糖尿病消化不良患者的自主神经功能及其对近端胃功能的影响  

Function of Autonomic Nerve and its Effect on Proximal Stomach in Diabetic Patients with Dyspepsia

作　　者：蓝宇[1] 吴改玲[1] 闫冰[1] 王杞[1] 张灵云[1] 张月霞[1] 

机构地区：[1]北京积水潭医院消化科,100035

出　　处：《胃肠病学》2006年第8期484-487,共4页Chinese Journal of Gastroenterology

摘　　要：背景:神经病变是糖尿病患者的常见并发症。研究表明糖尿病消化不良患者存在近端胃功能障碍,但糖尿病自主神经病变对近端胃功能的影响尚不清楚。目的:了解糖尿病消化不良患者的自主神经功能及其对近端胃功能的影响。方法:23例糖尿病消化不良患者和10名健康志愿者分别行自主神经功能测定(标准心血管反射试验)和近端胃功能测定(水负荷试验),以B超测量近端胃(胃底)和远端胃(胃窦)的横截面周长和面积。结果:糖尿病消化不良组自主神经功能异常者占95.7%,其交感、副交感和自主神经功能计分均显著高于健康对照组,副交感神经功能受损更为明显。糖尿病消化不良组的阈值饮水量和饱足饮水量均较健康对照组显著减少(518.04ml±205.52ml对640.00ml±154.20ml,887.39ml±277.17ml对1185.00ml±266.72ml,P<0.05),饱足饮水量与饱足饮水后近端胃面积的变化呈正相关(r=0.441,P=0.035),交感神经功能计分与饱足饮水后近端胃周长的变化呈负相关(r=-0.566,P=0.005)。结论:糖尿病消化不良患者有明显的自主神经功能异常,其中副交感神功能受损更为明显,且近端胃感觉阈值减低,适应性舒张功能减退。糖尿病患者近端胃功能障碍可能与自主神经功能受损有一定关系。Background： Neuropathy is a common complication of diabetes mellitus. Previous study showed that there was impaired function of proximal stomach in diabetic patients with dyspepsia. However, the influence of diabetic autonomic neuropatby on proximal stomach function is unclarified. Aims： To study the autonomic nerve function and its effect on proximal stomach in diabetic patients with dyspepsia. Methods： Twenty-three diabetic patients with dyspepsia and 10 healthy volunteers were enrolled. Standard cardiovascular reflex test and water load test were performed to determine the functions of autonomic nerve and proximal stomach. The area and circumferences of proximal （corpus） and distal stomach （antrum） were measured by uhrasonography. Results： 95.7% of diabetic patients with dyspepsia had autonomic neuropatby, the sympathetic, parasympathetic and total autonomic nerve scores were significantly higher than those of the healthy subjects, and parasympathetic nerve function impairment was greater than that of sympathetic nerve function. Threshold of initial epigastric filling perception and satiety （bloating sensation） drinking volumes in diabetic patients with dyspepsia were 518.04 ml±205.52 ml and 887.39 ml±277.17 ml, respectively, significantly less when compared with those in healthy subjects （640.00 ml±154.20 ml and 1185.00 ml±266.72 ml, respectively, P〈0.05）. There was a positive correlation between satiety drinking volume and change of area of proximal stomach after satiety drinking in diabetic patients with dyspepsia （r=0.441, P=0.035）. The sympathetic score was negatively correlated with the change of circumference of proximal stomach after satiety drinking in diabetic patients with dyspepsia （r=-0.566, P=0.005）. Conclusions： Autonomic neuropatby exists in most of the diabetic patients with dyspepsia, whose impairment of parasympathetic nerve function is greater than that of sympathetic nerve function. Impaired fundic accommodation and sensitivity to water distension oc

关 键 词：糖尿病 消化不良 自主神经系统 胃 近端 

分 类 号：R587.1[医药卫生—内分泌] R473.6[医药卫生—内科学]