指肠运动功能紊乱病史的糖尿病患者在15分钟时P的血清浓度较低，并且通常表现出较高的个体间变异性，表明该组患者存在胃排空的亚临床紊乱。
