糖尿病结肠传输异常的发生率及相关因素分析
摘要
目的1.验证不透X线标记物在临床诊断结肠慢传输的作用。
2.研究2型糖尿病(DM)患者的结肠传输异常的发生情况及相关的影响因素。
方法以152例DM患者,健康志愿者30例为研究对象,其中48hGITT检测异常合并消化道症状DM患者33例设分为观察组1、31例48hGITT检测异常无消化道症状患者为观察组2,并以88例48hGITT检测正常无消化道症状DM患者为对照组,对三组别进行多因素分析。
结果152例DM患者结肠传输异常发生率为42.1%,三组平均病程、FPG、SBP、SDP观察组1与其他两组均存在统计学差异,HbAlc三组别两两比较均有统计学差异。
结论长期的血糖、血压控制不良会加速DM患者结肠功能紊乱并发症的发生。
Objective1.To prove the role of radioopaque markers in the evaluation of colonic transit function.
2. To study of type2diabetes mellitus (DM) patients with colonic transmission abnormality occurrence and related factors.
Methods152cases of patients with DM and30cases of healthy volunteers as the research object, wherein48hGITT detection of abnormalities associated with gastrointestinal symptoms of33patients with DM have divided into the observation group1,31cases of48hGITT detection of abnormal gastrointestinal symptoms patients into the observation group2, and8848hGITT detection of normal gastrointestinal symptoms in DM patients as a control group, three groups of multiple factors analysis.
Result The152cases of DM patients with abnormal colonic transit rate was42.1%, the average duration of three groups, FPG and SBP, the SDP observation group and the other two groups there was significant difference of HbAlc three groups were statistically significant pairwise comparisons between.
Conclusion long-term glucose, poor control of blood pressure can accelerate DM patients with colonic dysfunction complications.
2.研究2型糖尿病(DM)患者的结肠传输异常的发生情况及相关的影响因素。
方法以152例DM患者,健康志愿者30例为研究对象,其中48hGITT检测异常合并消化道症状DM患者33例设分为观察组1、31例48hGITT检测异常无消化道症状患者为观察组2,并以88例48hGITT检测正常无消化道症状DM患者为对照组,对三组别进行多因素分析。
结果152例DM患者结肠传输异常发生率为42.1%,三组平均病程、FPG、SBP、SDP观察组1与其他两组均存在统计学差异,HbAlc三组别两两比较均有统计学差异。
结论长期的血糖、血压控制不良会加速DM患者结肠功能紊乱并发症的发生。
Objective1.To prove the role of radioopaque markers in the evaluation of colonic transit function.
2. To study of type2diabetes mellitus (DM) patients with colonic transmission abnormality occurrence and related factors.
Methods152cases of patients with DM and30cases of healthy volunteers as the research object, wherein48hGITT detection of abnormalities associated with gastrointestinal symptoms of33patients with DM have divided into the observation group1,31cases of48hGITT detection of abnormal gastrointestinal symptoms patients into the observation group2, and8848hGITT detection of normal gastrointestinal symptoms in DM patients as a control group, three groups of multiple factors analysis.
Result The152cases of DM patients with abnormal colonic transit rate was42.1%, the average duration of three groups, FPG and SBP, the SDP observation group and the other two groups there was significant difference of HbAlc three groups were statistically significant pairwise comparisons between.
Conclusion long-term glucose, poor control of blood pressure can accelerate DM patients with colonic dysfunction complications.
引文
1.高显奎,余跃,杨琰,等.高糖对体外培养的Cajal间质细胞P2X7嘌呤能受体表达的影响[J]世界华人消化杂志,2010.18(12)1211-1216
2.许新芳陈国昌毛伯能等,糖尿病大鼠胃肠功能紊乱时结肠组织中的cajal间质细胞的表达[J]胃肠病学和肝病学杂志2009.18(12)1087-1090
3.蓝宇,张贲、叶华、梁学亚,糖尿病消化不良调查及其与其他脏器合并症关系 [J]基础医学与临床2001.21(增刊)81
4. Daigo Y, Takayama I, Ward SM. Novel human and mouse genes encoding a shank-interacting protein and its upregulation in gastric fundus of W/WV mouse Journal of Gastroenterology and Hepatology,2006,18 (6) 712-718
5.柯美云蓝宇 糖尿病胃肠并发症的动力障碍及其机制,中华内分泌代谢杂志2003.6.19(3) 164-165
6. Tomita R, Tanjoh K,Fujisaki S, et al. Regulation of the enteric nervous system in the colon of patients with slow transion constipation [J]. Hepatogastroenterology, 2002,49:1540-1544
7.罗云,林琳,张红杰.糖尿病慢传输运动结肠Cajal间质细胞和干细胞因子的变化[J].世界华人消化杂志,2007(15)；534-536
8.孙维孔侃, 胃肠激素与糖尿病结肠功能紊乱[J].世界华人消化杂志,2006 14(5)；519-521
9.林琳,徐丽明,罗云等.糖尿病结肠功能障碍时Cajal细胞和干细胞因子的变化及胰岛素的干预效应[J].胃肠病学2008 13(4)； 200-204
10.张亚萍,张宽学,罗金燕等,糖尿病大鼠肠道Cajal间质细胞结构变化的研究[J].中华内科杂志,2002,41(5)：310-312
11. Ackerman Z, Lysy J, Meiner-Lavie V. The association of fecal impaction and verapamil in a patient with scleroderma[J]. Am J Gastroenterol,1989,84:981-982.
12.王亚旭,时德,刘宝华,慢传输性便秘结肠阿片受体的病理生理改变[J],中华胃肠外科杂志,2002,5：70-72.
13. Kito Y, ward SM, Sanders KM. Pacemaker potentials generated by interstitial cells of Cajal in the murine intestine[J]. American Journal of Physiology-Cell Physiology,2005
14.鲁素彩,房红梅,田自力等.老年2型糖尿病患者胃肠动力紊乱及其相关因素的研究[J].中 国老年学杂志,2010,2(20)：80-81.
15. Forrest A, Parsons M The enhanced Spontaneous activity of the diabetic colon is not the consequence of impaired inhibitory control mechanisms. Auton autacoid Pharmcol 2003; 23:149-158.
16. Forster J, Damjanov I, Lin Z, et al. Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg,2005,9 (1):102-108.
17. Horvath VJ, Vittal H, LOrincz A, et al. Reduced stem cell factor links smooth myopathy and loss of interstitial cells of cajal in murine diabetic gastroparesis. Gastroenterology,2006,130 (3):759-770.
18.孟凡良.糖尿病胃肠并发症的动力障碍及治疗观察[J].中国医药导报,2006,3(29)：44-46.
19. Wedel T. Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit. constioation and megacolon [J]. Gastroenterology,2006,123(5):1459-1467.
20. Rao SS,Camilleri M, Hasler WL,et al. Evaluation of gastrointestinal transit in clinical practice:position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil,2011, 23(1):8-23.
21. Southwell BR, Clarke MC, Sutcliffe J, et al. Colonic transit studies:normal values for adults and children with comparison of radiological and scintigraphic methods. Pediatr Surg Int,2009,25(7):559-572.
22. Xu HM, Han JG, Na Y, et al. Colonic transit time in patient with slow-transit constipation:Comparison of radiopaque markers and barium suspension method.Eur J Radiol,2010(Epub ahead of print).
23.中华医学会消化病学分会胃肠动力学组,外科学分会结直肠肛门外科学组.中国慢性便秘的诊治指南(2007,扬州).中华消化杂志,2007,27(9)：619-622.
24. Ohshiro K, Yamataka A, Kobayashi H,Hirai S,Miyahara K, Sueyoshi N, Suda K, Miyano T. Idiopathic gastric perforation in neonates and abnormal diatribution of intestinal pacemaker cells, J Pediatr Surg 2000:35:673-676
25.黄旭,张扬,高玲,赵鹏,韩燕飞等。P2X受体对豚鼠胃窦环形肌自发性收缩运动的影响。世界华人消化杂志2007；15：1185-1190
26. Yaser Alduais孔浩谢小平杜凡刘诗侯晓华。不透X线标记物法在评价结肠传输功能中的作用。胃肠病学2011；16(6)：337-340.
27. Chan YK, Kwan AC, Yuen H, et al. Normal colon transit time in healthy chinese adults in Hong Kong. J Gastroenterol Hepatol,2004,19(11):1270-1275.
28. Jung HK, Kim DY, Moon IH, Effects of gender and menstrual cycle on colonic transit time in healthy subjects. Korean J Intern Med,2003,18(3):181-186.
29. Arhan P,Devroede G, Jehannin B,et al.Segmental colonic transit time. Dis Colon Rectum,1981,24(8):625-629.
30. Chaussade S, Roche H, Khyari A, et al, Measurement of colonic transit time:description and validation of a new method (Article in French). Gastroenterol Clin Biol,1986,10(5):385-389.
31.王毅,龚水根,吴少平.结肠运输试验对诊断便秘标准的探讨。中国医学影像技术,1997,13(4)：345-347.
32. Horvath VJ, Vittal H, Redelman D, et al. Stimulation of stem cell factor (SGF) expression by insulin or insulin-like growth factor-1(IGF-1) is required for the long-term maintenance of intestinal cells of Cajal(ICC). Gastro-enterology,2004,126(4 suppl 2):A102.
33. Wild S, Roglic G, Green A et al. Global prevalence of diabetes:estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-1053.
34. Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum)[J]. Ann Intern Med,1958,48(4):797-812.
35. Hosoda H, Kojima M, Matsuo H, et al. Purification and characterization of rat des-Glnl4-Ghrelin, a second endogenous ligand for the growth hormone secretagogue receptor [J]. J Boil Chem,2000,275(29):21995-22000.
36. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis[J]. Gastroenterology,2004,127 (5):1592-1622.
37. Jones KL, Russo A, Stevens JE, et al. Predictors of delayed gastric emptying in diabetes[J]. Diabetes Care,2001,24(7):1264-1269.
38. Forster J, Damjanov I, Lin Z, Sarosiek I, Wetzel P, McCallum RW. Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings[J]. J Gastrointest Surg,2005,9(1):102-108.
39. Li CX, Liu BH, Tong WD, et al. Disslciation, culture and morphologic changes of interstitial cells of Cajal in vitro. World J Gastroenterol,2005,11(18):2838-2840
40. Lembo A, Camilleri M. Chronic contipation, N Engl J Med,2003,349(14)1360-1368.
41. Bouchoucha M, Devroede G, Arhan P, et al.What is the meaning of colorectal transit time measurement? Dis Colon Rectum,1992,35(8):773-782.
42. Longstreth GF, Thompson WG, Chey WD,et al. Functional bowel disorders. Gastroenterology,2006,130(5):1480-1491.
43. Metcalf AM, Philips SF, Zinsmeister AR, et al. Simplified assessment of segmental colonic transit. Gastroenterology,1987,92(1):40-47
44. Buhmann S, Kirechhoff C, Ladumer R, et al. Assessment of colonic transit time using MRI:a fessibility study. Eurradiol.2007,17(3):669-674.
1. Tomita R, Tanjoh K, Fujisaki S, et al. Regulation of the enteric nervous system in the colon of patients with slow transit constipation. Hepatogas-troenterology,2002,49: 1540-1544.
2. Ackerman Z, Lysy J, Meiner-Lavie V. The association of fecal impaction and verapamil in a patient with scleroderma. Am J Gastroenterol,1989,84:981-982.
3.高显奎,余跃,杨琰,等.高糖对体外培养的Cajal间质细胞P2X7嘌呤能受体表达的影响[J]世界华人消化杂志,2010.18(12)1211-1216.
4. Dai go Y, Takayama I, Ward SM. Novel human and mouse genes encoding a shank-interacting protein and its upregulation in gastric fundus of W/WV mouse Journal of Gastro-enterology and Hepatology,2006,18 (6) 712-718.
5.许新芳陈国昌毛伯能等,糖尿病大鼠胃肠功能紊乱时结肠组织中的cajal间质细胞的表达[J]胃肠病学和肝病学杂志2009.18(12)1087-1090.
6.罗云,林琳,张红杰.糖尿病慢传输运动结肠Cajal间质细胞和干细胞因子的变化[J].世界华人消化杂志,2007(15)：534-536.
7. Ohshiro-K, Yamataka A, Kobayashi H,Hirai S,Miyahara K,Sueyoshi N, Suda K, Miyano T. Idiopathic gastric perforation in neonates and abnormal diatribution of intestinal pacemaker cells, J Pediatr Surg 2000;35:673-676
8.黄旭,张扬,高玲,赵鹏,韩燕飞等。P2X受体对豚鼠胃窦环形肌自发性收缩运动的影响。世界华人消化杂志2007；15：1185-1190
9.林琳徐丽明罗云吴高珏汤玉蓉张红杰李学良糖尿病结肠功能障碍时Cajal细胞和干细胞因子的变化及胰岛素的干预效应胃肠病学2008；13(4)：681-686.
10. Bellone G, Smirne C, Carbone A, Buffolino A, Scirelli T, Prati A, Solerio D, Pirisi M, Valente G, Nano M, Emanuelli G. KIT/stem cell factor expression in premalignant and malignant lesions of the colon mucosa in relationship to disease progression and outcomes. International journal of oncology,2006;4:571-573.
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12.吴波,郑长青.幽门螺杆菌、胃肠激素与糖尿病胃轻瘫的关系[J].世界华人消化杂志, 2010,18(15)：1616-1619.
13. Wild S, Roglic G, Green A et al. Global prevalence of diabetes:estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-1053.
14. Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum)[J]. Ann Intern Med,1958,48(4):797-812.
15. Hosoda H, Kojima M, Matsuo H, et al. Purification and characterization of rat des-Glnl4-Ghrelin, a second endogenous ligand for the growth hormone secretagogue receptor [J]. J Boil Chem,2000,275(29):21995-22000.
16. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis[J]. Gastroenterology,2004,127(5):1592-1622.
17. Jones KL, Russo A, Stevens JE, et al. Predictors of delayed gastric emptying in diabetes[J]. Diabetes Care,2001,24(7):1264-1269.
18. Forster J, Damjanov I, Lin Z, Sarosiek I, Wetzel P, McCallum RW. Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings[J]. J Gastrointest Surg,2005,9 (1):102-108.
19. Longstreth GF, Thomopson WG, Chey WD, et al. tunctional bowel diaorders. Gastroenterology,2006,130(5):1480-1491.
20. Dennison C, Prasad M, Lioyd A, et al. The health-related quality of life and.economic burden of constipation. Pharmacoeconomics,2005,23(5):461-476.
21. Cheng C, Chan A0, Hui WM, et al. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation:a population -based study.Aliment Pharmacol Ther,2003,18(3):319-326.
22.林征,林琳,张红杰,等。功能性便秘患者社会、心理、行为状况调查及生物反馈治疗效果.中国临床康复,2005,9(28)：67-69.
23. Lembo A, Camilleri M. Chronic contipation, N Engl J Med,2003,349(14)1360-1368.
24. Bouchoucha M,Devroede G, Arhan P, et al. What is the meaning of colorectal transit time measurement? Dis Colon Rectum,1992,35(8):773-782.
25. Longstreth GF, Thompson WG, Chey WD,et al. Functional bowel disorders. Gastroenterology,2006,130(5):1480-1491.
26. Metcalf AM, Philips SF, Zinsmeister AR, et al. Simplified assessment of segmental colonic transit. Gastroenterology,1987,92(1):40-47
27. Buhmann S, Kirechhoff C, Ladumer R, et al. Assessment of colonic transit time using MRI:a fessibility study. Eurradiol.2007,17(3):669-674.
2.许新芳陈国昌毛伯能等,糖尿病大鼠胃肠功能紊乱时结肠组织中的cajal间质细胞的表达[J]胃肠病学和肝病学杂志2009.18(12)1087-1090
3.蓝宇,张贲、叶华、梁学亚,糖尿病消化不良调查及其与其他脏器合并症关系 [J]基础医学与临床2001.21(增刊)81
4. Daigo Y, Takayama I, Ward SM. Novel human and mouse genes encoding a shank-interacting protein and its upregulation in gastric fundus of W/WV mouse Journal of Gastroenterology and Hepatology,2006,18 (6) 712-718
5.柯美云蓝宇 糖尿病胃肠并发症的动力障碍及其机制,中华内分泌代谢杂志2003.6.19(3) 164-165
6. Tomita R, Tanjoh K,Fujisaki S, et al. Regulation of the enteric nervous system in the colon of patients with slow transion constipation [J]. Hepatogastroenterology, 2002,49:1540-1544
7.罗云,林琳,张红杰.糖尿病慢传输运动结肠Cajal间质细胞和干细胞因子的变化[J].世界华人消化杂志,2007(15)；534-536
8.孙维孔侃, 胃肠激素与糖尿病结肠功能紊乱[J].世界华人消化杂志,2006 14(5)；519-521
9.林琳,徐丽明,罗云等.糖尿病结肠功能障碍时Cajal细胞和干细胞因子的变化及胰岛素的干预效应[J].胃肠病学2008 13(4)； 200-204
10.张亚萍,张宽学,罗金燕等,糖尿病大鼠肠道Cajal间质细胞结构变化的研究[J].中华内科杂志,2002,41(5)：310-312
11. Ackerman Z, Lysy J, Meiner-Lavie V. The association of fecal impaction and verapamil in a patient with scleroderma[J]. Am J Gastroenterol,1989,84:981-982.
12.王亚旭,时德,刘宝华,慢传输性便秘结肠阿片受体的病理生理改变[J],中华胃肠外科杂志,2002,5：70-72.
13. Kito Y, ward SM, Sanders KM. Pacemaker potentials generated by interstitial cells of Cajal in the murine intestine[J]. American Journal of Physiology-Cell Physiology,2005
14.鲁素彩,房红梅,田自力等.老年2型糖尿病患者胃肠动力紊乱及其相关因素的研究[J].中 国老年学杂志,2010,2(20)：80-81.
15. Forrest A, Parsons M The enhanced Spontaneous activity of the diabetic colon is not the consequence of impaired inhibitory control mechanisms. Auton autacoid Pharmcol 2003; 23:149-158.
16. Forster J, Damjanov I, Lin Z, et al. Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg,2005,9 (1):102-108.
17. Horvath VJ, Vittal H, LOrincz A, et al. Reduced stem cell factor links smooth myopathy and loss of interstitial cells of cajal in murine diabetic gastroparesis. Gastroenterology,2006,130 (3):759-770.
18.孟凡良.糖尿病胃肠并发症的动力障碍及治疗观察[J].中国医药导报,2006,3(29)：44-46.
19. Wedel T. Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit. constioation and megacolon [J]. Gastroenterology,2006,123(5):1459-1467.
20. Rao SS,Camilleri M, Hasler WL,et al. Evaluation of gastrointestinal transit in clinical practice:position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil,2011, 23(1):8-23.
21. Southwell BR, Clarke MC, Sutcliffe J, et al. Colonic transit studies:normal values for adults and children with comparison of radiological and scintigraphic methods. Pediatr Surg Int,2009,25(7):559-572.
22. Xu HM, Han JG, Na Y, et al. Colonic transit time in patient with slow-transit constipation:Comparison of radiopaque markers and barium suspension method.Eur J Radiol,2010(Epub ahead of print).
23.中华医学会消化病学分会胃肠动力学组,外科学分会结直肠肛门外科学组.中国慢性便秘的诊治指南(2007,扬州).中华消化杂志,2007,27(9)：619-622.
24. Ohshiro K, Yamataka A, Kobayashi H,Hirai S,Miyahara K, Sueyoshi N, Suda K, Miyano T. Idiopathic gastric perforation in neonates and abnormal diatribution of intestinal pacemaker cells, J Pediatr Surg 2000:35:673-676
25.黄旭,张扬,高玲,赵鹏,韩燕飞等。P2X受体对豚鼠胃窦环形肌自发性收缩运动的影响。世界华人消化杂志2007；15：1185-1190
26. Yaser Alduais孔浩谢小平杜凡刘诗侯晓华。不透X线标记物法在评价结肠传输功能中的作用。胃肠病学2011；16(6)：337-340.
27. Chan YK, Kwan AC, Yuen H, et al. Normal colon transit time in healthy chinese adults in Hong Kong. J Gastroenterol Hepatol,2004,19(11):1270-1275.
28. Jung HK, Kim DY, Moon IH, Effects of gender and menstrual cycle on colonic transit time in healthy subjects. Korean J Intern Med,2003,18(3):181-186.
29. Arhan P,Devroede G, Jehannin B,et al.Segmental colonic transit time. Dis Colon Rectum,1981,24(8):625-629.
30. Chaussade S, Roche H, Khyari A, et al, Measurement of colonic transit time:description and validation of a new method (Article in French). Gastroenterol Clin Biol,1986,10(5):385-389.
31.王毅,龚水根,吴少平.结肠运输试验对诊断便秘标准的探讨。中国医学影像技术,1997,13(4)：345-347.
32. Horvath VJ, Vittal H, Redelman D, et al. Stimulation of stem cell factor (SGF) expression by insulin or insulin-like growth factor-1(IGF-1) is required for the long-term maintenance of intestinal cells of Cajal(ICC). Gastro-enterology,2004,126(4 suppl 2):A102.
33. Wild S, Roglic G, Green A et al. Global prevalence of diabetes:estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-1053.
34. Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum)[J]. Ann Intern Med,1958,48(4):797-812.
35. Hosoda H, Kojima M, Matsuo H, et al. Purification and characterization of rat des-Glnl4-Ghrelin, a second endogenous ligand for the growth hormone secretagogue receptor [J]. J Boil Chem,2000,275(29):21995-22000.
36. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis[J]. Gastroenterology,2004,127 (5):1592-1622.
37. Jones KL, Russo A, Stevens JE, et al. Predictors of delayed gastric emptying in diabetes[J]. Diabetes Care,2001,24(7):1264-1269.
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