糖尿病胃轻瘫中西医结合诊治进展
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摘要
糖尿病胃轻瘫(DGP)是糖尿病最常见的消化道并发症,其发病机制尚不十分明确,西医缺乏理想的治疗药物,中西医结合疗法可以改善DGP症状,且少有不良反应。文章综述了近年来DGP诊断和中西医治疗进展,诊断方法包括胃排空闪烁扫描术、胃排空呼气试验、无线动力胶囊内镜、胃十二指肠测压、超声和胃电图;中西医治疗包括饮食调整与血糖控制、西医药物治疗、西医非药物治疗、中药治疗和针灸治疗。
Diabetic gastroparesis(DGP) is the most common gastrointestinal complication of diabetes. The pathogenesis of this disease has not been completely clarified. Western medicine lacks ideal therapeutic drugs. The combination of traditional Chinese and western medicine can alleviate the symptoms of DGP and has fewer adverse reactions. This article reviewed the progress of diagnosis and treatment on DGP with integrated traditional Chinese and western medicine in recent years. Diagnostic methods contain gastric emptying scintigraphy, gastric emptying breath test, wireless capsule endoscopy, antrum duodenum pressure measurement, ultrasonic technique, electrogastrogram. Combined treatment of traditional Chinese medicine and western medicine contain diet adjustment and blood sugar control, western medicine therapy, western non-medicine therapy, traditional Chinese medicinal therapy and acupuncture therapy.
Diabetic gastroparesis(DGP) is the most common gastrointestinal complication of diabetes. The pathogenesis of this disease has not been completely clarified. Western medicine lacks ideal therapeutic drugs. The combination of traditional Chinese and western medicine can alleviate the symptoms of DGP and has fewer adverse reactions. This article reviewed the progress of diagnosis and treatment on DGP with integrated traditional Chinese and western medicine in recent years. Diagnostic methods contain gastric emptying scintigraphy, gastric emptying breath test, wireless capsule endoscopy, antrum duodenum pressure measurement, ultrasonic technique, electrogastrogram. Combined treatment of traditional Chinese medicine and western medicine contain diet adjustment and blood sugar control, western medicine therapy, western non-medicine therapy, traditional Chinese medicinal therapy and acupuncture therapy.
引文
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[2]吴文静,赵进喜,王世东,等.吕仁和“六对论治”治疗糖尿病性胃轻瘫经验.中华中医药杂志,2015,30(12):4340-4342
[3]CamilleriM,ParkmanHP,ShafiMA,etal.Clinical guideline:management of gastroparesis.Am J Gastroenterol.2013,108:18-37
[4]许瑾瑾,刘倩琦.糖尿病胃轻瘫发病机制的研究进展.医学综述,2017,23(18):3680-3684
[5]Camilleri M.Novel diet,drugs,and gastric interventions for gastroparesis.Clinical Gastroenterology and Hpatology:The Official Clinical Practice Journal of the American Gastroenterological Association,2016,14(8):1072-1080
[6]Choung R S,Locke G R,Schleck C D,et al.Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population.The American Journal of Gastroenterology,2012,107(1):82-88
[7]Bromer M Q,Kantor S B,Wagner D A,et al.Simultaneous measurement of gastric emptying with a simple muffin meal using[13C]octanoate breath test and scintigraphy in normal subjects and patients with dyspeptic symptoms.Digestive Diseases and Sciences,2002,47(7):1657-1663
[8]Fogle C J.Diabetic gastroparesis:an overview of diagnostic and treatment strategies.Advance for NPs&PAs 2013,4(11):14-18
[9]Perri F,Bellini M,Portincasa P,et al.(13)C-octanoic acid breath test(OBT)with a new test meal(EXPIROGer):Toward standardization for testing gastric emptying of solids.Digestive and Liver Disease:Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver,2010,42(8):549-553
[10]Shin A S,Camilleri M.Diagnostic assessment of diabetic gastroparesis.Diabetes,2013,62(8):2667-2673
[11]Krishnasamy S,Abell T L.Diabetic Gastroparesis:Principles and Current Trends in Management.Diabetes Ther,2018,9(1):1-42
[12]Anitha M,Gondha C,Sutliff R,et al.GDNF rescues hyperglycemia induced diabetic enteric neuropathy through activation of the PI3K/Akt pathway.J Clin Invest,2006,116(2):344-356
[13]Navas C M,Patel N K,Lacy B E.Gastroparesis:Medical and therapeutic advances.Digestive Diseases and Sciences,2017,62(9):2231-2240
[14]Pasricha P J,Pehlivanov N,Sugumar A,et al.J.Drug Insight:From disturbed motility to disordered movement--a review of the clinical benefits and medicolegal risks of metoclopramide.Nature Clinical Practice Gastroenterology&Hepatology,2006,3(3):138-148
[15]Patterson D,Abell T,Rothstein R,et al.A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis.The American Journal of Gastroenterology,1999,94(5):1230-1234
[16]Mc Callum R W,Cynshi O.Clinical trial:Effect of mitemcinal(a motilin agonist)on gastric emptying in patients with gastroparesis-a randomized,multicentre,placebo-controlled study.Alimentary Pharmacology&Therapeutics,2007,26(8):1121-1130
[17]杨晓晖,丛佳林.糖尿病胃轻瘫的诊断与处理.中华全科医学,2017,15(3):369-370
[18]Hasler W L.Gastroparesis:Pathogenesis,diagnosis and management.Nat Rev Gastro-enterol Hepatol,2011,8(8):438-453
[19]Kim S W,Shin I S,Kim J M,et al.Mirtazepine for severe gastroparesis unresponsive to conventional prokinetic treatment.Psychosomatics,2006,47(5):440-442
[20]Laine M,Siren J,Koskenpato J,et al.Outcomes of high-frequency gastric electric stimulation for the treatment of severe,medically refractory gastroparesis in Finland.Scandinavian Journal of Surgery:SJS:Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society,2018,107(2):124-129
[21]Heddle R,Fone D,Dent J,et al.Stimulation of pyloric motility by intraduodenal dextrose in normal subjects.Gut,1988,29(10):1349-1357
[22]Khashab M A,Besharati S,Ngamruengphong S,et al.Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation(with video).Gastrointestinal Endoscopy,2015,82(6):1106-1109
[23]殷贝,李佑生,陈玲玲,等.半夏泻心汤治疗糖尿病胃轻瘫随机对照试验的Meta分析.中国中西医结合消化杂志,2018,26(9):766-774
[24]王诗才,施秀娟,邓钰杰,等.糖尿病胃轻瘫中医辨证分型文献再评价.中医临床研究,2015,7(20):42-44
[25]逢冰,周强,李君玲,等.仝小林教授治疗糖尿病性胃轻瘫经验.中华中医药杂志,2014,29(7):2246-2249
[26]李宗学.中西医结合治疗糖尿病胃轻瘫32例临床观察.首都医药,2011,18(12):17-19
[27]张月,董艳,周静,等.消痞方治疗糖尿病胃轻瘫的临床研究.河北中医药学报,2016,31(1):51-53
[28]张月,董艳,王倩,等.自拟消痞方治疗糖尿病胃轻瘫临床研究.中国中医药信息杂志,2017,24(2):25-28
[29]金海珍.针灸治疗糖尿病胃轻瘫70例的临床观察.中国实用医药,2014,9(27):246-247
[30]佟媛媛,吕建明,卞金玲,等.针刺治疗糖尿病性胃轻瘫62例的疗效观察.中华中医药杂志,2014,29(11):3657-3659
[31]张弘,沈旭君,倪海祥,等.针灸结合中药治疗糖尿病胃轻瘫Meta分析.浙江中西医结合杂志,2016,26(10):961-964
[32]马慧卿,张利平,张凯鑫,等.针灸治疗胃轻瘫研究进展.针灸临床杂志,2018,34(8):76-79
[33]王志萍,朱文霞.推拿联合干涉波治疗糖尿病性胃轻瘫的疗效观察.中国冶金工业医学杂志,2016,33(6):694-696
[2]吴文静,赵进喜,王世东,等.吕仁和“六对论治”治疗糖尿病性胃轻瘫经验.中华中医药杂志,2015,30(12):4340-4342
[3]CamilleriM,ParkmanHP,ShafiMA,etal.Clinical guideline:management of gastroparesis.Am J Gastroenterol.2013,108:18-37
[4]许瑾瑾,刘倩琦.糖尿病胃轻瘫发病机制的研究进展.医学综述,2017,23(18):3680-3684
[5]Camilleri M.Novel diet,drugs,and gastric interventions for gastroparesis.Clinical Gastroenterology and Hpatology:The Official Clinical Practice Journal of the American Gastroenterological Association,2016,14(8):1072-1080
[6]Choung R S,Locke G R,Schleck C D,et al.Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population.The American Journal of Gastroenterology,2012,107(1):82-88
[7]Bromer M Q,Kantor S B,Wagner D A,et al.Simultaneous measurement of gastric emptying with a simple muffin meal using[13C]octanoate breath test and scintigraphy in normal subjects and patients with dyspeptic symptoms.Digestive Diseases and Sciences,2002,47(7):1657-1663
[8]Fogle C J.Diabetic gastroparesis:an overview of diagnostic and treatment strategies.Advance for NPs&PAs 2013,4(11):14-18
[9]Perri F,Bellini M,Portincasa P,et al.(13)C-octanoic acid breath test(OBT)with a new test meal(EXPIROGer):Toward standardization for testing gastric emptying of solids.Digestive and Liver Disease:Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver,2010,42(8):549-553
[10]Shin A S,Camilleri M.Diagnostic assessment of diabetic gastroparesis.Diabetes,2013,62(8):2667-2673
[11]Krishnasamy S,Abell T L.Diabetic Gastroparesis:Principles and Current Trends in Management.Diabetes Ther,2018,9(1):1-42
[12]Anitha M,Gondha C,Sutliff R,et al.GDNF rescues hyperglycemia induced diabetic enteric neuropathy through activation of the PI3K/Akt pathway.J Clin Invest,2006,116(2):344-356
[13]Navas C M,Patel N K,Lacy B E.Gastroparesis:Medical and therapeutic advances.Digestive Diseases and Sciences,2017,62(9):2231-2240
[14]Pasricha P J,Pehlivanov N,Sugumar A,et al.J.Drug Insight:From disturbed motility to disordered movement--a review of the clinical benefits and medicolegal risks of metoclopramide.Nature Clinical Practice Gastroenterology&Hepatology,2006,3(3):138-148
[15]Patterson D,Abell T,Rothstein R,et al.A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis.The American Journal of Gastroenterology,1999,94(5):1230-1234
[16]Mc Callum R W,Cynshi O.Clinical trial:Effect of mitemcinal(a motilin agonist)on gastric emptying in patients with gastroparesis-a randomized,multicentre,placebo-controlled study.Alimentary Pharmacology&Therapeutics,2007,26(8):1121-1130
[17]杨晓晖,丛佳林.糖尿病胃轻瘫的诊断与处理.中华全科医学,2017,15(3):369-370
[18]Hasler W L.Gastroparesis:Pathogenesis,diagnosis and management.Nat Rev Gastro-enterol Hepatol,2011,8(8):438-453
[19]Kim S W,Shin I S,Kim J M,et al.Mirtazepine for severe gastroparesis unresponsive to conventional prokinetic treatment.Psychosomatics,2006,47(5):440-442
[20]Laine M,Siren J,Koskenpato J,et al.Outcomes of high-frequency gastric electric stimulation for the treatment of severe,medically refractory gastroparesis in Finland.Scandinavian Journal of Surgery:SJS:Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society,2018,107(2):124-129
[21]Heddle R,Fone D,Dent J,et al.Stimulation of pyloric motility by intraduodenal dextrose in normal subjects.Gut,1988,29(10):1349-1357
[22]Khashab M A,Besharati S,Ngamruengphong S,et al.Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation(with video).Gastrointestinal Endoscopy,2015,82(6):1106-1109
[23]殷贝,李佑生,陈玲玲,等.半夏泻心汤治疗糖尿病胃轻瘫随机对照试验的Meta分析.中国中西医结合消化杂志,2018,26(9):766-774
[24]王诗才,施秀娟,邓钰杰,等.糖尿病胃轻瘫中医辨证分型文献再评价.中医临床研究,2015,7(20):42-44
[25]逢冰,周强,李君玲,等.仝小林教授治疗糖尿病性胃轻瘫经验.中华中医药杂志,2014,29(7):2246-2249
[26]李宗学.中西医结合治疗糖尿病胃轻瘫32例临床观察.首都医药,2011,18(12):17-19
[27]张月,董艳,周静,等.消痞方治疗糖尿病胃轻瘫的临床研究.河北中医药学报,2016,31(1):51-53
[28]张月,董艳,王倩,等.自拟消痞方治疗糖尿病胃轻瘫临床研究.中国中医药信息杂志,2017,24(2):25-28
[29]金海珍.针灸治疗糖尿病胃轻瘫70例的临床观察.中国实用医药,2014,9(27):246-247
[30]佟媛媛,吕建明,卞金玲,等.针刺治疗糖尿病性胃轻瘫62例的疗效观察.中华中医药杂志,2014,29(11):3657-3659
[31]张弘,沈旭君,倪海祥,等.针灸结合中药治疗糖尿病胃轻瘫Meta分析.浙江中西医结合杂志,2016,26(10):961-964
[32]马慧卿,张利平,张凯鑫,等.针灸治疗胃轻瘫研究进展.针灸临床杂志,2018,34(8):76-79
[33]王志萍,朱文霞.推拿联合干涉波治疗糖尿病性胃轻瘫的疗效观察.中国冶金工业医学杂志,2016,33(6):694-696