2型糖尿病患者胃排空功能異常及其相關(guān)因素的研究
發(fā)布時間：2018-11-12 11:42
【摘要】：研究目的:糖尿病是一組在遺傳和環(huán)境因素相互作用下,由于胰島素分泌缺乏和(或)其生物作用障礙導致糖代謝紊亂、同時伴有脂肪、蛋白質(zhì)、水、電解質(zhì)等的代謝障礙、以慢性高血糖為主要特征的代謝性疾病。隨著病程進展,易引發(fā)各種并發(fā)癥,其中糖尿病胃腸排空功能異常是常見的一種。糖尿病胃排空功能異常不僅明顯影響患者食物的消化,還會影響口服藥物的吸收,從而對糖尿病的治療帶來很大的干擾。既往認為胃輕癱是2型糖尿病患者最常見的胃排空功能異常類型,然而近年的研究發(fā)現(xiàn)胃排空過快的病例亦不在少數(shù)。因此明確2型糖尿病患者胃排空功能異常的類型及其影響因素對于指導臨床診治具有重要的意義。發(fā)射型計算機斷層掃描儀(Emission Computed Tomography,ECT)是目前評估胃排空功能的重要手段,被視為是"金標準"。本研究利用ECT對40例2型糖尿病患者和50例健康對照組的胃排空功能進行檢測從而明確2型糖尿病患者胃排空功能異常的類型特點,進一步地研究胃排空速度對血糖波動的影響以及研究影響胃排空速度的相關(guān)因素,為臨床中發(fā)現(xiàn)和治療胃排空功能異常提供理論依據(jù)。研究方法:1、采集受試者基本信息:隨機收集了 40例我院內(nèi)分泌科門診及病房確診的2型糖尿病患者作為實驗組,同時以隨機抽取年齡性別匹配的50例來自山東中醫(yī)藥大學第二附屬醫(yī)院查體中心的健康查體志愿者作為正常對照組,統(tǒng)一測量受試者的身高、體重,空腹末梢血糖,并填寫胃腸道癥狀積分調(diào)查表和核素胃排空檢查信息表。對于符合病例選擇標準的2型糖尿病患者,本研究收集其在我院就診的化驗資料,并指導其填寫胃腸道癥狀積分調(diào)查表和核素胃排空檢查信息表。2、胃部ECT檢測胃排空功能:所有受試者隔夜空腹8 h以上,將含有1mci 99mTcDTPA的燕麥粥服用后,行胃部ECT檢查,于餐后0、30、60、120、180 min分別采集胃排空圖像。劃定感興趣區(qū),獲得放射性活度計數(shù),分別計算各個時間點的胃殘留率;繪制時間-殘留率曲線并計算T1/2。(T1/2為半排空時間,即服下規(guī)定食物后胃中食物的殘余量為50%時所用的時間)3、制定胃排空功能的參考標準:對正常對照組各個時間點的胃殘留率和T1/2進行統(tǒng)計學分析,采用5百分位數(shù)和95百分位數(shù)描述,制定胃排空延遲和過快的參考標準。在該標準的基礎(chǔ)上對2型糖尿病患者胃排空功能異常類型進行分析。4、分析2型糖尿病患者的空腹血糖、餐后2小時血糖、糖化血紅蛋白、是否合并并發(fā)癥包括糖尿病視網(wǎng)膜病變及周圍神經(jīng)病變與T1/2的相關(guān)性;研究影響2型糖尿病患者胃排空功能的相關(guān)因素。研究結(jié)果:1、實驗組和對照組在性別、年齡、和體重指數(shù)無統(tǒng)計學差異(P0.05),但實驗組的胃腸道積分明顯高于對照組(P0.05)。實驗組和對照組各時間點胃殘留率及半排空時間(T1/2)存在明顯的差異,且該差異具有統(tǒng)計學意義(P0.05)。2、以正常對照組的數(shù)值作為參考值,制定胃排空過快及胃排空延遲的標準。即:3h胃殘留率大于7%或Ti/2大于50min,即可定義為胃排空延遲;0.5h胃殘留率低于22%或1h胃殘留率低于6%,即可定義為胃排空過快。3、根據(jù)對照組獲得的正常人群胃排空功能參考標準,實驗組的40例糖尿病患者中6例符合胃排空延遲,12例符合胃排空過快,胃排空異常率為45%。4、本研究發(fā)現(xiàn),胃排空過快組餐后2小時血糖與空腹血糖差值最大,胃排空正常組次之,胃排空延遲組餐后2小時血糖與空腹血糖差值最小。5、胃排空過快組其病程明顯短于胃排空延遲組,胃排空速度與病程有關(guān),與空腹血糖、糖化血紅蛋白無相關(guān)性。6、T1/2與糖尿病視網(wǎng)膜病變、糖尿病周圍神經(jīng)病變具有相關(guān)性。研究結(jié)論:1、2型糖尿病患者胃腸道癥狀積分明顯高于對照組,胃排空功能與對照組相比存在顯著性差異,可表現(xiàn)為胃排空過快或胃排空延遲。2、2型糖尿病患者胃排空功能異常影響血糖水平,胃排空過快患者餐后血糖與空腹血糖差值較大,胃排空延遲患者餐后血糖與空腹血糖差值較小。3、2型糖尿病患者胃排空功能異常與病程密切相關(guān),胃排空過快多出現(xiàn)在糖尿病早期,隨著糖尿病進展,胃排空延遲比例逐漸增高。4、2型糖尿病患者同時合并糖尿病視網(wǎng)膜病變、糖尿病周圍神經(jīng)病變出現(xiàn)胃排空功能異常的比例增高,在這些患者中應及早地進行篩查。
[Abstract]:The purpose of the study is that diabetes is a group of metabolic disorders due to the lack of insulin secretion and/ or its biological action, due to the lack of insulin secretion and/ or its biological effects, and also the metabolic disorders such as fat, protein, water, electrolyte, etc., Metabolic disease characterized by chronic hyperglycemia. With the progress of the course of the disease, it is easy to cause various complications, among which, the function of the gastrointestinal emptying function of the diabetes is one of the most common. the abnormal gastric emptying function of the diabetes not only obviously influences the digestion of the food of the patient, but also can influence the absorption of the oral medicine, thereby causing great interference to the treatment of the diabetes. It is considered that gastroparesis is the most common type of gastric emptying function in patients with type 2 diabetes. Therefore, the type of gastric emptying function in type 2 diabetic patients and its influencing factors are of great significance for guiding the clinical diagnosis and treatment. Emission Computed Tomography (ECT) is an important means to assess the function of gastric emptying, and is considered to be a "gold standard". In this study, the gastric emptying function of 40 patients with type 2 diabetes and 50 healthy controls was detected by ECT, and the type of gastric emptying in type 2 diabetes was determined. To further study the effect of gastric emptying rate on blood glucose fluctuation and the related factors that influence the rate of gastric emptying, to provide a theoretical basis for finding and treating gastric emptying function in clinic. Methods: 1. The basic information of the subject was collected: 40 patients with type 2 diabetes diagnosed by the Department of Endocrinology in our hospital were randomly collected as the experimental group. At the same time, 50 healthy volunteers from the second affiliated hospital of Shandong University of Traditional Chinese Medicine were used as the normal control group to measure the height, body weight and fasting peripheral blood sugar of the subject. and filling in the gastrointestinal symptoms integral questionnaire and the nuclide gastric emptying inspection information table. For patients with type 2 diabetes which met the criteria for the selection of the case, the study collected the test data of the patients in our hospital and instructed them to fill in the gastrointestinal symptoms integration questionnaire and the nuclide gastric emptying check information table. The stomach emptying images were collected at 0, 30, 60, 120 and 180 min after taking the Yanmai porridge containing 1mci 99mTcDTPA. a region of interest is defined, a radioactivity count is obtained, the gastric residual rate of each time point is calculated, and a time-residual rate curve is plotted and T1/ 2 is calculated. (T1/ 2 is the half-emptying time, that is, the time taken when the residual amount of the food in the stomach after the specified food is 50%) is 3, the reference standard for the function of the gastric emptying is established: the gastric residual rate and T1/ 2 of each time point in the normal control group are statistically analyzed, The gastric emptying delay and the over-rapid reference standard were developed using the 5th Percentile and the 95 Percentile. The abnormal type of gastric emptying in type 2 diabetic patients was analyzed on the basis of this standard. Whether the combination of complications included diabetic retinopathy and the correlation of peripheral neuropathy with T1/ 2, and the related factors that influence the function of gastric emptying in type 2 diabetes. Results: 1. There was no statistical difference between the experimental group and the control group in the sex, age and body weight index (P0.05), but the gastrointestinal integral in the experimental group was significantly higher than that in the control group (P0.05). There was a significant difference in the gastric residual rate and the half-emptying time (T1/ 2) in the experimental group and the control group, and the difference was statistically significant (P0.05). 2. The standard of gastric emptying and delayed gastric emptying was established by using the value of the normal control group as the reference value. namely, the gastric emptying delay is defined after the gastric residual rate of 3h is more than 7% or Ti/ 2 is more than 50min, and the gastric emptying time is defined as the gastric emptying delay; the gastric emptying rate of the stomach is lower than 22% or the gastric residual rate of the 1h is lower than 6%, so that the gastric emptying time can be defined; and 3, according to the reference standard of the gastric emptying function of the normal people obtained in the control group, In the experimental group, 6 of the 40 patients with diabetes were in accordance with the delayed gastric emptying, 12 of them were in accordance with the gastric emptying rate and the abnormal rate of gastric emptying was 45%. The difference of blood glucose and fasting blood glucose was the minimum in the gastric emptying delay group. The course of gastric emptying was significantly shorter than that of the gastric emptying delay group. The gastric emptying rate was related to the course of the course of the course of the gastric emptying. Diabetic peripheral neuropathy has a correlation. The results showed that the gastrointestinal symptoms of the patients with type 2 diabetes were significantly higher than that in the control group, and the gastric emptying function was significantly different from that of the control group. The difference of blood glucose and fasting blood glucose was large after the gastric emptying, and the difference between the blood glucose and the fasting blood sugar in the patients with delayed gastric emptying was small. The abnormal gastric emptying function in patients with type 2 diabetes was closely related to the course of the course of the disease. The proportion of delayed gastric emptying was increased gradually. In patients with type 2 diabetes, the proportion of diabetic retinopathy and diabetic peripheral neuropathy was increased, and the rate of abnormal gastric emptying in diabetic peripheral neuropathy was increased, and screening should be carried out early in these patients.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1
[Abstract]:The purpose of the study is that diabetes is a group of metabolic disorders due to the lack of insulin secretion and/ or its biological action, due to the lack of insulin secretion and/ or its biological effects, and also the metabolic disorders such as fat, protein, water, electrolyte, etc., Metabolic disease characterized by chronic hyperglycemia. With the progress of the course of the disease, it is easy to cause various complications, among which, the function of the gastrointestinal emptying function of the diabetes is one of the most common. the abnormal gastric emptying function of the diabetes not only obviously influences the digestion of the food of the patient, but also can influence the absorption of the oral medicine, thereby causing great interference to the treatment of the diabetes. It is considered that gastroparesis is the most common type of gastric emptying function in patients with type 2 diabetes. Therefore, the type of gastric emptying function in type 2 diabetic patients and its influencing factors are of great significance for guiding the clinical diagnosis and treatment. Emission Computed Tomography (ECT) is an important means to assess the function of gastric emptying, and is considered to be a "gold standard". In this study, the gastric emptying function of 40 patients with type 2 diabetes and 50 healthy controls was detected by ECT, and the type of gastric emptying in type 2 diabetes was determined. To further study the effect of gastric emptying rate on blood glucose fluctuation and the related factors that influence the rate of gastric emptying, to provide a theoretical basis for finding and treating gastric emptying function in clinic. Methods: 1. The basic information of the subject was collected: 40 patients with type 2 diabetes diagnosed by the Department of Endocrinology in our hospital were randomly collected as the experimental group. At the same time, 50 healthy volunteers from the second affiliated hospital of Shandong University of Traditional Chinese Medicine were used as the normal control group to measure the height, body weight and fasting peripheral blood sugar of the subject. and filling in the gastrointestinal symptoms integral questionnaire and the nuclide gastric emptying inspection information table. For patients with type 2 diabetes which met the criteria for the selection of the case, the study collected the test data of the patients in our hospital and instructed them to fill in the gastrointestinal symptoms integration questionnaire and the nuclide gastric emptying check information table. The stomach emptying images were collected at 0, 30, 60, 120 and 180 min after taking the Yanmai porridge containing 1mci 99mTcDTPA. a region of interest is defined, a radioactivity count is obtained, the gastric residual rate of each time point is calculated, and a time-residual rate curve is plotted and T1/ 2 is calculated. (T1/ 2 is the half-emptying time, that is, the time taken when the residual amount of the food in the stomach after the specified food is 50%) is 3, the reference standard for the function of the gastric emptying is established: the gastric residual rate and T1/ 2 of each time point in the normal control group are statistically analyzed, The gastric emptying delay and the over-rapid reference standard were developed using the 5th Percentile and the 95 Percentile. The abnormal type of gastric emptying in type 2 diabetic patients was analyzed on the basis of this standard. Whether the combination of complications included diabetic retinopathy and the correlation of peripheral neuropathy with T1/ 2, and the related factors that influence the function of gastric emptying in type 2 diabetes. Results: 1. There was no statistical difference between the experimental group and the control group in the sex, age and body weight index (P0.05), but the gastrointestinal integral in the experimental group was significantly higher than that in the control group (P0.05). There was a significant difference in the gastric residual rate and the half-emptying time (T1/ 2) in the experimental group and the control group, and the difference was statistically significant (P0.05). 2. The standard of gastric emptying and delayed gastric emptying was established by using the value of the normal control group as the reference value. namely, the gastric emptying delay is defined after the gastric residual rate of 3h is more than 7% or Ti/ 2 is more than 50min, and the gastric emptying time is defined as the gastric emptying delay; the gastric emptying rate of the stomach is lower than 22% or the gastric residual rate of the 1h is lower than 6%, so that the gastric emptying time can be defined; and 3, according to the reference standard of the gastric emptying function of the normal people obtained in the control group, In the experimental group, 6 of the 40 patients with diabetes were in accordance with the delayed gastric emptying, 12 of them were in accordance with the gastric emptying rate and the abnormal rate of gastric emptying was 45%. The difference of blood glucose and fasting blood glucose was the minimum in the gastric emptying delay group. The course of gastric emptying was significantly shorter than that of the gastric emptying delay group. The gastric emptying rate was related to the course of the course of the course of the gastric emptying. Diabetic peripheral neuropathy has a correlation. The results showed that the gastrointestinal symptoms of the patients with type 2 diabetes were significantly higher than that in the control group, and the gastric emptying function was significantly different from that of the control group. The difference of blood glucose and fasting blood glucose was large after the gastric emptying, and the difference between the blood glucose and the fasting blood sugar in the patients with delayed gastric emptying was small. The abnormal gastric emptying function in patients with type 2 diabetes was closely related to the course of the course of the disease. The proportion of delayed gastric emptying was increased gradually. In patients with type 2 diabetes, the proportion of diabetic retinopathy and diabetic peripheral neuropathy was increased, and the rate of abnormal gastric emptying in diabetic peripheral neuropathy was increased, and screening should be carried out early in these patients.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1
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