2型糖尿病患者胃排空功能异常及其相关因素的研究
发布时间：2018-11-12 11:42
【摘要】：研究目的:糖尿病是一组在遗传和环境因素相互作用下,由于胰岛素分泌缺乏和(或)其生物作用障碍导致糖代谢紊乱、同时伴有脂肪、蛋白质、水、电解质等的代谢障碍、以慢性高血糖为主要特征的代谢性疾病。随着病程进展,易引发各种并发症,其中糖尿病胃肠排空功能异常是常见的一种。糖尿病胃排空功能异常不仅明显影响患者食物的消化,还会影响口服药物的吸收,从而对糖尿病的治疗带来很大的干扰。既往认为胃轻瘫是2型糖尿病患者最常见的胃排空功能异常类型,然而近年的研究发现胃排空过快的病例亦不在少数。因此明确2型糖尿病患者胃排空功能异常的类型及其影响因素对于指导临床诊治具有重要的意义。发射型计算机断层扫描仪(Emission Computed Tomography,ECT)是目前评估胃排空功能的重要手段,被视为是"金标准"。本研究利用ECT对40例2型糖尿病患者和50例健康对照组的胃排空功能进行检测从而明确2型糖尿病患者胃排空功能异常的类型特点,进一步地研究胃排空速度对血糖波动的影响以及研究影响胃排空速度的相关因素,为临床中发现和治疗胃排空功能异常提供理论依据。研究方法:1、采集受试者基本信息:随机收集了 40例我院内分泌科门诊及病房确诊的2型糖尿病患者作为实验组,同时以随机抽取年龄性别匹配的50例来自山东中医药大学第二附属医院查体中心的健康查体志愿者作为正常对照组,统一测量受试者的身高、体重,空腹末梢血糖,并填写胃肠道症状积分调查表和核素胃排空检查信息表。对于符合病例选择标准的2型糖尿病患者,本研究收集其在我院就诊的化验资料,并指导其填写胃肠道症状积分调查表和核素胃排空检查信息表。2、胃部ECT检测胃排空功能:所有受试者隔夜空腹8 h以上,将含有1mci 99mTcDTPA的燕麦粥服用后,行胃部ECT检查,于餐后0、30、60、120、180 min分别采集胃排空图像。划定感兴趣区,获得放射性活度计数,分别计算各个时间点的胃残留率;绘制时间-残留率曲线并计算T1/2。(T1/2为半排空时间,即服下规定食物后胃中食物的残余量为50%时所用的时间)3、制定胃排空功能的参考标准:对正常对照组各个时间点的胃残留率和T1/2进行统计学分析,采用5百分位数和95百分位数描述,制定胃排空延迟和过快的参考标准。在该标准的基础上对2型糖尿病患者胃排空功能异常类型进行分析。4、分析2型糖尿病患者的空腹血糖、餐后2小时血糖、糖化血红蛋白、是否合并并发症包括糖尿病视网膜病变及周围神经病变与T1/2的相关性;研究影响2型糖尿病患者胃排空功能的相关因素。研究结果:1、实验组和对照组在性别、年龄、和体重指数无统计学差异(P0.05),但实验组的胃肠道积分明显高于对照组(P0.05)。实验组和对照组各时间点胃残留率及半排空时间(T1/2)存在明显的差异,且该差异具有统计学意义(P0.05)。2、以正常对照组的数值作为参考值,制定胃排空过快及胃排空延迟的标准。即:3h胃残留率大于7%或Ti/2大于50min,即可定义为胃排空延迟;0.5h胃残留率低于22%或1h胃残留率低于6%,即可定义为胃排空过快。3、根据对照组获得的正常人群胃排空功能参考标准,实验组的40例糖尿病患者中6例符合胃排空延迟,12例符合胃排空过快,胃排空异常率为45%。4、本研究发现,胃排空过快组餐后2小时血糖与空腹血糖差值最大,胃排空正常组次之,胃排空延迟组餐后2小时血糖与空腹血糖差值最小。5、胃排空过快组其病程明显短于胃排空延迟组,胃排空速度与病程有关,与空腹血糖、糖化血红蛋白无相关性。6、T1/2与糖尿病视网膜病变、糖尿病周围神经病变具有相关性。研究结论:1、2型糖尿病患者胃肠道症状积分明显高于对照组,胃排空功能与对照组相比存在显著性差异,可表现为胃排空过快或胃排空延迟。2、2型糖尿病患者胃排空功能异常影响血糖水平,胃排空过快患者餐后血糖与空腹血糖差值较大,胃排空延迟患者餐后血糖与空腹血糖差值较小。3、2型糖尿病患者胃排空功能异常与病程密切相关,胃排空过快多出现在糖尿病早期,随着糖尿病进展,胃排空延迟比例逐渐增高。4、2型糖尿病患者同时合并糖尿病视网膜病变、糖尿病周围神经病变出现胃排空功能异常的比例增高,在这些患者中应及早地进行筛查。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1
【相似文献】
相关期刊论文 前10条
1 陈金海;;贲门周围血管离断术后胃排空延缓11例诊治体会[J];工企医刊;2001年02期
2 何美蓉 ,宋于刚 ,何春容;氟西汀治疗胃排空延缓的非溃疡性消化不良的疗效观察[J];中国综合临床;2002年09期
3 林敏;郁立菲;徐克群;薛乐宁;;胃排空检测方法的研究进展[J];国际消化病杂志;2011年01期
4 刘国祥,司雁菱,武秀文;肝硬变患者胃排空功能的研究(附24例报告)[J];中国煤炭工业医学杂志;2000年05期
5 何小平;胃排空功能的检测方法[J];医学研究生学报;2003年05期
6 李章勇;沙洪;赵舒;王妍;任超世;;采用电阻抗法测量液体胃排空[J];中国医疗器械杂志;2008年04期
7 邢进宏,梁志平,关凤信,李新,陈国生,程爱国;不透X线标志物法胃排空及胃肠通过时间的测定[J];华北煤炭医学院学报;2000年06期
8 宋于刚,何美蓉 ,何燕萍 ,智发朝 ,吴保平;氟西汀对非溃疡性消化不良患者精神状态及胃排空的影响[J];世界华人消化杂志;2002年04期
9 杨成奎,李冬玲,马桓;胃排空的基础与检测[J];中国医学影像技术;1997年05期
10 梁志平;杨冬生;李向民;;不透X线标志物法对胃排空及胃肠通过时间的测定[J];中国中西医结合影像学杂志;2006年03期
相关会议论文 前4条
1 李章勇;沙洪;赵舒;王妍;王伟;任超世;;生物电阻抗法测量胃排空的研究[A];中国生物医学工程进展——2007中国生物医学工程联合学术年会论文集（下册）[C];2007年
2 王沁;马苏美;;功能性消化不良对餐后胃排空功能影响的临床研究[A];中华医学会2001年全国胃电图和胃肠动力研讨会论文摘要集[C];2001年
3 于康;柯美云;李文慧;张淑琴;王Y，
本文编号：2327013
本文链接：https://www.wllwen.com/yixuelunwen/nfm/2327013.html
最近更新
教材专著
