Peeters T L, Muls E, Janssens J, Urbain J L, Bex M, Van Cutsem E, Depoortere I, De Roo M, Vantrappen G, Bouillon R
Department of Medical Research, University of Leuven, Belgium.
Gastroenterology. 1992 Jan;102(1):97-101. doi: 10.1016/0016-5085(92)91788-6.
Erythromycin markedly accelerates gastric emptying, possibly because it acts as a motilin agonist. In the present study, the effect of an equipotent dose of motilin was tested. In six patients with severe diabetic gastroparesis, gastric emptying of liquids and solids was examined scintigraphically after motilin or placebo in a double-blind crossover study. Motilin (10 pmol.kg-1.min-1) or saline was infused over a 90-minute period starting 5 minutes before breakfast. Motilin markedly accelerated emptying. For liquids, the half-emptying time was reduced from 51 +/- 6 to 22 +/- 11 minutes (P less than 0.01) and for solids from 111 +/- 4 to 51 +/- 12 minutes (P less than 0.01). The mean increase in plasma motilin levels was 1315 +/- 342 pg/mL, corresponding to an effective infusion rate of about 4 pmol.kg-1.min-1. In the control experiments, basal motilin levels (173 +/- 17 pg/mL) were within the normal range but increased steadily postprandially, reaching 321 +/- 25 pg/mL at the end of the study period, probably reflecting gastric distension. The postprandial increase in pancreatic polypeptide level was blunted compared with accepted normal values but was more pronounced during motilin infusion, i.e., 650 +/- 217 vs. 279 +/- 66 pg/mL (P less than 0.01), probably because of the improved emptying. Our data show that motilin accelerates gastric emptying in diabetic gastroparesis and support the hypothesis that erythromycin's effect is mediated through motilin receptors.
红霉素可显著加速胃排空，可能是因为它作为一种胃动素激动剂发挥作用。在本研究中，测试了等效剂量胃动素的效果。在一项双盲交叉研究中，对6例严重糖尿病胃轻瘫患者在给予胃动素或安慰剂后，通过闪烁扫描法检查液体和固体的胃排空情况。从早餐前5分钟开始，在90分钟内输注胃动素（10 pmol·kg⁻¹·min⁻¹）或生理盐水。胃动素显著加速了排空。对于液体，半排空时间从51±6分钟减少至22±11分钟（P＜0.01），对于固体从111±4分钟减少至51±12分钟（P＜0.01）。血浆胃动素水平的平均升高为1315±342 pg/mL，相当于约4 pmol·kg⁻¹·min⁻¹的有效输注速率。在对照实验中，基础胃动素水平（173±17 pg/mL）在正常范围内，但餐后稳步升高，在研究期末达到321±25 pg/mL，这可能反映了胃扩张。与公认的正常值相比，餐后胰多肽水平的升高减弱，但在输注胃动素期间更为明显，即分别为650±217 vs. 279±66 pg/mL（P＜0.01），这可能是由于排空改善所致。我们的数据表明，胃动素可加速糖尿病胃轻瘫患者的胃排空，并支持红霉素的作用是通过胃动素受体介导的这一假说。
