重度胃轻瘫治疗方式的研究进展

Factors associated with diabetic gastrointestinal dysfunction

AIM: To compare the data of diabetic patients with diabetic gastrointestinal dysfunction and those without to identify factors associated with gastrointestinal dysfunction in patients with diabetes mellitus.

METHODS: One hundred and eighty diabetes mellitus patients treated from 2006 to 2015 at the Second Affiliated Hospital of Kunming Medical University were included, including 80 with diabetic gastrointestinal dysfunction as a case group, and 100 without diabetic gastrointestinal dysfunction as a control group. The two groups were compared with regard to gender, age, medical history, islet function (C-peptide release test), glycosylated hemoglobin, fasting blood-glucose, 2 h postprandial blood glucose, diabetic complications (diabetic nephropathy, diabetic eye disease, coronary heart disease, diabetic ketosis and cerebral artery elasticity, peripheral vascular atherosclerosis, and diabetic peripheral neuropathy) and other related paramters.

RESULTS: There was no significant difference in sex distribution between the two groups (P = 0.083). C-peptide levels at 0, 1, and 2 h were significantly lower in the case group than in the control group (1.79 ng/mL ± 1.54 ng/mL vs 1.98 ng/mL ± 1.20 ng/mL, P = 0.367; 2.86 ng/mL ± 2.33 ng/mL vs 3.97 ng/mL ± 2.77 ng/mL, P = 0.05; 3.33 ng/mL ± 2.58 ng/mL vs 8.44 ng/mL ± 3.62 ng/mL, P < 0.001). Fasting blood glucose was lower in the case group than in the control group (8.53 mmol/L ± 3.61 mmol/L vs 9.10 mmol/L ± 3.70 mmol/L, P = 0.30). The proportions of patients with peripheral atherosclerosis and those with coronary heart disease in the case group were significantly higher than those in the control group (25% vs 7%, P = 0.01; 26.25% vs 24%, P = 0.73). The proportions of diabetic nephropathy, diabetes, eye diseases, diabetic ketosis, and peripheral neuropathy were also significantly higher in the case group than in the control group (37.5% vs 16%, P = 0.02; 45% vs 15%, P < 0.001; 22.5% vs 20%, P = 0.72; 51.25% vs 21%, P < 0.001).

CONCLUSION: The occurrence of diabetic gastrointestinal dysfunction is associated with islet function, history, coronary heart disease, diabetic nephropathy, diabetic eye disease, and peripheral neuropathy. Patients with poor islet function, long history of disease, complications like coronary heart disease, diabetic nephropathy, diabetic eye disease, and peripheral neuropathy are more likely to develop diabetic gastrointestinal disorders. However, diabetic gastrointestinal dysfunction has no significant correlation with age, glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, diabetes ketosis, or peripheral vascular atherosclerosis.

Pathogenesis of diabetic gastrointestinal dysfunction

Diabetic gastrointestinal dysfunction is a common complication in patients with diabetes mellitus. Most of the symptoms are related to impaired gastrointestinal function. The pathogenesis and etiology of diabetic gastroenteropathy are complex, involving the parasympathetic and sympathetic nervous systems, enteric neurons, smooth muscle cells, the network of interstitial cells of Cajal, cholinergic receptors and neuronal nitric oxide synthase. This article reviews the pathogenesis of diabetic gastrointestinal dysfunction.

Electroacupuncture combined with omeprazole for treatment of gastric dysmotility in patients with diabetic gastroparesis

AIM: To explore the efficacy of electroacupuncture combined with omeprazole in the treatment of gastric dysmotility in patients with diabetic gastroparesis (DGP).

METHODS: Eighty DGP patients with gastric dysmotility were randomly divided into two groups: a control group and a treatment group. On the basis of conventional treatment, the control group was treated with omeprazole, and the treatment group was treated by electroacupuncture combined with omeprazole. The fullness syndrome, the symptom score before and after treatment, and laboratory indexes were compared between the two groups.

RESULTS: The cure rate (32.50% vs 17.50%) and total response rate (87.50% vs 67.50%) were significantly better in the treatment group than in the control group (P < 0.05 for both). In both the study group and control group, the grade of fullness (0.67 ± 0.56 vs 1.72 ± 0.63, 0.95 ± 0.58 vs 1.75 ± 0.57), pressure pain score (0.71 ± 0.53 vs 1.83 ± 0.62, 1.00 ± 0.55 vs 1.86 ± 0.64), belching score (0.81 ± 0.48 vs 1.71 ± 0.59, 1.13 ± 0.56 I 1.73 ± 0.62), eat score (0.74 ± 0.53 vs 1.39 ± 0.56, 1.03 ± 0.48 vs 1.41 ± 0.62) and stool score (0.55 ± 0.47 vs 1.52 ± 0.56, 0.97 ± 0.50 vs 1.50 ± 0.56) were significantly lower after treatment than before treatment (P < 0.05 for all). After treatment, these parameters were significantly lower in the treatment group than in the control group (P < 0.05 for all). In both the study group and control group, the quantity of residual barium (3.43 ± 1.33 vs 13.03 ± 2.77; 3.51 ± 1.36 vs 13.32 ± 2.46), motilin (MLT) level (331.36 ng/L ± 14.82 ng/L vs 408.61 ng/L ± 28.57 ng/L, 336.75 ng/L ± 15.83 ng/L vs 410.56 ng/L ± 33.55 ng/L), gastrin (GAS) level (86.67 ng/L ± 10.30 ng/L vs 114.89 ng/L ± 17.91 ng/L, 93.85 ng/L ± 10.78 ng/L vs 117.02 ng/L ± 19.41ng/L) and fasting blood glucose level (6.04 mmol/L ± 1.01 mmol/L vs 9.53 mmol/L ± 3.51 mmol/L, 6.45 mmol/L ± 0.90 mmol/L vs 9.58 mmol/L ± 2.64 mmol/L) were significantly lower after treatment than before treatment (P < 0.05 for all). After treatment, these parameters were significantly lower in the treatment group than in the control group (P < 0.05 for all).

CONCLUSION: Electroacupuncture combined with omeprazole can improve fullness syndrome and gastric dysmotility, promote gastric emptying and lower FPG in patients with DGP.