Cucchiara S, Franzese A, Salvia G, Alfonsi L, Iula V D, Montisci A, Moreira F L
Gastrointestinal Endoscopy and Motility Unit, University of Naples, Italy.
Diabetes Care. 1998 Mar;21(3):438-43. doi: 10.2337/diacare.21.3.438.
Patients with diabetes can develop gastrointestinal motor complications; however, prevalence of gut dysmotility in children with diabetes is poorly understood. We measured gastric emptying time and gastric electrical activity in children with IDDM; presence of dyspeptic symptoms was also assessed.
Gastric emptying time and gastric electrical activity were measured by ultrasonography and electrogastrography (EGG), respectively, in 40 consecutive IDDM children (median age: 9 years [6-14]) without autonomic neuropathy; 15 healthy children (median age: 7 years [4-15]) served as control subjects. The EGG variables studied were percent of electrical dysrhythmias (bradygastria or 0.5-2.0 cpm, tachygastria or 4.0-9.0 cpm; normal rhythm is 2.0-4.0 cpm) and fed-to-fasting ratio of the dominant EGG power. Blood glucose level in the fasting state and 180 min after feeding and HbA1C concentration were also measured. Data are given as median (ranges) and means +/- SD. Statistical analysis was performed using the parametric t test and the nonparametric signed-rank tests, with P < 0.05 considered significant.
Gastric emptying time was delayed in 26 patients (group A), whereas in 14 patients (group B), it was in the same range as control values; group A patients significantly differed from group B for increased prevalence of gastric electrical dysrhythmias (P < 0.01) and for a lower fed-to-fasting ratio of the dominant EGG power (P < 0.01). Group B patients did not differ from control subjects for the EGG variables measured. Diabetic children with gastroparesis had significantly higher levels of both HbA1C and blood glucose measured 180 min after feeding than those with normal gastric emptying time (P < 0.05); there was a significant correlation between levels of HbA1C and degree of gastric emptying delay, whereas a significant inverse correlation between gastric emptying time and fed-to-fasting ratio of the dominant EGG power was found both in patients and control subjects.
Delay of gastric emptying time and gastric electrical abnormalities are found in a high proportion of children with diabetes and can contribute to poor glycemic control, most likely by causing a mismatch between the onset of insulin action and the delivery of nutrients into the small intestine. Diabetic children with unexplained poor glycemic control should be investigated for abnormalities in gastric motility.
糖尿病患者可出现胃肠道运动并发症；然而，糖尿病患儿肠道运动障碍的患病率尚不清楚。我们测量了1型糖尿病患儿的胃排空时间和胃电活动；还评估了消化不良症状的存在情况。
分别通过超声检查和胃电图（EGG）测量了40例无自主神经病变的连续1型糖尿病患儿（中位年龄：9岁[6 - 14岁]）的胃排空时间和胃电活动；15例健康儿童（中位年龄：7岁[4 - 15岁]）作为对照。研究的EGG变量包括电节律紊乱百分比（胃缓或0.5 - 2.0次/分钟，胃速或4.0 - 9.0次/分钟；正常节律为2.0 - 4.0次/分钟）以及优势EGG功率的进食后与空腹后比值。还测量了空腹状态及进食后180分钟的血糖水平和糖化血红蛋白（HbA1C）浓度。数据以中位数（范围）和均值±标准差表示。采用参数t检验和非参数符号秩检验进行统计分析，P < 0.05认为具有统计学意义。
26例患者（A组）胃排空时间延迟，而14例患者（B组）胃排空时间与对照值范围相同；A组患者胃电节律紊乱患病率增加（P < 0.01）以及优势EGG功率的进食后与空腹后比值较低（P < 0.01），与B组患者有显著差异。B组患者所测的EGG变量与对照受试者无差异。胃轻瘫的糖尿病患儿进食后180分钟时的HbA1C和血糖水平显著高于胃排空时间正常的患儿（P < 0.05）；HbA1C水平与胃排空延迟程度之间存在显著相关性，而在患者和对照受试者中均发现胃排空时间与优势EGG功率的进食后与空腹后比值之间存在显著负相关。
在很大比例的糖尿病患儿中发现胃排空时间延迟和胃电异常，这可能导致血糖控制不佳，很可能是通过引起胰岛素作用开始与营养物质进入小肠之间的不匹配。对于血糖控制不佳且原因不明的糖尿病患儿，应检查其胃动力异常情况。
