Okamoto Hiroshi, Nomura Masahiro, Nakaya Yutaka, Uehara Kohzou, Saito Ken, Kimura Masaru, Chikamori Kazumasa, Ito Susumu
Department of Internal Medicine, Kochi Red Cross Hospital, Kochi.
Intern Med. 2003 Aug;42(8):655-64. doi: 10.2169/internalmedicine.42.655.
Diabetic patients with severe autonomic nervous disorder show delayed gastric emptying accompanied by diabetic gastroparesis, which decreases the electric activity of the stomach associated with gastric motility. It is reported that epalrestat, an aldose reductase inhibitor, is useful for treating diabetic neuropathy. Therefore, we evaluated whether this drug improves the decreased gastric motility in diabetic patients.
The present study evaluated the electrogastrograms (EGG) and autonomic nervous activity in 15 healthy volunteers (N group), and in 15 diabetic patients before and after the administration of epalrestat (DM group). Autonomic nervous activity was evaluated by spectral analysis of heart rate variability. The EGGs were recorded before and after oral administration of epalrestat (3 months or more) in the DM group.
The dominant frequency of EGG was 3 cycles/min (cpm) in the N group. However, these 3 cpm waves disappeared with bradygastria, and postprandial increases in the peak powers of EGG were not observed in the DM group. Both the amplitude of 3 cpm waves and the postprandial peak powers were significantly increased after the administration of epalrestat. The parameters of autonomic nervous activities (LF power, HF power, and the LF/HF ratio) were significantly lower in the DM group before the administration of epalrestat than in the N group. However, these parameters were improved after the administration of epalrestat.
Since gastroparesis is a form of diabetic dysautonomia, complication by gastroparesis may influence blood sugar control and the absorbance of oral antidiabetics. Epalrestat significantly increased the amplitude of 3 cpm waves on EGG and improved the spectral analytical parameters of heart rate variability. These findings suggest that epalrestat is useful for the treatment of diabetic gastroparesis.
患有严重自主神经功能障碍的糖尿病患者会出现胃排空延迟，并伴有糖尿病胃轻瘫，这会降低与胃动力相关的胃电活动。据报道，醛糖还原酶抑制剂依帕司他可用于治疗糖尿病神经病变。因此，我们评估了该药物是否能改善糖尿病患者胃动力下降的情况。
本研究评估了15名健康志愿者（N组）以及15名糖尿病患者在服用依帕司他前后的胃电图（EGG）和自主神经活动（DM组）。通过心率变异性频谱分析评估自主神经活动。在DM组中，记录口服依帕司他（3个月或更长时间）前后的EGG。
N组EGG的主导频率为3次/分钟（cpm）。然而，随着胃动力减慢，这些3 cpm波消失，DM组未观察到餐后EGG峰值功率增加。服用依帕司他后，3 cpm波的幅度和餐后峰值功率均显著增加。在服用依帕司他之前，DM组的自主神经活动参数（低频功率、高频功率和低频/高频比值）显著低于N组。然而，服用依帕司他后这些参数得到改善。
由于胃轻瘫是糖尿病自主神经功能障碍的一种形式，胃轻瘫并发症可能会影响血糖控制和口服降糖药的吸收。依帕司他显著增加了EGG上3 cpm波的幅度，并改善了心率变异性的频谱分析参数。这些发现表明依帕司他对糖尿病胃轻瘫的治疗有用。
