Björnsson E S, Urbanavicius V, Eliasson B, Attvall S, Smith U, Abrahamsson H
Dept. of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Scand J Gastroenterol. 1994 Dec;29(12):1096-104. doi: 10.3109/00365529409094894.
Gastrointestinal motility disorders are common in patients with diabetes mellitus. Recent studies indicate that hyperglycemia can affect gastric emptying and gastric motility in healthy subjects and diabetics.
The effect of acute hyperglycemia on gastrointestinal motility was studied with a manometric technique in healthy subjects. Seven individuals, four men and three women, 23-34 years old, were studied on 2 different days. On 1 of the days a 5-h registration was performed after an overnight fast. On another day and after an initial basal period, acute steady-state hyperglycemia was induced by intravenous glucose infusion for 90 min. Motility variables were evaluated in four segments: in the gastric antrum, the proximal duodenum, the distal duodenum, and the proximal jejunum.
Fasting migrating motor complex rhythm including migration of phase III prevailed during hyperglycemia. Compared with euglycemia, the motility index in phase II was lower during hyperglycemia in all segments studied. In the antrum the difference was 62% (p < 0.01); in the proximal duodenum, 37% (p < 0.01); in the distal duodenum, 44% (p < 0.05); and in the jejunum, 58% (p < 0.01). During hyperglycemia the prevalence of propagated contractions in phase II was significantly lower than during euglycemia both in the antrum and the proximal duodenum. In the last part of phase III in proximal duodenum most individual contractions were propagated in orad direction compared with early phase III, and this difference persisted during hyperglycemia. The number of long clusters was significantly increased during hyperglycemia as compared with euglycemia: 2.0 +/- 0.6 per hour versus 0.4 +/- 0.14 (p < 0.01). In late phase II plasma levels of motilin and pancreatic polypeptide were significantly decreased during hyperglycemia.
Hyperglycemia not only reduces the motility in the stomach but also inhibits motility in both the duodenum and the jejunum. The results show that acute hyperglycemia has an important impact on small-intestinal motility.
胃肠道动力障碍在糖尿病患者中很常见。近期研究表明，高血糖可影响健康受试者和糖尿病患者的胃排空及胃动力。
采用测压技术研究急性高血糖对健康受试者胃肠道动力的影响。研究对象为7名年龄在23 - 34岁之间的个体，其中4名男性，3名女性，在2个不同日期进行研究。在其中1天，过夜禁食后进行5小时的记录。在另一天，在初始基础期后，通过静脉输注葡萄糖90分钟诱导急性稳态高血糖。在胃窦、十二指肠近端、十二指肠远端和空肠近端四个节段评估动力变量。
高血糖期间，空腹移行性运动复合波节律（包括Ⅲ相迁移）占主导。与血糖正常相比，在所有研究节段中，高血糖期间Ⅱ相的动力指数均较低。在胃窦，差异为62%（p < 0.01）；在十二指肠近端，为37%（p < 0.01）；在十二指肠远端，为44%（p < 0.05）；在空肠，为58%（p < 0.01）。高血糖期间，Ⅱ相在胃窦和十二指肠近端的传播性收缩发生率均显著低于血糖正常时。在十二指肠近端Ⅲ相的最后部分，与Ⅲ相早期相比，大多数单个收缩向口腔方向传播，且这种差异在高血糖期间持续存在。与血糖正常相比，高血糖期间长簇的数量显著增加：每小时2.0±0.6次对0.4±0.14次（p < 0.01）。在Ⅱ相后期，高血糖期间胃动素和胰多肽的血浆水平显著降低。
高血糖不仅降低胃动力，还抑制十二指肠和空肠的动力。结果表明，急性高血糖对小肠动力有重要影响。
