Utility of the plasma pancreatic polypeptide response to modified sham feeding in diabetic gastroenteropathy and non-ulcer dyspepsia
Utility of the plasma pancreatic polypeptide response to modified sham feeding in diabetic gastroenteropathy and non-ulcer dyspepsia
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DOI：
10.1111/nmo.13744
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发表时间：
2019-10-22
影响因子：
3.5
通讯作者：
Bharucha, Adil E.
中科院分区：
文献类型：
--
作者：
Desai, Anshuman;Low, Phillip A.;Bharucha, Adil E.
背景心血管和胃肠道（即血浆胰多肽[PP]对改良假喂养[MSF]的反应）迷走神经功能指数之间的关系尚不清楚。高血压通过迷走神经介导的机制抑制PP分泌。我们的目的是（a）比较PP反应，（B）其与胃排空的关系，以及（c）在健康对照、糖尿病胃肠病（DM）和非溃疡性消化不良（NUD）患者的胃排空研究期间，PP对MSF的反应、固体胃排空（GE）和症状之间的关系。方法在24名健康对照者、40名糖尿病患者和40名NUD患者中，我们在GE研究期间测量了MSF期间的血浆PP浓度、心迷走神经功能、GE和症状。糖尿病患者的基线PP浓度高于对照组和NUD患者（P = 0.01），2型糖尿病患者的基线PP浓度高于1型糖尿病患者（P <0.01）。在MSF期间，70%的对照、54%的DM和47%的NUD患者的PP增量正常（>= 20 pg/mL）。总体而言，PP反应和心迷走神经试验一致（P = .01）。在MSF降低PP增量的患者中，7/10的T1 DM和1/7的T2 DM患者具有中度或重度心迷走神经功能障碍（P <0.05）。PP对MSF的反应与GE无关。结论与推论高达30%的健康对照者在MSF期间PP增量降低，限制了该试验检测迷走神经损伤的实用性。PP反应正常时比异常时更有用。与T2 DM相比，T1 DM患者PP反应降低更可能与心迷走神经功能障碍相关。
Background The relationship between cardiovascular and gastrointestinal (ie, plasma pancreatic polypeptide [PP] response to modified sham feeding [MSF]) indices of vagal function is unclear. Hyperglycemia inhibits PP secretion via vagally mediated mechanisms. Our aims were to (a) compare the PP response, (b) its relationship with glycemia, and (c) the relationship between PP response to MSF, gastric emptying (GE) of solids, and symptoms during GE study in healthy controls, patients with diabetic gastroenteropathy (DM), and non-ulcer dyspepsia (NUD). Methods In 24 healthy controls, 40 DM, and 40 NUD patients, we measured plasma PP concentrations during MSF, cardiovagal functions, GE, and symptoms during a GE study. Key Results Baseline PP concentrations were higher in DM than in controls and NUD (P = .01), and in type 2 than in type 1 DM patients (P < .01). The PP increment during MSF was normal (>= 20 pg/mL) in 70% of controls, 54% of DM, and 47% of NUD patients. Overall, the PP response and cardiovagal tests were concordant (P = .01). Among patients with a reduced PP increment with MSF, 7/10 of T1DM and 1/7 of T2DM patients had moderate or severe cardiovagal dysfunctions (P < .05). The PP response to MSF was not associated with GE. Conclusions & Inferences Up to 30% of healthy controls have a reduced PP increment during MSF, limiting the utility of this test to detect vagal injury. The PP response is more useful when it is normal than abnormal. A reduced PP response is more likely to be associated with cardiovagal dysfunctions in T1DM than in T2DM.