Oesophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis
Oesophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis
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DOI：
10.1007/s00125-006-0354-9
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发表时间：
2006-09-01
期刊：
影响因子：
8.2
通讯作者：
Sundkvist, G.
中科院分区：
文献类型：
--
作者：
Ohlsson, B.;Melander, O.;Sundkvist, G.
目的/假设在糖尿病患者中，葡萄糖稳态可能受到异常胃肠动力和自主神经病变的影响。本研究分析了食管动力障碍、胃排空延迟或自主神经病变是否影响血糖稳态。材料与方法对20例糖尿病患者进行食管测压和胃排空造影。在深呼吸（呼气/吸气[E/I]比）和连续皮下葡萄糖浓度为72 h的一段时间内的心率变化也monitoredin相同patients.Results食管动力障碍被发现在14例患者中的8。20例患者中有11例出现胃排空延迟（胃排空半衰期异常[T（50）]），18例患者中有9例E/I比值异常。腹部饱胀的投诉是胃排空延迟的预测。食管蠕动速度慢与T（50）受损相关（r（s）=-0.67; p=0.02）。早餐后1小时，胃排空延迟的患者皮下葡萄糖水平下降，但正常排空的患者继续上升。因此，前者早餐后2.5小时的中位葡萄糖水平较低（9.1 [4.2-12.5] vs 14.3 [11.2-17.7] mmol/l; p < 0.05）。在72小时内的血糖波动显着高于E/I比值异常的患者比那些正常的E/I比值（变异系数：41 [46-49] vs 28 [27-34]%; p=0.008）。结论/解释腹部饱胀预测胃排空延迟，这与早餐后葡萄糖摄取减少有关。低食管蠕动速度与胃排空缓慢相关，而副交感神经病变与血糖变化增加相关。
Aims/hypothesis Among diabetic patients, glucose homeostasis may be affected by abnormal gastrointestinal motility and autonomic neuropathy. This study analysed whether oesophageal dysmotility, delayed gastric emptying or autonomic neuropathy affect glucose homeostasis.Materials and methods Oesophageal manometry and gastric emptying scintigraphy were performed in 20 diabetic patients. Heart-rate variation during deep breathing (expiration/inspiration [E/I] ratio) and continuous subcutaneous glucose concentrations for a period of 72 h were also monitored in the same patients.Results Oesophageal dysmotility was found in eight of 14 patients. Eleven of 20 patients had delayed gastric emptying (abnormal gastric emptying half-time [T (50)]) and nine of 18 had an abnormal E/I ratio. Complaints of abdominal fullness were predictive of delayed gastric emptying. A low peristaltic speed of the oesophagus was associated with impaired T (50) (r (s) =-0.67; p=0.02). One hour after breakfast, subcutaneous glucose levels decreased in patients with delayed gastric emptying but continued to rise in those with normal emptying. Consequently, the median glucose level 2.5 h after breakfast was lower in the former (9.1 [4.2-12.5] vs 14.3 [11.2-17.7] mmol/l; p < 0.05). Glucose fluctuations during the 72 h were significantly higher in patients with an abnormal E/I ratio than in those with a normal E/I ratio (coefficient of variation: 41 [46-49] vs 28 [27-34]%; p=0.008).Conclusions/interpretation Abdominal fullness predicted delayed gastric emptying that was associated with diminished glucose uptake after breakfast. Low oesophageal peristaltic speed was associated with slow gastric emptying whereas parasympathetic neuropathy was associated with increased glucose variations.