超声研究糖尿病患者的胃餐容纳情况。与迷走神经张力的关系。

Gastric meal accommodation studied by ultrasound in diabetes. Relation to vagal tone.

作者信息

Undeland K A, Hausken T, Gilja O H, Aanderud S, Berstad A

机构信息

Division of Gastroenterology and Endocrinology, Medical Dept., Haukeland University Hospital, Bergen, Norway.

出版信息

Scand J Gastroenterol. 1998 Mar;33(3):236-41. doi: 10.1080/00365529850170784.

DOI:10.1080/00365529850170784

PMID:9548614

Abstract

BACKGROUND

Disturbed gastric meal accommodation may cause abdominal symptoms in patients with functional dyspepsia and diabetes mellitus who have poor vagal control of gastric motility. In the present study we aimed to explore the relation between gastric meal accommodation and vagal tone in diabetic patients with vagal neuropathy.

METHODS

Twenty patients with diabetes (DM) (insulin-dependent type; 10 men and 10 women, aged 35.3 +/- 7.6 years) and 20 healthy controls (HC) (10 men and 10 women; aged 34.7 +/- 10.7 years) were studied. Proximal gastric size was assessed with ultrasound in a sagittal area and a frontal diameter. Distal gastric (antrum) size was assessed in a sagittal area. Vagal tone was assessed non-invasively by recording of respiratory sinus arrhythmia (RSA) in beats per minute.

RESULTS

Proximal sagittal area was significantly (P = 0.03) smaller in DM (18.5 +/- 5.5 cm2) than in HC (22.2 +/- 4.6 cm2). Proximal frontal diameter did not differ significantly (P = 0.60) between DM and HC (5.9 +/- 1.1 cm versus 5.7 +/- 0.8 cm). Antral area, too, did not differ significantly (P = 0.59) between DM and HC (14.5 +/- 4.1 cm2 versus 13.6 +/- 5.8 cm2). Proximal/distal meal distribution ratio, defined as proximal sagittal area/distal sagittal area, was significantly (P = 0.05) smaller in DM (6.8 +/- 0.6) than in HC (9.9 +/- 5.5). Vagal tone was significantly (P = 0.03) lower in DM (4.5 +/- 1.9 beats/min) than in HC (6.3 +/- 2.7 beats/min). Vagal tone tended (r = 0.33, P = 0.06) to correlate with proximal sagittal area in DM and HC pooled. Vagal tone correlated (r = 0.34, P = 0.05) with proximal frontal diameter in DM and HC pooled. A significant negative correlation (r = -0.39, P = 0.03) was observed between vagal tone and antral area in DM and HC pooled.

CONCLUSIONS

Patients with diabetes and low vagal tone have an impaired postprandial gastric meal distribution characterized by a small proximal stomach and a small proximal/distal meal distribution ratio.

摘要

背景

胃对进食的适应性紊乱可能会导致功能性消化不良和糖尿病患者出现腹部症状，这些患者对胃动力的迷走神经控制较差。在本研究中，我们旨在探讨迷走神经病变的糖尿病患者胃对进食的适应性与迷走神经张力之间的关系。

方法

研究了20例糖尿病（DM）患者（胰岛素依赖型；10名男性和10名女性，年龄35.3±7.6岁）和20名健康对照者（HC）（10名男性和10名女性；年龄34.7±10.7岁）。通过超声在矢状面区域和额径评估近端胃大小。在矢状面区域评估远端胃（胃窦）大小。通过记录每分钟的呼吸性窦性心律不齐（RSA）以无创方式评估迷走神经张力。

结果

DM患者的近端矢状面面积（18.5±5.5 cm²）显著小于HC（22.2±4.6 cm²）（P = 0.03）。DM与HC之间的近端额径无显著差异（P = 0.60）（分别为5.9±1.1 cm和5.7±0.8 cm）。DM与HC之间的胃窦面积也无显著差异（P = 0.59）（分别为14.5±4.1 cm²和13.6±5.8 cm²）。近端/远端进食分布比定义为近端矢状面面积/远端矢状面面积，DM患者（6.8±0.6）显著小于HC（9.9±5.5）（P = 0.05）。DM患者的迷走神经张力（4.5±1.9次/分钟）显著低于HC（6.3±2.7次/分钟）（P = 0.03）。合并DM和HC时，迷走神经张力与近端矢状面面积呈倾向相关性（r = 0.33，P = 0.06）。合并DM和HC时，迷走神经张力与近端额径相关（r = 0.34，P = 0.05）。合并DM和HC时，观察到迷走神经张力与胃窦面积之间存在显著负相关（r = -0.39，P = 0.03）。