Hahm J S, Park J Y, Park K G, Ahn Y H, Lee M H, Park K N
Department of Internal Medicine, Hanyang University Medical School, Seoul, Korea.
Am J Gastroenterol. 1996 Nov;91(11):2391-4.
Diabetes mellitus is one of the risk factors in cholesterol gallstones. Individuals with diabetes mellitus are reported to have a 2-fold to 3-fold increase in the incidence of cholesterol gallstones. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes.
We compared the gallbladder volume and ejection fraction of 24 diabetics with those of 19 age-matched and weight-matched controls using real-time ultrasonography. Blood sampling for biochemical study of all the subjects were performed.
No significant differences in any physiochemical parameters between the diabetic group and control group could be found. Fasting gallbladder volume increased significantly in the diabetic group (21.90 +/- 9.53 cm3) compared with the control group (16.99 +/- 5.97 cm3). Gallbladder volume measured after a fatty meal were greater in the diabetic group (10.76 +/- 7.19 cm3) than in the control group (4.22 +/- 3.31 cm3) (p < 0.04). When the diabetic group was divided according to the presence or absence of autonomic neuropathy, a significant reduction of ejection fraction was found in diabetics with autonomic neuropathy (42.75 +/- 19.37%) in comparison with diabetics without autonomic neuropathy (61.75 +/- 17.63%) (p < 0.02).
Gallbladder volume in diabetics was significantly greater compared with that of the control. Moreover, in diabetics with autonomic neuropathy, gallbladder motility was markedly reduced in comparison to diabetics without autonomic neuropathy. Thus, we suggest that impairment of gallbladder motility complicated with autonomic neuropathy causes stasis and results in cholesterol gallstone crystal formation and gallstone growth.
糖尿病是胆固醇性胆结石的危险因素之一。据报道，糖尿病患者胆固醇性胆结石的发病率增加了2至3倍。尽管这一现象的病理生理机制尚不清楚，但有人提出诸如胆囊运动减弱等假说来解释糖尿病患者胆结石发病率较高的原因。
我们使用实时超声检查比较了24名糖尿病患者与19名年龄和体重匹配的对照组患者的胆囊体积和射血分数。对所有受试者进行了血液采样以进行生化研究。
糖尿病组和对照组之间的任何理化参数均无显著差异。与对照组（16.99±5.97 cm³）相比，糖尿病组的空腹胆囊体积显著增加（21.90±9.53 cm³）。糖尿病组进食脂肪餐后测量的胆囊体积（10.76±7.19 cm³）大于对照组（4.22±3.31 cm³）（p<0.04）。当根据是否存在自主神经病变对糖尿病组进行划分时，发现有自主神经病变的糖尿病患者的射血分数（42.75±19.37%）与无自主神经病变的糖尿病患者（61.75±17.63%）相比显著降低（p<0.02）。
糖尿病患者的胆囊体积明显大于对照组。此外，与无自主神经病变的糖尿病患者相比，有自主神经病变的糖尿病患者胆囊运动明显减弱。因此，我们认为合并自主神经病变的胆囊运动障碍会导致胆汁淤积，进而导致胆固醇胆结石晶体形成和胆结石生长。
