2型糖尿病与胶囊内镜下小肠黏膜损伤的相关性

发布时间：2018-06-12 03:43

本文选题：2型糖尿病 + 小肠黏膜损伤　；参考：《广东药科大学》2017年硕士论文

【摘要】：【背景与目的】2型糖尿病,作为最常见的慢性疾病之一,在中国部分地区的患病率已高达12.7%。我国已成为世界上糖尿病患者最多的国家。研究发现,糖尿病患者更易出现腹痛、腹泻、便秘等消化系统症状。此外,基础研究也提示糖尿病可引起肠道动力异常、肠道微生态失衡、肠道通透性升高、微循环障碍、肠道干细胞功能异常等一系列病理生理改变,这些改变均可诱发小肠黏膜损伤。但是,2型糖尿病与小肠黏膜损伤关系的研究主要集中于基础方面,两者关系的临床研究,尤其是通过内镜观察两者相关性的临床研究在国外仍未见报道。因此,本研究拟使用胶囊内镜探讨2型糖尿病与小肠黏膜损伤的相关性,为糖尿病肠病这一概念的提出提供依据,并为糖尿病肠病的预防、早诊、早治寻求新方向。【材料与方法】患者的纳入标准:自2011年8月至2016年1月于广东药科大学附属第一医院,因不明原因的消化道出血、腹痛、腹泻、消瘦等原因行胶囊内镜检查的住院患者。排除标准:(1)被诊断为恶性肿瘤;(2)近期服用非甾体类抗炎药;(3)被诊断或高度怀疑为克罗恩病;(4)被诊断为肠道感染,如急性胃肠炎、肠结核、肠道寄生虫等;(5)小肠梗阻及其他原发性小肠疾病;(6)患有严重心、肝、肺、肾(糖尿病肾病除外)疾病;(7)病历资料不齐全。收集患者性别、年龄、基础疾病病史、烟酒史、胶囊内镜结果及其他相关辅助检查结果等。按患者是否患有2型糖尿病分为2型糖尿病组及非糖尿病组,并分析两组患者的基本资料。使用卡方检验分析两组患者小肠不同类型损伤的发生率;使用Mann-Whitney U检验分析两组患者小肠Lewis评分情况及2型糖尿病不同并发症对小肠Lewis评分的影响;使用Spearman相关性检验分析胰岛素抵抗指数及糖化血浓蛋白浓度与小肠Lewis评分的相关性。【结果】1.2型糖尿病组及非糖尿病组患者的基本资料,除高血压患病率外,性别、年龄、体质指数等均无明显差异。2.2型糖尿病患者小肠绒毛水肿发生率显著高于非糖尿病患者(78.95%vs.42.76%,P0.001),但两者的小肠溃疡发生率则无统计学差异(P=1.000)。3.2型糖尿病患者小肠Lewis评分显著高于非糖尿病患者[112(8-112)vs.0(0-112),P=0.003]。4.糖尿病肾病与无糖尿病肾病者相比,小肠Lewis评分显著升高(P=0.033);有无其他并发症对小肠Lewis评分则无显著影响。5.2型糖尿病患者,不论有无使用降糖药物,以及通过何种方式使用糖尿病药物,小肠黏膜损伤情况无明显差异(P=0.831;P=0.579)。6.胰岛素抵抗指数与小肠Lewis评分成正相关关系(γ=0.141,P=0.042);而糖化血红蛋白浓度则与小肠Lewis评分无明显相关性(P=0.359)。【结论】2型糖尿病患者比非糖尿病患者有更严重的小肠黏膜损伤。当2型糖尿病患者,尤其是合并糖尿病肾病者出现不明原因的消化道出血、腹痛、腹泻,应尽早行胶囊内镜检查明确诊断。糖尿病肾病有望成为胶囊内镜检查新的指征。通过运动减肥以减轻胰岛素抵抗或有助于合并2型糖尿病的小肠黏膜损伤的预防及治疗。
[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.
【学位授予单位】：广东药科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R574

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