糖尿病患者周围神经病变与胃动力障碍的关系

发布时间：2018-03-03 15:33

本文选题：糖尿病　切入点：糖尿病周围神经病变　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:目前针对糖尿病胃动力障碍(Diabetic gastromotility disorder,DGMD)的早期诊断手段匮乏,既往对胃肠激素与DGMD的研究众多,而糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)与DGMD之间关系的研究较少,且针对DPN的病变程度与DGMD之间关系的研究文章则鲜见。目的:通过检测胃肠电图等,了解不同程度DPN患者发生胃肠动力障碍的风险。方法:符合研究标准的2型糖尿病患者75例,其中男43例,女32例,男女比例1:0.7,年龄31~75岁,平均(55.6±10.7)岁,根据患者的DPN的临床症状及肌电图结果,将患者分为无病变组,轻度病变组及中重度病变组三组,所有患者均行6分钟的餐前及餐后胃电图检查,同时详细评估患者的DPN症状及消化道症状,行肌电图检查,检测空腹、餐后血糖、糖化血红蛋白及甘油三脂等生化指标,最后比较三组患者的胃电参数及生化指标。结果:(1)三组患者的临床资料:性别、年龄、BMI比较差异无统计学意义(P0.05),三组患者的糖尿病病程差异有统计学意义,再经LSD检验除轻度病变组与中度病变组无差异外,其他俩组间比较都有差异,即无病变组患者的平均病程与轻中度病变组均存在差异性(P1=0.002,P2=0.013),无病变组患者的平均病程分别小于轻中度病变组(无病变组与轻中度病变组的均值差分别为-5.59、-4.19);三组患者的相关生化指标:空腹血糖、糖化血红蛋白、血脂均呈升高趋势,但差异无统计学意义(P0.05)。(2)三组患者的餐前波幅及餐前反应面积按神经病变轻重程度依次呈下降趋势,但差异无统计学意义(P0.05);三组患者的餐后波幅、餐后反应面积、餐后与餐前功率比均依次呈下降趋势,三组间的差异有统计学意义(P0.05)。(3)从糖尿病患者的胃电参数变化的临床资料的相关性(表3)分析,BMI与餐前波幅、餐前反应面积呈负相关(r=-0.260、P=0.024;r=-0.265、P=0.022),BMI与餐后波幅、餐后反应面积不相关;年龄、病程分别与F值呈负相关(r=-0.236、P=0.041;r=-0.358、P=0.002),FBG、HBA1C、BMI与F值呈正相关(r=0.306、P=0.008;r=0.230、P=0.048;r=0,300、P=0.009),年龄、病程、FBG、HBA1C与胃电参数餐前波幅、餐后波幅、餐前RA及餐后RA均不相关。结论:糖尿病周围神经病变的患者早期即可出现胃电图异常,而随着周围神经病变程度加重,患者胃电图异常更为明显。
[Abstract]:Background: at present, there is a lack of early diagnostic methods for diabetic gastromotility disorder.There have been many studies on gastrointestinal hormones and DGMD in the past, but there are few studies on the relationship between diabetic peripheral neuropathyDPNs and DGMD in diabetic peripheral neuropathy. There are few articles on the relationship between the pathological degree of DPN and DGMD. Methods: 75 patients with type 2 diabetes mellitus, including 43 males and 32 females, were enrolled in this study. The ratio of male to female was 1: 0.7, with an average age of 55.6 卤10.7 years. According to the clinical symptoms and the results of electromyography of DPN, the patients were divided into three groups: no lesion group, mild lesion group and moderate and severe lesion group. All the patients were examined by 6 minutes of preprandial and postprandial electrogastrogram. At the same time, the symptoms of DPN and digestive tract were evaluated in detail, electromyography was performed, fasting, postprandial blood glucose, glycosylated hemoglobin and triglyceride were detected. Results the clinical data of the three groups were as follows: sex, age and BMI had no significant difference (P 0.05). The course of diabetes in the three groups was significantly different. After LSD test, there was no difference between mild and moderate lesion groups, but there were differences between the other two groups. That is to say, there was difference between the mean course of disease in the non-pathological group and that in the mild to moderate lesion group. The mean course of disease in the non-pathological group was lower than that in the mild to moderate lesion group (-5.59 卤4.19), and the difference among the three groups was also higher than that in the non-pathological group and the mild to moderate lesion group, and the difference between the non-pathological group and the mild to moderate lesion group was -5.59% -4.19%. Related biochemical measures: fasting blood glucose, Glycosylated hemoglobin and serum lipids showed an increasing trend, but there was no significant difference between the three groups. The amplitude of preprandial wave and the area of preprandial reaction showed a decreasing trend according to the severity of neuropathy. But the difference was not statistically significant (P 0.05), the amplitude of postprandial wave, the area of postprandial reaction and the power ratio of postprandial to preprandial were all decreased in turn. There were significant differences among the three groups (P 0.05). The correlation between BMI and the amplitude of preprandial response was analyzed from the clinical data of gastric electrical parameters in diabetic patients (Table 3). The area of preprandial reaction was negatively correlated with the amplitude of postprandial response (P 0.024) and postprandial response area (P0.024) and postprandial response area (P0.02. 022), age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, age, and age. There was a negative correlation between the course of disease and F value (r = -0.236p = 0.041n ~ (-1) ~ 0.358p ~ (0.002)) and the BMI of HBA _ (1C) of FBGn / HBA _ (1) / F were positively correlated with F value (r = 0.306p ~ (0.008) P ~ (0.230) P ~ (0.048) P ~ (0) 300 P ~ (0.009)), age, age, course of disease, FBGG ~ (HBA1C) and the amplitude of gastric electrical parameters before and after meal, the amplitude of postprandial wave, the amplitude of postprandial wave, Conclusion: abnormal electrogastrogram can be found in patients with diabetic peripheral neuropathy at the early stage, but with the severity of peripheral neuropathy, the abnormal electrogastrogram is more obvious in patients with diabetic peripheral neuropathy than in patients with preprandial or postprandial RA.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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