Punkkinen J, Färkkilä M, Mätzke S, Korppi-Tommola T, Sane T, Piirilä P, Koskenpato J
Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland.
Diabet Med. 2008 May;25(5):570-7. doi: 10.1111/j.1464-5491.2008.02428.x.
Diabetic gastroparesis is a common condition occurring in some 30-50% of patients with long-term diabetes. Some studies have found a relationship between autonomic neuropathy and diabetic gastroparesis. In addition to autonomic neuropathy, acute changes in plasma glucose concentration can also affect gastric emptying. The objective was to examine the relationship between autonomic nerve function, glucose concentration, gastric emptying, and upper abdominal symptoms in Type 1 diabetic patients.
Gastric emptying of solids and liquids was measured with scintigraphy in 27 patients with longstanding Type 1 diabetes with upper abdominal symptoms. Autonomic nerve function was examined by standardized cardiovascular tests, and plasma glucose concentrations were measured during scintigraphy. Severity of abdominal symptoms and quality of life were explored by validated questionnaires.
Seven patients (26%) had delayed gastric emptying of solids and three (11%) of liquids. Mean gastric half-emptying time of solids was 128 +/- 116 min and of liquids 42 +/- 30 min. Of the 26 patients undergoing tests, 16 (62%) had autonomic nerve dysfunction. Autonomic neuropathy score (1.6 +/- 1.7) correlated positively with the gastric emptying rate of solids (P = 0.006), a rate unrelated to symptom scores or plasma glucose concentrations during scintigraphy. Quality of life in patients with abdominal symptoms was lower than in the normal Finnish population.
Impaired gastric emptying of solids in patients with Type 1 diabetes is related to autonomic neuropathy, but not to actual glycaemic control. The upper abdominal symptoms observed in these patients cannot be explained, however, by impaired gastric emptying.
糖尿病胃轻瘫是一种常见病症，约30%-50%的长期糖尿病患者会出现。一些研究发现自主神经病变与糖尿病胃轻瘫之间存在关联。除自主神经病变外，血糖浓度的急性变化也会影响胃排空。本研究旨在探讨1型糖尿病患者自主神经功能、血糖浓度、胃排空及上腹部症状之间的关系。
对27例有上腹部症状的长期1型糖尿病患者进行闪烁扫描测定固体和液体的胃排空情况。通过标准化心血管测试检查自主神经功能，并在闪烁扫描期间测量血浆葡萄糖浓度。通过有效问卷探究腹部症状的严重程度和生活质量。
7例患者（26%）固体胃排空延迟，3例患者（11%）液体胃排空延迟。固体的平均胃半排空时间为128±116分钟，液体为42±30分钟。在接受测试的26例患者中，16例（62%）存在自主神经功能障碍。自主神经病变评分（1.6±1.7）与固体胃排空率呈正相关（P=0.006），该排空率与闪烁扫描期间的症状评分或血浆葡萄糖浓度无关。有腹部症状患者的生活质量低于芬兰正常人群。
1型糖尿病患者固体胃排空受损与自主神经病变有关，但与实际血糖控制无关。然而，这些患者出现的上腹部症状不能用胃排空受损来解释。
