Catnach S M, Ballinger A B, Stevens M, Fairclough P D, Trembath R C, Drury P L, Watkins P J
Department of Gastroenterology, St Bartholomew's Hospital, London.
Gut. 1993 Aug;34(8):1123-7. doi: 10.1136/gut.34.8.1123.
Gall bladder motor function is impaired in some patients with diabetes. It has been suggested that the abnormalities of gall bladder motility are confined to those patients with autonomic neuropathy. Erythromycin, a motilin receptor agonist, causes gall bladder contraction in both normal subjects and patients with gall stones with impaired gall bladder emptying. The effect of erythromycin on gall bladder motility in seven patients with diabetes with an autonomic neuropathy, six patients with diabetes without autonomic neuropathy, and 17 normal subjects was studied using ultrasound. There was no significant difference in gall bladder fasting volume between the three groups, but the patients with diabetes with autonomic neuropathy had impaired postprandial gall bladder emptying compared with normal subjects (percentage emptied (SEM) 40 (10.3)% v 64 (2.8)%, p < 0.01) and those with autonomic neuropathy (48 (7.7)%, NS). Erythromycin produced a dramatic reduction in gall bladder fasting volume in patients with diabetes with an autonomic neuropathy, compared with either normal subjects or patients with diabetes without autonomic neuropathy (percentage reduction 62 (4.6)% in patients with autonomic neuropathy, v 37 (17.6)% in those without autonomic neuropathy, and 26 (7.3)% in the normal subjects, (p < 0.02) and returned gall bladder emptying to normal in all patients with impaired emptying. The pronounced effect of erythromycin in diabetic autonomic neuropathy suggests denervation supersensitivity and that the action of erythromycin on the gall bladder is neurally modulated.
部分糖尿病患者的胆囊运动功能受损。有人提出，胆囊运动异常仅限于那些患有自主神经病变的患者。红霉素是一种胃动素受体激动剂，在正常受试者和胆囊排空受损的胆结石患者中均可引起胆囊收缩。本研究采用超声检查了红霉素对7例患有自主神经病变的糖尿病患者、6例无自主神经病变的糖尿病患者以及17名正常受试者胆囊运动的影响。三组患者的胆囊空腹容积无显著差异，但与正常受试者相比，患有自主神经病变的糖尿病患者餐后胆囊排空受损（排空百分比（标准误）40（10.3）%对64（2.8）%，p<0.01），与无自主神经病变的患者相比也有差异（48（7.7）%，无显著性差异）。与正常受试者或无自主神经病变的糖尿病患者相比，红霉素使患有自主神经病变的糖尿病患者的胆囊空腹容积显著减少（自主神经病变患者减少百分比为62（4.6）%，无自主神经病变患者为37（17.6）%，正常受试者为26（7.3）%，（p<0.02），并使所有排空受损的患者的胆囊排空恢复正常。红霉素在糖尿病自主神经病变中的显著作用提示去神经超敏反应，且红霉素对胆囊的作用受神经调节。
