本文選題：2型糖尿病 + 小腸黏膜損傷��； 參考：《廣東藥科大學(xué)》2017年碩士論文

【摘要】：【背景與目的】2型糖尿病,作為最常見的慢性疾病之一,在中國(guó)部分地區(qū)的患病率已高達(dá)12.7%。我國(guó)已成為世界上糖尿病患者最多的國(guó)家。研究發(fā)現(xiàn),糖尿病患者更易出現(xiàn)腹痛、腹瀉、便秘等消化系統(tǒng)癥狀。此外,基礎(chǔ)研究也提示糖尿病可引起腸道動(dòng)力異常、腸道微生態(tài)失衡、腸道通透性升高、微循環(huán)障礙、腸道干細(xì)胞功能異常等一系列病理生理改變,這些改變均可誘發(fā)小腸黏膜損傷。但是,2型糖尿病與小腸黏膜損傷關(guān)系的研究主要集中于基礎(chǔ)方面,兩者關(guān)系的臨床研究,尤其是通過內(nèi)鏡觀察兩者相關(guān)性的臨床研究在國(guó)外仍未見報(bào)道。因此,本研究擬使用膠囊內(nèi)鏡探討2型糖尿病與小腸黏膜損傷的相關(guān)性,為糖尿病腸病這一概念的提出提供依據(jù),并為糖尿病腸病的預(yù)防、早診、早治尋求新方向�！静牧吓c方法】患者的納入標(biāo)準(zhǔn):自2011年8月至2016年1月于廣東藥科大學(xué)附屬第一醫(yī)院,因不明原因的消化道出血、腹痛、腹瀉、消瘦等原因行膠囊內(nèi)鏡檢查的住院患者。排除標(biāo)準(zhǔn):(1)被診斷為惡性腫瘤;(2)近期服用非甾體類抗炎藥;(3)被診斷或高度懷疑為克羅恩病;(4)被診斷為腸道感染,如急性胃腸炎、腸結(jié)核、腸道寄生蟲等;(5)小腸梗阻及其他原發(fā)性小腸疾病;(6)患有嚴(yán)重心、肝、肺、腎(糖尿病腎病除外)疾病;(7)病歷資料不齊全。收集患者性別、年齡、基礎(chǔ)疾病病史、煙酒史、膠囊內(nèi)鏡結(jié)果及其他相關(guān)輔助檢查結(jié)果等。按患者是否患有2型糖尿病分為2型糖尿病組及非糖尿病組,并分析兩組患者的基本資料。使用卡方檢驗(yàn)分析兩組患者小腸不同類型損傷的發(fā)生率;使用Mann-Whitney U檢驗(yàn)分析兩組患者小腸Lewis評(píng)分情況及2型糖尿病不同并發(fā)癥對(duì)小腸Lewis評(píng)分的影響;使用Spearman相關(guān)性檢驗(yàn)分析胰島素抵抗指數(shù)及糖化血濃蛋白濃度與小腸Lewis評(píng)分的相關(guān)性�！窘Y(jié)果】1.2型糖尿病組及非糖尿病組患者的基本資料,除高血壓患病率外,性別、年齡、體質(zhì)指數(shù)等均無(wú)明顯差異。2.2型糖尿病患者小腸絨毛水腫發(fā)生率顯著高于非糖尿病患者(78.95%vs.42.76%,P0.001),但兩者的小腸潰瘍發(fā)生率則無(wú)統(tǒng)計(jì)學(xué)差異(P=1.000)。3.2型糖尿病患者小腸Lewis評(píng)分顯著高于非糖尿病患者[112(8-112)vs.0(0-112),P=0.003]。4.糖尿病腎病與無(wú)糖尿病腎病者相比,小腸Lewis評(píng)分顯著升高(P=0.033);有無(wú)其他并發(fā)癥對(duì)小腸Lewis評(píng)分則無(wú)顯著影響。5.2型糖尿病患者,不論有無(wú)使用降糖藥物,以及通過何種方式使用糖尿病藥物,小腸黏膜損傷情況無(wú)明顯差異(P=0.831;P=0.579)。6.胰島素抵抗指數(shù)與小腸Lewis評(píng)分成正相關(guān)關(guān)系(γ=0.141,P=0.042);而糖化血紅蛋白濃度則與小腸Lewis評(píng)分無(wú)明顯相關(guān)性(P=0.359)�！窘Y(jié)論】2型糖尿病患者比非糖尿病患者有更嚴(yán)重的小腸黏膜損傷。當(dāng)2型糖尿病患者,尤其是合并糖尿病腎病者出現(xiàn)不明原因的消化道出血、腹痛、腹瀉,應(yīng)盡早行膠囊內(nèi)鏡檢查明確診斷。糖尿病腎病有望成為膠囊內(nèi)鏡檢查新的指征。通過運(yùn)動(dòng)減肥以減輕胰島素抵抗或有助于合并2型糖尿病的小腸黏膜損傷的預(yù)防及治療。
[Abstract]:[background and purpose] type 2 diabetes, as one of the most common chronic diseases, has reached 12.7%. in some areas of China. Our country has become the most diabetic country in the world. It is found that diabetics are more likely to have digestive system symptoms such as abdominal pain, diarrhea and constipation. In addition, basic research suggests diabetes can also be suggested. A series of pathophysiological changes, such as abnormal intestinal motility, intestinal microecological imbalance, increase of intestinal permeability, microcirculation barrier and abnormal function of intestinal stem cells, can induce intestinal mucosal injury. However, the study of the relationship between type 2 diabetes and small intestinal mucosa damage is mainly focused on the basic aspects of the clinical study of the relationship between the two. In particular, the clinical study on the correlation between the two has not been reported abroad. Therefore, this study intends to use capsule endoscopy to explore the relationship between type 2 diabetes and intestinal mucosal injury, provide a basis for the concept of diabetic enteropathy, and seek new directions for the prevention, early diagnosis and early treatment of diabetic enteropathy. The inclusion criteria: from August 2011 to January 2016 at the First Affiliated Hospital of Guangdong University of medicine, the hospitalized patients with gastrointestinal bleeding, abdominal pain, diarrhea, and emaciation were examined for unexplained reasons: (1) were diagnosed as malignant tumors; (2) recently taken non steroidal anti-inflammatory drugs; (3) were diagnosed or highly pregnant. Suspected Crohn's disease; (4) it was diagnosed as intestinal infection, such as acute gastroenteritis, intestinal tuberculosis, intestinal parasites, and (5) small intestinal obstruction and other primary intestinal diseases; (6) suffering from serious heart, liver, lung, kidney (except diabetic nephropathy) disease; (7) incomplete medical records. According to whether patients with type 2 diabetes were divided into type 2 diabetes group and non diabetic group, the basic data of the two groups were analyzed. The incidence of different types of small intestinal injuries in the two groups was analyzed by chi square test, and the Lewis score of small intestine and type 2 sugar in two groups of patients were analyzed by Mann-Whitney U test. The effect of different complications on the Lewis score of the small intestine, and the correlation between the insulin resistance index and the concentration of glycosylated blood concentrated protein and the Lewis score of the small intestine were analyzed by Spearman correlation test. [results] the basic data of patients with type 1.2 diabetes and non diabetic group were all in addition to the prevalence of hypertension, sex, age, and body mass index. The incidence of small intestinal villus edema in patients with type.2.2 diabetes was significantly higher than that of non diabetic patients (78.95%vs.42.76%, P0.001), but the incidence of small intestinal ulcers was not statistically significant (P=1.000) the small intestinal Lewis score in type.3.2 diabetic patients was significantly higher than that of non diabetic patients with [112 (8-112) vs.0 (0-112), P=0.003].4. diabetic nephropathy. Small intestinal Lewis scores were significantly higher than those with no diabetic nephropathy (P=0.033); there was no significant difference in small intestinal Lewis scores in patients with type.5.2 diabetes without any other complications. There was no significant difference in intestinal mucosal injury (P=0.831; P=0.579).6. insulin, regardless of the use of hypoglycemic drugs or by the way of using diabetes drugs (P=0.831; P=0.579) The resistance index was positively correlated with the small intestinal Lewis score (gamma =0.141, P=0.042), while the concentration of glycosylated hemoglobin had no significant correlation with the small intestinal Lewis score (P=0.359). [Conclusion] type 2 diabetes patients have more severe intestinal mucosal damage than non diabetic patients. Patients with gastrointestinal bleeding, abdominal pain, and diarrhea should be clearly diagnosed as early capsule endoscopy. Diabetic nephropathy is expected to be a new indication for capsule endoscopy. Prevention and treatment of intestinal mucosal injury in type 2 diabetes can be prevented by exercise to reduce insulin resistance by exercise.
【學(xué)位授予單位】：廣東藥科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R574

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