超声技术对糖尿病患者胆囊排空功能的研究及其机制探讨
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摘要
目的：采用超声技术探讨糖尿病患者胆囊排空功能的改变及其发生机制。
方法：超声测定24例糖尿病合并自主神经病变患者(AN组)、16例不合并自主神经病变患者(NAN组)及20例正常对照组空腹胆囊体积、脂餐后胆囊的排空功能及胆囊动脉血流；用放射免疫分析法测定各组空腹及脂餐后血浆CCK浓度。
结果：AN组较NAN组及正常组空腹胆囊体积明显增大(22.71±6.67 vs 14.39±5.10,15.49±4.66,P均<0.01),餐后各时点胆囊体积也显著增大(P<0.01),各时点胆囊排空率明显减低(P<0.01)；AN组胆囊动脉血流参数阻力指数(RI)较NAN组及正常组明显升高(0.74±0.07vs 0.65±0.05,0.61±0.06,P均<0.01),而舒张期最低流速(Vmin)较NAN组及正常组明显降低(5.62±1.19 vs 8.31±1.86,8.72±1.43,P均<0.01)；胆囊动脉RI与糖化血.红蛋白及胰岛素抵抗指数(Homa-IR)显著相关(r=0.648,0.822,P<0.05)。AN组及NAN组空腹及脂餐后血浆CCK浓度均明显低于C组(空腹：21.47±4.01,24.40±2.56 vs 29.18±1.38,P均<0.01；脂餐后：42.13±3.09,47.47±2.67 vs 51.13±3.02,P均<0.01),且AN组CCK浓度减低更为显著(P<0.01)。
结论：糖尿病患者胆囊排空功能明显减低,且与糖尿病患者自主神经受损及血浆CCK浓度减低有关；糖尿病合并自主神经病变时其胆囊动脉阻力指数(RI)和舒张期最低流速(Vmin)较NAN组及正常组有明显差异,糖尿病胆囊动脉血管病变也是影响胆囊排空功能的重要原因。
Objective:To investigate the dysfunction of gallbladder emptying in diabetic patients and its possible mechanism.
Methods:The gallbladder size and the blood flow of the gallbladder artery on the empty stomach, the gallbladder shrinking function by fat food test were measured with B ultrasound. as well as the serum concentration of Cholecystokinin-CCK was determined with radioimmunoassay in 24 diabetics with autonomic neuropathy(AN group),16 diabetics without autonomic neuropathy(NAN group) and 20 healthy controls.
Results:The gallbladder volumes of fasting distinctly increased in the AN group than that of the healthy subjects and the NAN group (22.71±6.67 vs 14.39±5.10,15.49±4.66, P<.01), and The gallbladder volumes of postprandial at all time points significantly increased (P<0.01). while The emptying rate of gallbladder at all time points was distinctly lower in the AN group than that of the healthy subjects and the NAN group (P<0.01). In AN group, The gallbladder artery's index (RI) was significantly higher than in NAN group and healthy subjects (0.74±0.07 vs0.65±0.05,0.61±0.06, P<0.01). moreover The gallbladder artery's index (Vmin) was significantly lower than in NAN group and healthy subjects (5.62±1.19 vs 8.31±1.86,8.72±1.43, P< 0.01). and gallbladder artery's index (RI) had significant relation to the glycolated hemoglobin and Insulin Resistance Index, Homa-IR (r=0.648,0.822, P<0.05). The fasting and fat postprandial's serum concentration of CCK increased in the AN group and the NAN group than that of the healthy subjects (fasting:21.47±4.01,24.40±2.56 vs 29.18±1.38, P<0.01; fat postprandial:42.13±3.09,47.47±2.67 vs 51.13±3.02, P<0.01), moreover the AN group's serum concentration of CCK increased more markedly (P<0.01).
Conclusion:The dysfunction of gallbladder emptying in diabetic patients is partly due to the impaired autonomic nerve and the decrease of serum concentration of CCK, There are significant difference on gallbladder artery's index (RI and Vmin) among the AN group, NAN group and healthy subjects, the decrease of gallbladder shrinking function may be caused by the change of the hemodynamics of gallbladder.
方法：超声测定24例糖尿病合并自主神经病变患者(AN组)、16例不合并自主神经病变患者(NAN组)及20例正常对照组空腹胆囊体积、脂餐后胆囊的排空功能及胆囊动脉血流；用放射免疫分析法测定各组空腹及脂餐后血浆CCK浓度。
结果：AN组较NAN组及正常组空腹胆囊体积明显增大(22.71±6.67 vs 14.39±5.10,15.49±4.66,P均<0.01),餐后各时点胆囊体积也显著增大(P<0.01),各时点胆囊排空率明显减低(P<0.01)；AN组胆囊动脉血流参数阻力指数(RI)较NAN组及正常组明显升高(0.74±0.07vs 0.65±0.05,0.61±0.06,P均<0.01),而舒张期最低流速(Vmin)较NAN组及正常组明显降低(5.62±1.19 vs 8.31±1.86,8.72±1.43,P均<0.01)；胆囊动脉RI与糖化血.红蛋白及胰岛素抵抗指数(Homa-IR)显著相关(r=0.648,0.822,P<0.05)。AN组及NAN组空腹及脂餐后血浆CCK浓度均明显低于C组(空腹：21.47±4.01,24.40±2.56 vs 29.18±1.38,P均<0.01；脂餐后：42.13±3.09,47.47±2.67 vs 51.13±3.02,P均<0.01),且AN组CCK浓度减低更为显著(P<0.01)。
结论：糖尿病患者胆囊排空功能明显减低,且与糖尿病患者自主神经受损及血浆CCK浓度减低有关；糖尿病合并自主神经病变时其胆囊动脉阻力指数(RI)和舒张期最低流速(Vmin)较NAN组及正常组有明显差异,糖尿病胆囊动脉血管病变也是影响胆囊排空功能的重要原因。
Objective:To investigate the dysfunction of gallbladder emptying in diabetic patients and its possible mechanism.
Methods:The gallbladder size and the blood flow of the gallbladder artery on the empty stomach, the gallbladder shrinking function by fat food test were measured with B ultrasound. as well as the serum concentration of Cholecystokinin-CCK was determined with radioimmunoassay in 24 diabetics with autonomic neuropathy(AN group),16 diabetics without autonomic neuropathy(NAN group) and 20 healthy controls.
Results:The gallbladder volumes of fasting distinctly increased in the AN group than that of the healthy subjects and the NAN group (22.71±6.67 vs 14.39±5.10,15.49±4.66, P<.01), and The gallbladder volumes of postprandial at all time points significantly increased (P<0.01). while The emptying rate of gallbladder at all time points was distinctly lower in the AN group than that of the healthy subjects and the NAN group (P<0.01). In AN group, The gallbladder artery's index (RI) was significantly higher than in NAN group and healthy subjects (0.74±0.07 vs0.65±0.05,0.61±0.06, P<0.01). moreover The gallbladder artery's index (Vmin) was significantly lower than in NAN group and healthy subjects (5.62±1.19 vs 8.31±1.86,8.72±1.43, P< 0.01). and gallbladder artery's index (RI) had significant relation to the glycolated hemoglobin and Insulin Resistance Index, Homa-IR (r=0.648,0.822, P<0.05). The fasting and fat postprandial's serum concentration of CCK increased in the AN group and the NAN group than that of the healthy subjects (fasting:21.47±4.01,24.40±2.56 vs 29.18±1.38, P<0.01; fat postprandial:42.13±3.09,47.47±2.67 vs 51.13±3.02, P<0.01), moreover the AN group's serum concentration of CCK increased more markedly (P<0.01).
Conclusion:The dysfunction of gallbladder emptying in diabetic patients is partly due to the impaired autonomic nerve and the decrease of serum concentration of CCK, There are significant difference on gallbladder artery's index (RI and Vmin) among the AN group, NAN group and healthy subjects, the decrease of gallbladder shrinking function may be caused by the change of the hemodynamics of gallbladder.
引文
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