单纯性肥胖者胃排空、近端胃功能、胃电活动、胃肠激素和电针刺激的研究
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摘要
第一部分单纯性肥胖者胃排空的研究
目的:通过检测单纯性肥胖者、正常体重者和功能性消化不良患者核素胃排空,探讨胃排空与肥胖发病机理间的关系。
方法:30名单纯性肥胖伴暴食行为者为肥胖组,男女各15名,平均年龄25.43±6.74岁,体重指数(MBI)32.96±2.12kg/m2。30名正常体重健康志愿者作为正常对照组,男女各15名,平均年龄27.23±5.99岁,MBI 21.51±1.40 kg/m2。32名功能性消化不良(FD)患者为FD对照组,男14名,女18名,平均年龄35.47±7.21岁,MBI 23.09±1.68 kg/m2。所有受试者无消化脏器手术史,经胃镜、B超和生化检查除外肝病和消化道器质性疾病。受试者检查前禁食12h,在早晨进行核素闪烁扫描胃排空检测。
结果:肥胖组60分钟、90分钟、120分钟胃排空率(GEt%)均高于正常对照组( 44.27±4.82 vs 39.60±3.30, 72.90±5.26 vs 56.83±6.69, 91.20±4.29 vs 76.00±5.41, P<0.01),而2小时胃存留率及胃半排空时间(T1/2)则低于正常对照组(8.8±4.92 vs 24.00±5.41, 70.43±7.74 vs 83.10±6.88, P<0.01);三组间胃排空率、半排空时间和2小时胃存留率两两比较差异均有统计学意义(P<0.01)。与正常对照组相比,FD组胃排空明显延迟(P<0.01)。
结论:单纯性肥胖伴暴食行为者核素胃排空明显快于正常体重健康者,而FD患者胃排空与正常体重健康者比较明显延迟。快速胃排空可削弱胃内食物产生饱感的负反馈,加快摄取的营养物质在胃肠的传输和肠内的吸收,促进饥饿感,易多食暴食使能量过剩。即胃排空加速可能是造成食欲亢进和肥胖的胃动力学基础。
第二部分单纯性肥胖者近端胃功能和电针刺激的研究
目的:通过水负荷试验和机械性胃扩张,对正常体重和单纯性肥胖伴暴食行为者进行检测,探讨胃容量、胃容受性、胃内压、内脏感觉阈值等近端胃功能的变化与肥胖发病机理间的关系,并观察电针刺激对单纯性肥胖伴暴食行为者近端胃功能的影响,为科学减肥提供理论依据和可靠的方法。
方法:40例单纯性肥胖伴暴食行为者作为试验组,平均年龄24.30±4.99岁,BMI 32.07±2.44kg/m2,男性20例,女性20例。正常体重健康志愿者35例为正常对照组,平均年龄22.26±1.95岁,BMI 21.00±1.36kg/m2,男性19例,女性16例。30例单纯性肥胖伴暴食行为者作为对照组,平均年龄24.50±5.20岁,BMI 32.77±2.01kg/m2,男性15例,女性15例。所有受试者都没有胃肠道疾病和肝病史,没有消化道手术史。试验组和对照组饮食行为为暴食、多食或不停进食。
试验第一天,受试者禁食8h以上,进行水负荷试验观察胃容受性改变。试验第二天,受试者禁食12h,应用电子恒压器进行机械性等容胃扩张检测近端胃功能。正常对照组结束试验。试验组针刺双侧足三里、阴陵泉和天枢穴,阴陵泉和足三里穴接电针刺激,天枢穴不接电针刺激,通电时间为30min。电针串脉冲刺激设定为刺激2s,停3s(即12cpm),串脉冲的频率为40Hz,波宽500μs,输出电流1mA。对照组放气后不进行针刺,保留气囊导管30min,胃底气囊再次充气,两组重复近端胃功能指标检测。
结果:
1.饮水负荷试验:试验组饮水量(1325.75±196.79ml)大于正常对照组(1158.23±195.61ml),差异有统计学意义(P<0.01);试验组饮水量与对照组(1359.67±222.41ml)比差异无统计学意义(P>0.05);对照组饮水量显著大于正常对照组(P<0.01)。
2.胃容积的比较:试验组和对照组初始胃容积和最大耐受胃容积较正常对照组均显著增大(P<0.01);试验组初始胃容积和最大耐受胃容积与对照组比较差异均无统计学意义(P>0.05)。
3.胃内压的比较:三组间最小扩张压、初始胃内压和最大耐受胃内压各自两两相比差异均无统计学意义(P>0.05)。
4.胃顺应性的比较:试验组和对照组最小顺应性与正常对照组相比差异均无统计学意义(P>0.05),初始顺应性、最大耐受顺应性较正常对照组均增大(P<0.01);试验组最小顺应性、初始顺应性、最大耐受顺应性与对照组比较差异均无统计学意义(P>0.05)。
5.电针刺激对胃容积的影响:试验组电针刺激后初始胃容积和最大耐受胃容积较针刺前均显著变小(P<0.01);对照组放气后初始胃容积和最大耐受胃容积与放气前比差异均无统计学意义(P>0.05)。
6.电针刺激对胃内压的影响:试验组电针刺激后最小扩张压与针刺前比差异性无统计学意义(P>0.05),而初始胃内压、最大耐受胃内压较针刺前均增大(P<0.01)。对照组放气后最小扩张压、初始胃内压、最大耐受胃内压与放气前比差异均无统计学意义(P>0.05)。7.电针刺激对胃顺应性的影响:试验组电针刺激后最小顺应性与针刺前
比差异无统计学意义(P>0.05),而初始顺应性和最大耐受顺应性较针刺前均显著变小(P<0.01)。对照组放气后最小顺应性、初始顺应性、最大耐受顺应性与放气前比差异均无统计学意义(P>0.05)。
结论:
1.单纯性肥胖伴暴食行为者胃容受性、顺应性、胃敏感性异于健康正常体重者,使摄食量发生异常。胃容积增加、顺应性变大、容受性增强、饱感延迟发生可能是肥胖伴暴食行为发生的重要原因。
2.电针刺激可能通过降低胃容受性而减少食物的摄入,同时增加胃内压可降低饱感信号阈值从而有效减少饥饿感,达到无饥饿痛苦的减肥目的。
第三部分单纯性肥胖者胃电活动和电针刺激的研究
目的:机械性胃扩张同时,对单纯性肥胖伴暴食行为者和正常体重健康志愿者进行胃电图检测。探讨单纯性肥胖伴暴食行为者胃肌电活动特征和发病机理间的关系及电针刺激对单纯性肥胖伴暴食行为者胃电的影响。
方法:研究对象同第二部分。先记录机械扩张前静息状态胃电图,然后与近端胃功能检测同步进行。在静息、初始胃内压、最大耐受胃内压时各描记胃电图15min。正常对照组结束试验。试验组接受30min电针刺激,对照组不进行电针刺激,放气保留气囊导管30min,两组再进行机械性胃扩张,在静息、初始胃内压、最大耐受胃内压时各描记胃电图15min。
结果:
1.机械性胃扩张时的胃电活动
1.1静息状态三组胃电参数的比较:试验组主频、主功率、胃动过缓百分比、胃动过速百分比、主频不稳定系数五项参数与正常对照组及对照组三组间两两比较差异均无统计学意义(P>0.05)。试验组和对照组正常慢波百分比均显著低于正常对照组(P<0.01),而主功率不稳定系数明显高于正常对照组(P<0.05)。试验组胃电参数与对照组比较差异均无统计学意义(P>0.05)。
1.2初始胃内压状态三组胃电参数的比较:试验组主频、胃动过缓百分比、胃动过速百分比、主频不稳定系数四项参数与正常对照组及对照组三组间两两比较差异均无统计学意义(P>0.05)。试验组和对照组主功率均显著高于正常对照组(P<0.01)。试验组和对照组正常慢波百分比均明显低于正常对照组(P<0.05)。试验组和对照组主功率不稳定系数均明显高于正常对照组(P<0.05)。试验组胃电参数与对照组比较差异均无统计学意义(P>0.05)。
1.3最大耐受胃内压状态三组胃电参数的比较:试验组主频、胃动过缓百分比、胃动过速百分比、主频不稳定系数四项参数与正常对照组及对照组三组间两两比较差异均无统计学意义(P>0.05)。试验组和对照组主功率均显著高于正常对照组(P<0.01)。试验组和对照组正常慢波百分比均显著低于正常对照组(P<0.01)。试验组和对照组主功率不稳定系数均明显高于正常对照组(P<0.05)。试验组胃电参数与对照组比较差异均无统计学意义(P>0.05)。
2.机械性胃扩张对胃电活动的影响
2.1试验组不同胃扩张状态胃电参数的比较:40名单纯性肥胖伴暴食行为者随着胃内压的升高,在静息状态、初始胃内压(IP)状态、最大耐受胃内压(MP)状态:主频(DF)值呈下降趋势,但三者间差异无统计学意义(P>0.05)。主功率(DP)呈上升趋势,且在静息状态与在IP状态和在MP状态相比,差异均有统计意义(P<0.01),DP在IP状态与在MP状态相比差异也有统计学意义(P<0.01)。正常慢波百分比(N%)呈下降趋势,静息状态与MP状态相比差异有统计学意义(P<0.05)。胃动过缓百分比(B%)、胃动过速百分比(T%)和主功率不稳定系数(DPIC)均呈上升趋势,但三组间差异均无统计学意义(P>0.05)。主频不稳定系数(DFIC)呈上升趋势,且在静息状态与在MP状态相比差异有统计学意义(P<0.05)。
2.2对照组不同胃扩张状态胃电参数的比较:30名单纯性肥胖伴暴食行为者随着胃内压的升高,在静息状态、IP状态、MP状态:DF值三者间差异无统计学意义(P>0.05)。DP呈上升趋势,静息状态与IP状态和MP状态相比,差异均有统计学意义(P<0.05,P<0.01),IP状态与MP状态相比差异也有统计学意义(P<0.05)。N%呈下降趋势,静息状态与MP状态相比差异有统计学意义(P<0.05)。B%、T%均呈上升趋势,但三者间差异均无统计学意义(P>0.05)。DFIC呈上升趋势,且在静息状态与在MP状态相比差异有统计学意义(P<0.05)。DPIC呈上升趋势,但三者间差异无统计学意义(P>0.05)。
2.3正常对照组不同胃扩张状态胃电参数的比较:35名正常体重健康志愿者随着胃内压的升高,在静息状态、IP状态、MP状态:DF值三者间差异无统计学意义(P>0.05)。DP值呈上升趋势,静息状态与MP状态的DP值差异有统计学意义(P<0.01)。N%呈下降趋势,且在静息状态与IP状态和在MP状态相比,差异均有统计学意义(P<0.01)。B%呈上升趋势,静息状态与IP状态和MP状态相比,差异均有统计学意义(P<0.05, P<0.01)。T%、DPIC和DFIC值均呈上升趋势,但T%和DPIC三者间差异均无统计学意义(P>0.05),DFIC在静息状态与MP状态差异有统计学意义(P<0.05)。
3.电针刺激对胃扩张状态下胃电活动的影响
3.1电针刺激对静息状态胃电活动的影响:试验组电针刺激后DF值、B%、T%、DFIC、DPIC与针刺前比差异无统计学意义(P>0.05)。而DP和N%明显低于针刺前(P<0.05);对照组放气后胃电参数与放气前比差异均无统计学意义(P>0.05)。
3.2电针刺激对IP状态胃电活动的影响:试验组电针刺激后DF值、B%、DFIC、DPIC与针刺前比差异无统计学意义(P>0.05)。而DP、N%和T%明显低于针刺前(P<0.05);对照组放气后胃电参数与放气前比差异均无统计学意义(P>0.05)。
3.3电针刺激对MP状态胃电活动的影响:试验组电针刺激后DF值、B%、DFIC、DPIC与针刺前比差异均无统计学意义(P>0.05)。而DP显著低于针刺前(P<0.01),N%、T%明显低于针刺前(P<0.05);对照组放气后胃电参数与放气前比差异均无统计学意义(P>0.05)。
结论:
1.单纯性肥胖伴暴食行为者胃扩张时胃电节律异常率较正常体重者显著增高,可能与肥胖者胃容量增加,胃容受性增强,顺应性增大有关,且对饥饿感和饱感发生起着重要的影响。
2.单纯性肥胖伴暴食行为者主功率显著增高,有强的胃收缩力,与前面研究肥胖伴暴食行为者有快速胃排空结果相佐证,即单纯性肥胖伴暴食行为者可能与胃排空过速或动力亢进有关。
3.电针刺激能通过增加胃电节律紊乱和减弱胃收缩力,降低食欲和胃容受性,并延缓胃排空,减少摄食,这可能是电针刺激控制体重和减肥的电生理基础。
第四部分单纯性肥胖者胃动力相关激素和电针刺激的研究
目的:通过对单纯性肥胖伴暴食行为者和正常体重健康者进行餐前餐后胃动素、瘦素、生长素、胰高血糖素肽-1检测,探讨这些激素对肥胖者胃动力的影响,并验证电针刺激治疗的有效性。
方法:正常健康志愿者组(对照组)20例,男11例,女9例,平均年龄22.56±6.23岁,BMI 21.28±1.84kg/m2。单纯性肥胖伴暴食行为组(肥胖组)32例,男17例,女15例,平均年龄23.62±6.24岁,BMI 31.05±1.55kg/m2。禁食12h后于上午8点采空腹静脉血12ml,然后在10min内进食完试验餐,餐后30分钟第二次采血12ml,-70℃冷冻备用,酶联免疫法检测生长素(Ghrelin)、胰高糖素肽-1(GLP-1);放免法测定瘦素(Leptin)、胃动素(MTL)。肥胖组给予电针刺激治疗,每天一次,每次30min,连续七天。第八天重复第一天血样采取过程。记录电针治疗七天后体重的变化。
结果:
1.肥胖组激素水平与对照组的比较
1.1胃动素肥胖组和对照组餐后胃动素水平均较餐前显著升高(P<0.01)。无论是餐前还是餐后,肥胖组胃动素水平均较对照组显著升高(P<0.01)。
1.2瘦素肥胖组和对照组餐后和餐前瘦素水平差异均无统计学意义(P>0.05)。无论是餐前还是餐后,肥胖组瘦素水平均较对照组显著升高(P<0.01)。
1.3生长素肥胖组和对照组餐后生长素水平较餐前均降低(P<0.01)。无论是餐前还是餐后,肥胖组生长素水平均较对照组显著降低(P<0.01)。
1.4胰高糖素肽-1对照组餐后GLP-1水平较餐前明显升高(P<0.01),肥胖组餐后GLP-1水平较餐前释放减少(P<0.01)。无论是餐前还是餐后,肥胖组GLP-1水平均较对照组显著降低(P<0.01)。
2.肥胖组治疗后体重变化较治疗前体重减轻3.55±1.00kg。
3.电针治疗对激素水平的影响
3.1胃动素肥胖组治疗后餐后胃动素明显高于餐前(P<0.05),无论是餐前还是餐后,肥胖组治疗后均较治疗前显著下降(P<0.01)。
3.2瘦素肥胖组治疗后餐后瘦素水平与餐前比较差异无统计学意义(P>0.05),无论是餐前还是餐后,肥胖组治疗后均较治疗前显著下降(P<0.01)。
3.3生长素肥胖组治疗后餐后生长素水平显著低于餐前(P<0.01),无论是餐前还是餐后,肥胖组治疗后较治疗前差异均无统计学意义(P>0.05)。
3.4胰高糖素肽-1肥胖组治疗后餐后胰高糖素肽-1水平与餐前比较差异无统计学意义(P>0.05),无论是餐前还是餐后,肥胖组治疗后均较治疗前显著上升(P<0.01)。
结论:
1.肥胖组瘦素水平无论餐前还是餐后均显著高于正常对照组,而进餐对瘦素水平无明显影响,单纯性肥胖伴暴食行为者可能存在瘦素抵抗。电针刺激使瘦素水平均有显著下降。
2.肥胖组无论餐前还是餐后生长素水平均显著低于正常对照组,表明生长素降低可能是肥胖患者对正能量平衡的生理调节过程。肥胖暴食行为者可能存在进食对生长素的抑制作用较正常人减弱,进而引起食欲增大。
3.肥胖组无论餐前还是餐后胃动素水平均显著高于对照组,肥胖组和对照组餐后胃动素水平均较各自餐前显著升高。电针治疗后胃动素显著下降。
4.胰高糖素肽-1水平降低可能是造成肥胖者胃动力亢进、胃排空加快、胃感觉迟顿、饱感延迟发生的另一主要原因。而电针治疗能提高肥胖组餐前和餐后的胰高糖素肽-1水平。
5.电针刺激有减肥的治疗作用。
Part One Gastric emptying in simply obesity
Objective: To evaluate the relationship of gastric emptying with obese pathogenesis with scintigraphical measurement in simply obesity, normal control and FD patients.
Methods: 30 simple binge-eating obesity include 15 males and 15 females with mean age 25.43±6.74y and MBI of 32.96±2.12kg/m2, 30 healthy volunteers including 15 males and 15 females with mean age of 25.43±6.74y and MBI of 32.96±2.12kg/m2, and 32 FD patients including 14 males amd 18 females with mean age of 35.47±7.21y and MBI of 23.09±1.68kg/m2 were enrolled in this study. None had gastrointestinal and hepatic disorders. scintigraphic gastric emptying assays were performed with a radionuclide technique methods as previously decribed in the morning after twelve hours fasting.
Results: The gastric emptying rates at timepoint of 60 min, 90 min and 120 min in obese group were significantly higher than those of matched control with 44.27±4.82 vs 39.60±3.30, 72.90±5.26 vs 56.83±6.69 and 91.20±4.29 vs 76.00±5.41(P<0.01), respectively. Half-emptying time and gastric retention rate at 120 min were shorter and lower than those in control (8.8±4.92 vs 24.00±5.41, 70.43±7.74 vs 83.10±6.88, P<0.01). FD patients showed a significant delay of gastric emptying compared with control group at timepoint of 60 min, 90 min and 120 min (31.41±8.57 vs 39.60±3.30, 43.06±11.99 vs 56.83±6.69, 54.97±12.50 vs 76.00±5.41, P<0.01). Half-emptying time and gastric retention rate at 120 min were longer and higher than those in control (107.2±25.94 vs 83.10±6.88, 45.03±12.50 vs 24.00±5.41, P<0.01).
Conclusion: Our data demonstrated that obese group had faster gastric empty than normal control and FD patients. Rapid gastric emptying may induce rapid gastrointestinal transit of ingested nutrients and decreased satiety feeling, promote rapid intestinal absorption and enhance hunger feeling in simply obesity with binge eater to draw them to overeat. Our data implied that Rapid gastric emptying maybe the the foundament of overeating so as to obesity.
Part Two Proximal gastric function and Electroacupuncture in simple obesity
Objective: To evaluate the relation among gastric capacity, accommodation, intragastric pressure, visceral sensitivity and obesity in 70 simply binge-eating obesity and 30 normal control with water load test and mechanical gastric distension method. Observe the effece of electro- acupuncture on proximal gastric function of simply obesity with binge eater in order to provid evidence with scientific and reliable for weight loss therapy.
Methods: 105 subjects were divided into three groups: experiment group (40 simple obesity with binge eater, 20 males, 20 females, mean age 24.30±4.99y, BMI 32.07±2.44kg/m2), normal control group (30 healthy volunteers with normal body weight, 19 males, 16 females, mean age 22.26±1.95y, BMI 21.00±1.36kg/m2), control group (30 simple obesity with binge eater, 15 males, 15 females, mean age 24.50±5.20y, BMI 32.77±2.01kg/m2). None of the subjects had any gastrointestinal organic diseases or hepatopathy or a history of gastrointestinal surgery. On the first day, the water load test was performed. On the second day, accommodation, intragastric pressure and gastric compliance using an electronic barostat were measured by mechanical distension. The test of normal control group was over. For subjects of experiment group, Zusanli (ST36) and Yinlingquan (SP9) were punctured and stimulated with an electric pulse generator for 30 min by setting the parameters being 1mA in strength, 500s in the duration of pulses, 40Hz in frequency, 12cpm of pulse trains. Tianshu (ST25) was punctured with the needle retained. Acupuncture was not performed in control group. The repeated isovolumetric gastric distention was performed in the subjects of experiment group and control group.
Results:
1. the water load test: The consumption of water of experiment group and control group were all increased significantly comparison with that in normal control group (1325.75±196.79ml,1359.67±222.41ml vs 1158.23±195.61ml, P<0.01).
2. Gastric capacity: The initial volume (IV) and maximal tolerance volume (MV) in experiment and control group were all significantly larger than those in normal control group (P<0.01). No significant difference in IV and MV were found between experiment group and control group (P>0.05).
3. Intragastric pressure: No statistically significant difference in minimal distention pressure (MDP), initial intragastric pressure (IP) and maximal tolerance pressure (MP) were found among the three groups (P>0.05).
4. Gastric compliance:Minimal distention compliance (MDC) in experiment and control group were not all different from normal control group (P>0.05). The initial gastric compliance (IC),maximal tolerance compliance (MC) in experiment and control group were all significantly larger than those in normal control group (P<0.01). MDC, IC and MC in experiment group were not different from control group (P>0.05).
5. The effect of electroacupuncture on gastric capacity: After stimulation of electroacupuncture, IV and MV in experiment group were lower remarkably than those before (P<0.01). In control group, IV and MV in the first test were not different from those in the second test (P>0.05).
6. The effect of electroacupuncture on intragastric pressure: After stimulation, MDP was similar to before (P>0.05), whereas IP and MP were increased noticeably in comparison with before (P<0.01). In control group, IP and MP in the first test were not different from those in the second test (P>0.05).
7. The effect of electroacupuncture on gastric compliance: After stimulation, MDC was similar to before (P>0.05), whereas IC and MC were decreased noticeably in comparison with before (P<0.01). In control group, IC and MC in the first test were not different from those in the second test (P>0.05).
Conclusion:
1. The proximal gastric functions of simple obesity with binge eater were different from those of healthy people with normal body weight. With the alteration of proximal gastric functions, food intake was increased. Appropriate satiety signals were not triggered in response to gastric distension. Large gastric volume, big gastric compliance and delayed satiety signals were the main reasons of simple obesity with binge eater.
2. Stimulation of electroacupuncture caused food intake decreased by lowing gastric capacity, whereas caused threshold of satiety signal and feeling of hunger decreased by increasing intragastric pressure, so it meet the aim of weight loss without hunger suffering.
Part Three Gastric myoelectrical activity and Electroacupuncture in simple obesity
Objective: To explore the characteristics of gastric myoelectrical activity induced by mechanical distension in simply obese people with binge eater and healthy volunteers with normal body weight; to discuss the relation between gastric myoelectrical activity and obesity; to evaluate the effect of electroacupuncture on electrogastrography (EGG) in simply obese people with binge-eating.
Methods: Standards of subjects selected, rulled out and subjects are the same as above those of Part two. At the first time, all subjects’EGGs were recorded at baseline. All of the subjects were measured with electronic Barostat and Digitrapper electrogastrography equipments at the same time during mechanical distension. EGG was recorded at baseline, IP and MP state for 15 min respectively. Then the test of normal control group was over. The stimulation of electroacupuncture was enforced on experiment group for 30 min. Acupuncture was not performed in control group. The repeated isovolumetric gastric distention and EGG were performed on the experiment and control group.
Results:
1. Gastric myoelectrical activity during mechanical distension
1.1 Comparison of parameters in EGG at the state of baseline among three groups: Five parameters of EGG (DF, DP, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). The percentage of normal slow wave (N%) in experiment and control group were all lower than those in normal control group respectively (P<0.01), whereas DPIC were higher than those in normal control group respectively (P<0.05). No statistically significant difference was found in parameters of EGG between experiment group and control group (P>0.05).
1.2 Comparison of parameters in EGG at the state of IP among three groups: Four parameters of EGG (DF, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). Two parameters of EGG (DP, DPIC) in obese and control group were all higher compared with those in normal control group (P<0.01, P<0.05), whereas N% were lower than those in normal control group respectively (P<0.05). No statistically significant difference were found in parameters of EGG between experiment group and control group (P>0.05).
1.3 Comparison of parameters in EGG at the state of MP among three groups: Four parameters of EGG (DF, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). Two parameters of EGG (DP, DPIC) in experiment and control group were all higher compared with those in normal control group (P<0.01, P<0.05), whereas N% were lower than those in normal control group respectively (P<0.01). No statistically significant difference were found in parameters of EGG between experiment group and control group (P>0.05).
2. Effect of mechanical distension on gastric myoelectrical activity
2.1 Comparison of EGG in experiment group at different gastric dilatation: Four parameters of EGG (DF, B%, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased significantly (30.33±3.81 dB vs 33.01±4.70 dB vs 36.23±4.02 dB, P<0.01); N% was decreased (53.65±14.22 vs 50.37±12.20 vs 47.86±11.65), N% of MP state was lower significantly compared with that of baseline state (P<0.05); DFIC was increased (0.42±0.14 vs 0.45±0.11 vs 0.51±0.16), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).
2.2 Comparison of EGG in control group at different gastric dilatation: Four parameters of EGG (DF, B%, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased significantly(30.42±3.13 vs 33.28±4.79 vs 36.15±4.78); N% was decreased (54.03±16.65 vs 50.33±12.41 vs 45.90±11.93), N% of MP state was lower significantly compared with that of baseline state (P<0.05); DFIC was increased (0.43±0.16 vs 0.45±0.13 vs 0.51±0.17), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).
2.3 Comparison of EGG in normal control group at different gastric dilatation: Three parameters of EGG (DF, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased (29.02±3.27 vs 30.28±3.76 vs 32.06±4.84), DP of MP state was higher significantly compared with that of baseline state (P<0.01); N% was decreased (69.20±15.09 vs 57.50±15.54 vs 56.61±12.80), N% of MP and IP state were all lower significantly compared with that of baseline state (P<0.01); DFIC was increased (0.40±0.12 vs 0.44±0.17 vs 0.49±0.17), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).
3. Effects of acupuncture and electrical stimulation on EGG during mechanical distension
3.1 Effects of acupuncture and electrical stimulation on EGG at state of baseline: Five parameters of EGG (DF, B%, T%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 28.55±3.50 vs 30.33±3.81, P<0.05), (N%: 47.56±11.78 vs 53.56±14.22, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).
3.2 Effects of acupuncture and electrical stimulation on EGG at state of IP: Four parameters of EGG (DF, B%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 30.68±4.58 vs 33.01±4.70, P<0.05), (N%: 44.30±13.18 vs 50.37±12.20, P<0.05), whereas T% was higher noticeably compared with before electroacupuncture (23.59±11.10 vs 18.44±11.97, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).
3.3 Effects of acupuncture and electrical stimulation on EGG at state of MP: Four parameters of EGG (DF, B%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 33.35±5.11 vs 36.23±4.02, P<0.01), (N%: 41.77±12.35 vs 47.86±11.65, P<0.05), whereas T% was higher noticeably compared with before electroacupuncture (25.23±9.66 vs 20.06±10.05, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).
Conclusion:
1. Obese people have remarkable abnormalities in gastric myoelectrical activity. Gastric compacity, accommodation and compliance increase in obese people perhaps play much more important role in above changes of gastric myoelectrical activity. The changes of gastric myoelectrical activity may influence feeling of hunger and satiety in human。
2. A remarkable increasement of DP in the obese suggested that the obese with binge-eater had stronger contraction in comparison with normal subjects. This is evidence of correlation between simply obesity with binge eater and rapid gastric emptying.
3. Stimulation of electroacupuncture in the obese lowed appetite and accommodation by increased abnormalities in gastric myoelectrical activity and weakened gastric contraction. Prolonged gastric emptying and decreased food intake are the electrophysiological foundaments on weight reduction.
Part Four Hormons correlated with gastric motility and Electroacu- puncture in simply obese people
Objective: To detdect serum Motilin, Leptin, Ghrelin, Glucogan-like peptide-1 in 32 simply binge-eating obesity and 20 normal control; to explore the relationship among serum MTL, Leptin, Ghrelin, GLP-1 and gastric motility of obese people and to verify the availability of electroacupuncture.
Methods: 32 simply obese subjects with binge eater (17 males, 15 females, BMI 31.05±1.55kg/m2, age 23.62±6.24y) and 20 healthy subjects with normal weight (11 males, 9 females, BMI 21.28±1.84kg/m2, age 22.56±6.23y) were enrolled. At 8:00 in the morning venous blood was collected after an overnight fast period. and 30 minutes after meal (Kangshifu convenient noodles 127g: carbohydrate 88g, fat 25g, protein 14g, total kalorie 633Kcal) venous blood was recollected and stored at -70℃; Serum Ghrelin, GLP-1 were detected with ELISA method; MTL, Leptin were detected with RI method. 30 min stimulation of electroacupuncture was performed daily on the obese for a week. On the eighth day, blood samples of the obese were collected again. Recorded the loss of weight of the obese for the week.
Results:
1. Comparison of hormones between the obese and the control
1.1 Motilin: Before and after meal, Serum MTL in obese people were higher than those in the control (283.95±83.84pg/ml vs 125.76±33.09pg/ml; 368.80±137.5pg/ml vs 276.8±50.55pg/ml, P<0.01);Compared with pre-meal MTL, post-meal MTL increased significantly in both groups (P<0.01).
1.2 Leptin: Before and after meal, Serum Leptin in obese people were higher than those in the control, (7.42±4.66ng/ml vs 1.33±0.51ng/ml, 7.53±4.98 ng/ml vs 1.21±0.55ng/ml, P<0.01); Post-meal Leptin level was similar to pre-meal Leptin level in obese and control group (P>0.05).
1.3 Ghrelin: Before and after meal, Serum Ghrelin in obese people was lower than those in the control, (3.23±1.24pg/ml vs 9.72±7.10pg/ml, 1.45±0.96pg/ml vs 3.36±2.38pg/ml, P<0.01); Compared with pre-meal Ghrelin, post-meal Ghrelin decreased significantly in both groups (P<0.01).
1.4 GLP-1: Before and after meal, Serum GLP-1 in obese people were lower than those in the control, (1.67±0.36pg/l vs 3.64±1.42pg/l, 1.08±0.81pg/l vs 6.59±1.23pg/l, P<0.01); Compared with pre-meal GLP-1, post-meal GLP-1 increased significantly in the control (P<0.01), while in the obese, post-meal GLP-1 secretion decreased (P<0.05).
2. A mean weight loss for a week: 3.55±1.00kg.
3. Effects of acupuncture and electrical stimulation on hormones
3.1 Motilin: Before and after meal, Serum MTL were lower than those before stimulation (230.73±9.25 vs 283.95±83.84, 264.52±91.51 vs 368.80±137.5, P<0.01). After stimulation in obese group, post-meal MTL increased significantly comared with pre-meal MTL (P<0.05).
3.2 Leptin: Before and after meal, Serum Leptin were lower than those before stimulation (3.31±1.28 vs 7.42±4.66, 3.49±1.35 vs 7.53±4.98, P<0.01). After stimulation in obese group, post-meal Leptin level was similar to pre-meal Leptin level (P>0.05).
3.3 Ghrelin: Before and after meal, Serum Ghrelin level were similar to those before stimulation (3.20±1.21 vs 3.23±1.24, 1.43±0.92 vs 1.45±0.96, P>0.05). After stimulation in obese group, post-meal Ghrelin decreased significantly comared with pre-meal Ghrelin (P<0.01).
3.4 GLP-1: Before and after meal, Serum GLP-1 increased significantly in comparison with those before stimulation (2.55±0.72 vs 1.67±0.36, 2.65±1.12 vs 1.08±0.81, P<0.01). After stimulation in obese group, post-meal GLP-1 level was similar to pre-meal GLP-1 level (P>0.05).
Conclusion:
1. Before and after meal, Serum Leptin in obese people with binge eater were higher than those in the control. Food intake has no effect on Serum Leptin level. Leptin resistance existed in the obese so that the role of inhibition eating cannot run. Stimulation of electroacupuncture for a week made Serum Leptin decreased significantly.
2. Before and after meal,Serum Ghrelin in obese people were lower than those in the control. Low Ghrelin level suggested that it adapted to positive energy balance. Perhaps food intake inhibition on Ghrelin was down-regulation, and then trigger appetite increased.
3. Before and after meal, Serum MTL level were lower than those before stimulation. Compared with pre-meal MTL, post-meal MTL increased significantly in both groups. Stimulation of electroacupuncture for a week made Serum MTL decreased significantly.
4. Serum GLP-1 level decreased resulted in gastric hypermotility, fast empting of stomach, visceral sensitivity obtuse and satiety occurence delayed. Stimulation of electroacupuncture for a week made Serum Leptin increased significantly.
5. The therapeutic effects of electroacupuncture on the simply obese with binge eater were sure.
目的:通过检测单纯性肥胖者、正常体重者和功能性消化不良患者核素胃排空,探讨胃排空与肥胖发病机理间的关系。
方法:30名单纯性肥胖伴暴食行为者为肥胖组,男女各15名,平均年龄25.43±6.74岁,体重指数(MBI)32.96±2.12kg/m2。30名正常体重健康志愿者作为正常对照组,男女各15名,平均年龄27.23±5.99岁,MBI 21.51±1.40 kg/m2。32名功能性消化不良(FD)患者为FD对照组,男14名,女18名,平均年龄35.47±7.21岁,MBI 23.09±1.68 kg/m2。所有受试者无消化脏器手术史,经胃镜、B超和生化检查除外肝病和消化道器质性疾病。受试者检查前禁食12h,在早晨进行核素闪烁扫描胃排空检测。
结果:肥胖组60分钟、90分钟、120分钟胃排空率(GEt%)均高于正常对照组( 44.27±4.82 vs 39.60±3.30, 72.90±5.26 vs 56.83±6.69, 91.20±4.29 vs 76.00±5.41, P<0.01),而2小时胃存留率及胃半排空时间(T1/2)则低于正常对照组(8.8±4.92 vs 24.00±5.41, 70.43±7.74 vs 83.10±6.88, P<0.01);三组间胃排空率、半排空时间和2小时胃存留率两两比较差异均有统计学意义(P<0.01)。与正常对照组相比,FD组胃排空明显延迟(P<0.01)。
结论:单纯性肥胖伴暴食行为者核素胃排空明显快于正常体重健康者,而FD患者胃排空与正常体重健康者比较明显延迟。快速胃排空可削弱胃内食物产生饱感的负反馈,加快摄取的营养物质在胃肠的传输和肠内的吸收,促进饥饿感,易多食暴食使能量过剩。即胃排空加速可能是造成食欲亢进和肥胖的胃动力学基础。
第二部分单纯性肥胖者近端胃功能和电针刺激的研究
目的:通过水负荷试验和机械性胃扩张,对正常体重和单纯性肥胖伴暴食行为者进行检测,探讨胃容量、胃容受性、胃内压、内脏感觉阈值等近端胃功能的变化与肥胖发病机理间的关系,并观察电针刺激对单纯性肥胖伴暴食行为者近端胃功能的影响,为科学减肥提供理论依据和可靠的方法。
方法:40例单纯性肥胖伴暴食行为者作为试验组,平均年龄24.30±4.99岁,BMI 32.07±2.44kg/m2,男性20例,女性20例。正常体重健康志愿者35例为正常对照组,平均年龄22.26±1.95岁,BMI 21.00±1.36kg/m2,男性19例,女性16例。30例单纯性肥胖伴暴食行为者作为对照组,平均年龄24.50±5.20岁,BMI 32.77±2.01kg/m2,男性15例,女性15例。所有受试者都没有胃肠道疾病和肝病史,没有消化道手术史。试验组和对照组饮食行为为暴食、多食或不停进食。
试验第一天,受试者禁食8h以上,进行水负荷试验观察胃容受性改变。试验第二天,受试者禁食12h,应用电子恒压器进行机械性等容胃扩张检测近端胃功能。正常对照组结束试验。试验组针刺双侧足三里、阴陵泉和天枢穴,阴陵泉和足三里穴接电针刺激,天枢穴不接电针刺激,通电时间为30min。电针串脉冲刺激设定为刺激2s,停3s(即12cpm),串脉冲的频率为40Hz,波宽500μs,输出电流1mA。对照组放气后不进行针刺,保留气囊导管30min,胃底气囊再次充气,两组重复近端胃功能指标检测。
结果:
1.饮水负荷试验:试验组饮水量(1325.75±196.79ml)大于正常对照组(1158.23±195.61ml),差异有统计学意义(P<0.01);试验组饮水量与对照组(1359.67±222.41ml)比差异无统计学意义(P>0.05);对照组饮水量显著大于正常对照组(P<0.01)。
2.胃容积的比较:试验组和对照组初始胃容积和最大耐受胃容积较正常对照组均显著增大(P<0.01);试验组初始胃容积和最大耐受胃容积与对照组比较差异均无统计学意义(P>0.05)。
3.胃内压的比较:三组间最小扩张压、初始胃内压和最大耐受胃内压各自两两相比差异均无统计学意义(P>0.05)。
4.胃顺应性的比较:试验组和对照组最小顺应性与正常对照组相比差异均无统计学意义(P>0.05),初始顺应性、最大耐受顺应性较正常对照组均增大(P<0.01);试验组最小顺应性、初始顺应性、最大耐受顺应性与对照组比较差异均无统计学意义(P>0.05)。
5.电针刺激对胃容积的影响:试验组电针刺激后初始胃容积和最大耐受胃容积较针刺前均显著变小(P<0.01);对照组放气后初始胃容积和最大耐受胃容积与放气前比差异均无统计学意义(P>0.05)。
6.电针刺激对胃内压的影响:试验组电针刺激后最小扩张压与针刺前比差异性无统计学意义(P>0.05),而初始胃内压、最大耐受胃内压较针刺前均增大(P<0.01)。对照组放气后最小扩张压、初始胃内压、最大耐受胃内压与放气前比差异均无统计学意义(P>0.05)。7.电针刺激对胃顺应性的影响:试验组电针刺激后最小顺应性与针刺前
比差异无统计学意义(P>0.05),而初始顺应性和最大耐受顺应性较针刺前均显著变小(P<0.01)。对照组放气后最小顺应性、初始顺应性、最大耐受顺应性与放气前比差异均无统计学意义(P>0.05)。
结论:
1.单纯性肥胖伴暴食行为者胃容受性、顺应性、胃敏感性异于健康正常体重者,使摄食量发生异常。胃容积增加、顺应性变大、容受性增强、饱感延迟发生可能是肥胖伴暴食行为发生的重要原因。
2.电针刺激可能通过降低胃容受性而减少食物的摄入,同时增加胃内压可降低饱感信号阈值从而有效减少饥饿感,达到无饥饿痛苦的减肥目的。
第三部分单纯性肥胖者胃电活动和电针刺激的研究
目的:机械性胃扩张同时,对单纯性肥胖伴暴食行为者和正常体重健康志愿者进行胃电图检测。探讨单纯性肥胖伴暴食行为者胃肌电活动特征和发病机理间的关系及电针刺激对单纯性肥胖伴暴食行为者胃电的影响。
方法:研究对象同第二部分。先记录机械扩张前静息状态胃电图,然后与近端胃功能检测同步进行。在静息、初始胃内压、最大耐受胃内压时各描记胃电图15min。正常对照组结束试验。试验组接受30min电针刺激,对照组不进行电针刺激,放气保留气囊导管30min,两组再进行机械性胃扩张,在静息、初始胃内压、最大耐受胃内压时各描记胃电图15min。
结果:
1.机械性胃扩张时的胃电活动
1.1静息状态三组胃电参数的比较:试验组主频、主功率、胃动过缓百分比、胃动过速百分比、主频不稳定系数五项参数与正常对照组及对照组三组间两两比较差异均无统计学意义(P>0.05)。试验组和对照组正常慢波百分比均显著低于正常对照组(P<0.01),而主功率不稳定系数明显高于正常对照组(P<0.05)。试验组胃电参数与对照组比较差异均无统计学意义(P>0.05)。
1.2初始胃内压状态三组胃电参数的比较:试验组主频、胃动过缓百分比、胃动过速百分比、主频不稳定系数四项参数与正常对照组及对照组三组间两两比较差异均无统计学意义(P>0.05)。试验组和对照组主功率均显著高于正常对照组(P<0.01)。试验组和对照组正常慢波百分比均明显低于正常对照组(P<0.05)。试验组和对照组主功率不稳定系数均明显高于正常对照组(P<0.05)。试验组胃电参数与对照组比较差异均无统计学意义(P>0.05)。
1.3最大耐受胃内压状态三组胃电参数的比较:试验组主频、胃动过缓百分比、胃动过速百分比、主频不稳定系数四项参数与正常对照组及对照组三组间两两比较差异均无统计学意义(P>0.05)。试验组和对照组主功率均显著高于正常对照组(P<0.01)。试验组和对照组正常慢波百分比均显著低于正常对照组(P<0.01)。试验组和对照组主功率不稳定系数均明显高于正常对照组(P<0.05)。试验组胃电参数与对照组比较差异均无统计学意义(P>0.05)。
2.机械性胃扩张对胃电活动的影响
2.1试验组不同胃扩张状态胃电参数的比较:40名单纯性肥胖伴暴食行为者随着胃内压的升高,在静息状态、初始胃内压(IP)状态、最大耐受胃内压(MP)状态:主频(DF)值呈下降趋势,但三者间差异无统计学意义(P>0.05)。主功率(DP)呈上升趋势,且在静息状态与在IP状态和在MP状态相比,差异均有统计意义(P<0.01),DP在IP状态与在MP状态相比差异也有统计学意义(P<0.01)。正常慢波百分比(N%)呈下降趋势,静息状态与MP状态相比差异有统计学意义(P<0.05)。胃动过缓百分比(B%)、胃动过速百分比(T%)和主功率不稳定系数(DPIC)均呈上升趋势,但三组间差异均无统计学意义(P>0.05)。主频不稳定系数(DFIC)呈上升趋势,且在静息状态与在MP状态相比差异有统计学意义(P<0.05)。
2.2对照组不同胃扩张状态胃电参数的比较:30名单纯性肥胖伴暴食行为者随着胃内压的升高,在静息状态、IP状态、MP状态:DF值三者间差异无统计学意义(P>0.05)。DP呈上升趋势,静息状态与IP状态和MP状态相比,差异均有统计学意义(P<0.05,P<0.01),IP状态与MP状态相比差异也有统计学意义(P<0.05)。N%呈下降趋势,静息状态与MP状态相比差异有统计学意义(P<0.05)。B%、T%均呈上升趋势,但三者间差异均无统计学意义(P>0.05)。DFIC呈上升趋势,且在静息状态与在MP状态相比差异有统计学意义(P<0.05)。DPIC呈上升趋势,但三者间差异无统计学意义(P>0.05)。
2.3正常对照组不同胃扩张状态胃电参数的比较:35名正常体重健康志愿者随着胃内压的升高,在静息状态、IP状态、MP状态:DF值三者间差异无统计学意义(P>0.05)。DP值呈上升趋势,静息状态与MP状态的DP值差异有统计学意义(P<0.01)。N%呈下降趋势,且在静息状态与IP状态和在MP状态相比,差异均有统计学意义(P<0.01)。B%呈上升趋势,静息状态与IP状态和MP状态相比,差异均有统计学意义(P<0.05, P<0.01)。T%、DPIC和DFIC值均呈上升趋势,但T%和DPIC三者间差异均无统计学意义(P>0.05),DFIC在静息状态与MP状态差异有统计学意义(P<0.05)。
3.电针刺激对胃扩张状态下胃电活动的影响
3.1电针刺激对静息状态胃电活动的影响:试验组电针刺激后DF值、B%、T%、DFIC、DPIC与针刺前比差异无统计学意义(P>0.05)。而DP和N%明显低于针刺前(P<0.05);对照组放气后胃电参数与放气前比差异均无统计学意义(P>0.05)。
3.2电针刺激对IP状态胃电活动的影响:试验组电针刺激后DF值、B%、DFIC、DPIC与针刺前比差异无统计学意义(P>0.05)。而DP、N%和T%明显低于针刺前(P<0.05);对照组放气后胃电参数与放气前比差异均无统计学意义(P>0.05)。
3.3电针刺激对MP状态胃电活动的影响:试验组电针刺激后DF值、B%、DFIC、DPIC与针刺前比差异均无统计学意义(P>0.05)。而DP显著低于针刺前(P<0.01),N%、T%明显低于针刺前(P<0.05);对照组放气后胃电参数与放气前比差异均无统计学意义(P>0.05)。
结论:
1.单纯性肥胖伴暴食行为者胃扩张时胃电节律异常率较正常体重者显著增高,可能与肥胖者胃容量增加,胃容受性增强,顺应性增大有关,且对饥饿感和饱感发生起着重要的影响。
2.单纯性肥胖伴暴食行为者主功率显著增高,有强的胃收缩力,与前面研究肥胖伴暴食行为者有快速胃排空结果相佐证,即单纯性肥胖伴暴食行为者可能与胃排空过速或动力亢进有关。
3.电针刺激能通过增加胃电节律紊乱和减弱胃收缩力,降低食欲和胃容受性,并延缓胃排空,减少摄食,这可能是电针刺激控制体重和减肥的电生理基础。
第四部分单纯性肥胖者胃动力相关激素和电针刺激的研究
目的:通过对单纯性肥胖伴暴食行为者和正常体重健康者进行餐前餐后胃动素、瘦素、生长素、胰高血糖素肽-1检测,探讨这些激素对肥胖者胃动力的影响,并验证电针刺激治疗的有效性。
方法:正常健康志愿者组(对照组)20例,男11例,女9例,平均年龄22.56±6.23岁,BMI 21.28±1.84kg/m2。单纯性肥胖伴暴食行为组(肥胖组)32例,男17例,女15例,平均年龄23.62±6.24岁,BMI 31.05±1.55kg/m2。禁食12h后于上午8点采空腹静脉血12ml,然后在10min内进食完试验餐,餐后30分钟第二次采血12ml,-70℃冷冻备用,酶联免疫法检测生长素(Ghrelin)、胰高糖素肽-1(GLP-1);放免法测定瘦素(Leptin)、胃动素(MTL)。肥胖组给予电针刺激治疗,每天一次,每次30min,连续七天。第八天重复第一天血样采取过程。记录电针治疗七天后体重的变化。
结果:
1.肥胖组激素水平与对照组的比较
1.1胃动素肥胖组和对照组餐后胃动素水平均较餐前显著升高(P<0.01)。无论是餐前还是餐后,肥胖组胃动素水平均较对照组显著升高(P<0.01)。
1.2瘦素肥胖组和对照组餐后和餐前瘦素水平差异均无统计学意义(P>0.05)。无论是餐前还是餐后,肥胖组瘦素水平均较对照组显著升高(P<0.01)。
1.3生长素肥胖组和对照组餐后生长素水平较餐前均降低(P<0.01)。无论是餐前还是餐后,肥胖组生长素水平均较对照组显著降低(P<0.01)。
1.4胰高糖素肽-1对照组餐后GLP-1水平较餐前明显升高(P<0.01),肥胖组餐后GLP-1水平较餐前释放减少(P<0.01)。无论是餐前还是餐后,肥胖组GLP-1水平均较对照组显著降低(P<0.01)。
2.肥胖组治疗后体重变化较治疗前体重减轻3.55±1.00kg。
3.电针治疗对激素水平的影响
3.1胃动素肥胖组治疗后餐后胃动素明显高于餐前(P<0.05),无论是餐前还是餐后,肥胖组治疗后均较治疗前显著下降(P<0.01)。
3.2瘦素肥胖组治疗后餐后瘦素水平与餐前比较差异无统计学意义(P>0.05),无论是餐前还是餐后,肥胖组治疗后均较治疗前显著下降(P<0.01)。
3.3生长素肥胖组治疗后餐后生长素水平显著低于餐前(P<0.01),无论是餐前还是餐后,肥胖组治疗后较治疗前差异均无统计学意义(P>0.05)。
3.4胰高糖素肽-1肥胖组治疗后餐后胰高糖素肽-1水平与餐前比较差异无统计学意义(P>0.05),无论是餐前还是餐后,肥胖组治疗后均较治疗前显著上升(P<0.01)。
结论:
1.肥胖组瘦素水平无论餐前还是餐后均显著高于正常对照组,而进餐对瘦素水平无明显影响,单纯性肥胖伴暴食行为者可能存在瘦素抵抗。电针刺激使瘦素水平均有显著下降。
2.肥胖组无论餐前还是餐后生长素水平均显著低于正常对照组,表明生长素降低可能是肥胖患者对正能量平衡的生理调节过程。肥胖暴食行为者可能存在进食对生长素的抑制作用较正常人减弱,进而引起食欲增大。
3.肥胖组无论餐前还是餐后胃动素水平均显著高于对照组,肥胖组和对照组餐后胃动素水平均较各自餐前显著升高。电针治疗后胃动素显著下降。
4.胰高糖素肽-1水平降低可能是造成肥胖者胃动力亢进、胃排空加快、胃感觉迟顿、饱感延迟发生的另一主要原因。而电针治疗能提高肥胖组餐前和餐后的胰高糖素肽-1水平。
5.电针刺激有减肥的治疗作用。
Part One Gastric emptying in simply obesity
Objective: To evaluate the relationship of gastric emptying with obese pathogenesis with scintigraphical measurement in simply obesity, normal control and FD patients.
Methods: 30 simple binge-eating obesity include 15 males and 15 females with mean age 25.43±6.74y and MBI of 32.96±2.12kg/m2, 30 healthy volunteers including 15 males and 15 females with mean age of 25.43±6.74y and MBI of 32.96±2.12kg/m2, and 32 FD patients including 14 males amd 18 females with mean age of 35.47±7.21y and MBI of 23.09±1.68kg/m2 were enrolled in this study. None had gastrointestinal and hepatic disorders. scintigraphic gastric emptying assays were performed with a radionuclide technique methods as previously decribed in the morning after twelve hours fasting.
Results: The gastric emptying rates at timepoint of 60 min, 90 min and 120 min in obese group were significantly higher than those of matched control with 44.27±4.82 vs 39.60±3.30, 72.90±5.26 vs 56.83±6.69 and 91.20±4.29 vs 76.00±5.41(P<0.01), respectively. Half-emptying time and gastric retention rate at 120 min were shorter and lower than those in control (8.8±4.92 vs 24.00±5.41, 70.43±7.74 vs 83.10±6.88, P<0.01). FD patients showed a significant delay of gastric emptying compared with control group at timepoint of 60 min, 90 min and 120 min (31.41±8.57 vs 39.60±3.30, 43.06±11.99 vs 56.83±6.69, 54.97±12.50 vs 76.00±5.41, P<0.01). Half-emptying time and gastric retention rate at 120 min were longer and higher than those in control (107.2±25.94 vs 83.10±6.88, 45.03±12.50 vs 24.00±5.41, P<0.01).
Conclusion: Our data demonstrated that obese group had faster gastric empty than normal control and FD patients. Rapid gastric emptying may induce rapid gastrointestinal transit of ingested nutrients and decreased satiety feeling, promote rapid intestinal absorption and enhance hunger feeling in simply obesity with binge eater to draw them to overeat. Our data implied that Rapid gastric emptying maybe the the foundament of overeating so as to obesity.
Part Two Proximal gastric function and Electroacupuncture in simple obesity
Objective: To evaluate the relation among gastric capacity, accommodation, intragastric pressure, visceral sensitivity and obesity in 70 simply binge-eating obesity and 30 normal control with water load test and mechanical gastric distension method. Observe the effece of electro- acupuncture on proximal gastric function of simply obesity with binge eater in order to provid evidence with scientific and reliable for weight loss therapy.
Methods: 105 subjects were divided into three groups: experiment group (40 simple obesity with binge eater, 20 males, 20 females, mean age 24.30±4.99y, BMI 32.07±2.44kg/m2), normal control group (30 healthy volunteers with normal body weight, 19 males, 16 females, mean age 22.26±1.95y, BMI 21.00±1.36kg/m2), control group (30 simple obesity with binge eater, 15 males, 15 females, mean age 24.50±5.20y, BMI 32.77±2.01kg/m2). None of the subjects had any gastrointestinal organic diseases or hepatopathy or a history of gastrointestinal surgery. On the first day, the water load test was performed. On the second day, accommodation, intragastric pressure and gastric compliance using an electronic barostat were measured by mechanical distension. The test of normal control group was over. For subjects of experiment group, Zusanli (ST36) and Yinlingquan (SP9) were punctured and stimulated with an electric pulse generator for 30 min by setting the parameters being 1mA in strength, 500s in the duration of pulses, 40Hz in frequency, 12cpm of pulse trains. Tianshu (ST25) was punctured with the needle retained. Acupuncture was not performed in control group. The repeated isovolumetric gastric distention was performed in the subjects of experiment group and control group.
Results:
1. the water load test: The consumption of water of experiment group and control group were all increased significantly comparison with that in normal control group (1325.75±196.79ml,1359.67±222.41ml vs 1158.23±195.61ml, P<0.01).
2. Gastric capacity: The initial volume (IV) and maximal tolerance volume (MV) in experiment and control group were all significantly larger than those in normal control group (P<0.01). No significant difference in IV and MV were found between experiment group and control group (P>0.05).
3. Intragastric pressure: No statistically significant difference in minimal distention pressure (MDP), initial intragastric pressure (IP) and maximal tolerance pressure (MP) were found among the three groups (P>0.05).
4. Gastric compliance:Minimal distention compliance (MDC) in experiment and control group were not all different from normal control group (P>0.05). The initial gastric compliance (IC),maximal tolerance compliance (MC) in experiment and control group were all significantly larger than those in normal control group (P<0.01). MDC, IC and MC in experiment group were not different from control group (P>0.05).
5. The effect of electroacupuncture on gastric capacity: After stimulation of electroacupuncture, IV and MV in experiment group were lower remarkably than those before (P<0.01). In control group, IV and MV in the first test were not different from those in the second test (P>0.05).
6. The effect of electroacupuncture on intragastric pressure: After stimulation, MDP was similar to before (P>0.05), whereas IP and MP were increased noticeably in comparison with before (P<0.01). In control group, IP and MP in the first test were not different from those in the second test (P>0.05).
7. The effect of electroacupuncture on gastric compliance: After stimulation, MDC was similar to before (P>0.05), whereas IC and MC were decreased noticeably in comparison with before (P<0.01). In control group, IC and MC in the first test were not different from those in the second test (P>0.05).
Conclusion:
1. The proximal gastric functions of simple obesity with binge eater were different from those of healthy people with normal body weight. With the alteration of proximal gastric functions, food intake was increased. Appropriate satiety signals were not triggered in response to gastric distension. Large gastric volume, big gastric compliance and delayed satiety signals were the main reasons of simple obesity with binge eater.
2. Stimulation of electroacupuncture caused food intake decreased by lowing gastric capacity, whereas caused threshold of satiety signal and feeling of hunger decreased by increasing intragastric pressure, so it meet the aim of weight loss without hunger suffering.
Part Three Gastric myoelectrical activity and Electroacupuncture in simple obesity
Objective: To explore the characteristics of gastric myoelectrical activity induced by mechanical distension in simply obese people with binge eater and healthy volunteers with normal body weight; to discuss the relation between gastric myoelectrical activity and obesity; to evaluate the effect of electroacupuncture on electrogastrography (EGG) in simply obese people with binge-eating.
Methods: Standards of subjects selected, rulled out and subjects are the same as above those of Part two. At the first time, all subjects’EGGs were recorded at baseline. All of the subjects were measured with electronic Barostat and Digitrapper electrogastrography equipments at the same time during mechanical distension. EGG was recorded at baseline, IP and MP state for 15 min respectively. Then the test of normal control group was over. The stimulation of electroacupuncture was enforced on experiment group for 30 min. Acupuncture was not performed in control group. The repeated isovolumetric gastric distention and EGG were performed on the experiment and control group.
Results:
1. Gastric myoelectrical activity during mechanical distension
1.1 Comparison of parameters in EGG at the state of baseline among three groups: Five parameters of EGG (DF, DP, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). The percentage of normal slow wave (N%) in experiment and control group were all lower than those in normal control group respectively (P<0.01), whereas DPIC were higher than those in normal control group respectively (P<0.05). No statistically significant difference was found in parameters of EGG between experiment group and control group (P>0.05).
1.2 Comparison of parameters in EGG at the state of IP among three groups: Four parameters of EGG (DF, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). Two parameters of EGG (DP, DPIC) in obese and control group were all higher compared with those in normal control group (P<0.01, P<0.05), whereas N% were lower than those in normal control group respectively (P<0.05). No statistically significant difference were found in parameters of EGG between experiment group and control group (P>0.05).
1.3 Comparison of parameters in EGG at the state of MP among three groups: Four parameters of EGG (DF, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). Two parameters of EGG (DP, DPIC) in experiment and control group were all higher compared with those in normal control group (P<0.01, P<0.05), whereas N% were lower than those in normal control group respectively (P<0.01). No statistically significant difference were found in parameters of EGG between experiment group and control group (P>0.05).
2. Effect of mechanical distension on gastric myoelectrical activity
2.1 Comparison of EGG in experiment group at different gastric dilatation: Four parameters of EGG (DF, B%, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased significantly (30.33±3.81 dB vs 33.01±4.70 dB vs 36.23±4.02 dB, P<0.01); N% was decreased (53.65±14.22 vs 50.37±12.20 vs 47.86±11.65), N% of MP state was lower significantly compared with that of baseline state (P<0.05); DFIC was increased (0.42±0.14 vs 0.45±0.11 vs 0.51±0.16), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).
2.2 Comparison of EGG in control group at different gastric dilatation: Four parameters of EGG (DF, B%, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased significantly(30.42±3.13 vs 33.28±4.79 vs 36.15±4.78); N% was decreased (54.03±16.65 vs 50.33±12.41 vs 45.90±11.93), N% of MP state was lower significantly compared with that of baseline state (P<0.05); DFIC was increased (0.43±0.16 vs 0.45±0.13 vs 0.51±0.17), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).
2.3 Comparison of EGG in normal control group at different gastric dilatation: Three parameters of EGG (DF, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased (29.02±3.27 vs 30.28±3.76 vs 32.06±4.84), DP of MP state was higher significantly compared with that of baseline state (P<0.01); N% was decreased (69.20±15.09 vs 57.50±15.54 vs 56.61±12.80), N% of MP and IP state were all lower significantly compared with that of baseline state (P<0.01); DFIC was increased (0.40±0.12 vs 0.44±0.17 vs 0.49±0.17), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).
3. Effects of acupuncture and electrical stimulation on EGG during mechanical distension
3.1 Effects of acupuncture and electrical stimulation on EGG at state of baseline: Five parameters of EGG (DF, B%, T%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 28.55±3.50 vs 30.33±3.81, P<0.05), (N%: 47.56±11.78 vs 53.56±14.22, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).
3.2 Effects of acupuncture and electrical stimulation on EGG at state of IP: Four parameters of EGG (DF, B%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 30.68±4.58 vs 33.01±4.70, P<0.05), (N%: 44.30±13.18 vs 50.37±12.20, P<0.05), whereas T% was higher noticeably compared with before electroacupuncture (23.59±11.10 vs 18.44±11.97, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).
3.3 Effects of acupuncture and electrical stimulation on EGG at state of MP: Four parameters of EGG (DF, B%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 33.35±5.11 vs 36.23±4.02, P<0.01), (N%: 41.77±12.35 vs 47.86±11.65, P<0.05), whereas T% was higher noticeably compared with before electroacupuncture (25.23±9.66 vs 20.06±10.05, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).
Conclusion:
1. Obese people have remarkable abnormalities in gastric myoelectrical activity. Gastric compacity, accommodation and compliance increase in obese people perhaps play much more important role in above changes of gastric myoelectrical activity. The changes of gastric myoelectrical activity may influence feeling of hunger and satiety in human。
2. A remarkable increasement of DP in the obese suggested that the obese with binge-eater had stronger contraction in comparison with normal subjects. This is evidence of correlation between simply obesity with binge eater and rapid gastric emptying.
3. Stimulation of electroacupuncture in the obese lowed appetite and accommodation by increased abnormalities in gastric myoelectrical activity and weakened gastric contraction. Prolonged gastric emptying and decreased food intake are the electrophysiological foundaments on weight reduction.
Part Four Hormons correlated with gastric motility and Electroacu- puncture in simply obese people
Objective: To detdect serum Motilin, Leptin, Ghrelin, Glucogan-like peptide-1 in 32 simply binge-eating obesity and 20 normal control; to explore the relationship among serum MTL, Leptin, Ghrelin, GLP-1 and gastric motility of obese people and to verify the availability of electroacupuncture.
Methods: 32 simply obese subjects with binge eater (17 males, 15 females, BMI 31.05±1.55kg/m2, age 23.62±6.24y) and 20 healthy subjects with normal weight (11 males, 9 females, BMI 21.28±1.84kg/m2, age 22.56±6.23y) were enrolled. At 8:00 in the morning venous blood was collected after an overnight fast period. and 30 minutes after meal (Kangshifu convenient noodles 127g: carbohydrate 88g, fat 25g, protein 14g, total kalorie 633Kcal) venous blood was recollected and stored at -70℃; Serum Ghrelin, GLP-1 were detected with ELISA method; MTL, Leptin were detected with RI method. 30 min stimulation of electroacupuncture was performed daily on the obese for a week. On the eighth day, blood samples of the obese were collected again. Recorded the loss of weight of the obese for the week.
Results:
1. Comparison of hormones between the obese and the control
1.1 Motilin: Before and after meal, Serum MTL in obese people were higher than those in the control (283.95±83.84pg/ml vs 125.76±33.09pg/ml; 368.80±137.5pg/ml vs 276.8±50.55pg/ml, P<0.01);Compared with pre-meal MTL, post-meal MTL increased significantly in both groups (P<0.01).
1.2 Leptin: Before and after meal, Serum Leptin in obese people were higher than those in the control, (7.42±4.66ng/ml vs 1.33±0.51ng/ml, 7.53±4.98 ng/ml vs 1.21±0.55ng/ml, P<0.01); Post-meal Leptin level was similar to pre-meal Leptin level in obese and control group (P>0.05).
1.3 Ghrelin: Before and after meal, Serum Ghrelin in obese people was lower than those in the control, (3.23±1.24pg/ml vs 9.72±7.10pg/ml, 1.45±0.96pg/ml vs 3.36±2.38pg/ml, P<0.01); Compared with pre-meal Ghrelin, post-meal Ghrelin decreased significantly in both groups (P<0.01).
1.4 GLP-1: Before and after meal, Serum GLP-1 in obese people were lower than those in the control, (1.67±0.36pg/l vs 3.64±1.42pg/l, 1.08±0.81pg/l vs 6.59±1.23pg/l, P<0.01); Compared with pre-meal GLP-1, post-meal GLP-1 increased significantly in the control (P<0.01), while in the obese, post-meal GLP-1 secretion decreased (P<0.05).
2. A mean weight loss for a week: 3.55±1.00kg.
3. Effects of acupuncture and electrical stimulation on hormones
3.1 Motilin: Before and after meal, Serum MTL were lower than those before stimulation (230.73±9.25 vs 283.95±83.84, 264.52±91.51 vs 368.80±137.5, P<0.01). After stimulation in obese group, post-meal MTL increased significantly comared with pre-meal MTL (P<0.05).
3.2 Leptin: Before and after meal, Serum Leptin were lower than those before stimulation (3.31±1.28 vs 7.42±4.66, 3.49±1.35 vs 7.53±4.98, P<0.01). After stimulation in obese group, post-meal Leptin level was similar to pre-meal Leptin level (P>0.05).
3.3 Ghrelin: Before and after meal, Serum Ghrelin level were similar to those before stimulation (3.20±1.21 vs 3.23±1.24, 1.43±0.92 vs 1.45±0.96, P>0.05). After stimulation in obese group, post-meal Ghrelin decreased significantly comared with pre-meal Ghrelin (P<0.01).
3.4 GLP-1: Before and after meal, Serum GLP-1 increased significantly in comparison with those before stimulation (2.55±0.72 vs 1.67±0.36, 2.65±1.12 vs 1.08±0.81, P<0.01). After stimulation in obese group, post-meal GLP-1 level was similar to pre-meal GLP-1 level (P>0.05).
Conclusion:
1. Before and after meal, Serum Leptin in obese people with binge eater were higher than those in the control. Food intake has no effect on Serum Leptin level. Leptin resistance existed in the obese so that the role of inhibition eating cannot run. Stimulation of electroacupuncture for a week made Serum Leptin decreased significantly.
2. Before and after meal,Serum Ghrelin in obese people were lower than those in the control. Low Ghrelin level suggested that it adapted to positive energy balance. Perhaps food intake inhibition on Ghrelin was down-regulation, and then trigger appetite increased.
3. Before and after meal, Serum MTL level were lower than those before stimulation. Compared with pre-meal MTL, post-meal MTL increased significantly in both groups. Stimulation of electroacupuncture for a week made Serum MTL decreased significantly.
4. Serum GLP-1 level decreased resulted in gastric hypermotility, fast empting of stomach, visceral sensitivity obtuse and satiety occurence delayed. Stimulation of electroacupuncture for a week made Serum Leptin increased significantly.
5. The therapeutic effects of electroacupuncture on the simply obese with binge eater were sure.
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