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基于胃充盈超声造影的2型糖尿病血糖阈值与胃动力损伤量化研究

A quantitative study on glycemic thresholds and gastric motility impairment in type 2 diabetes mellitus based on gastric filling contrast-enhanced ultrasonography

    摘要
  • 摘要:
    目的 通过胃充盈超声造影技术探讨2型糖尿病（T2DM）患者血糖水平与胃动力损伤的关联，建立胃动力参数与血糖水平的量化评估模型。
    方法 采用病例对照研究设计，纳入2024年1月至6月于川北医学院附属医院就诊的56例T2DM患者，同期纳入性别、年龄、BMI相近的健康人62名，收集T2DM患者病史和糖化血红蛋白（HbA1c）、空腹血糖（FPG）及餐后2 h血糖（2hPG）等临床指标。所有参与者饮用500 mL胃肠造影剂后，观察贲门、胃排空率（GER）、胃壁应变率、胃蠕动速度、胃动力指数（GMI）等胃动力参数并进行分析。
    结果 T2DM组即刻胃蠕动速度、胃壁应变率、GMI、近端胃短轴横径及胃收缩强度均小于对照组，10～40 min GER均小于对照组（均P ＜ 0.05）；T2DM组中有并发症者10 min远端GER、30 min胃窦部GER均低于无并发症者（均P ＜ 0.05）；T2DM组中FPG≤10 mmol/L者10 min及20 min胃窦部GER均高于FPG ＞ 10 mmol/L者（均P ＜ 0.05）；T2DM组中HbA1c≤8.5%者10 min远端GER、20 min胃窦部GER均高于HbA1c ＞ 8.5%者（均P ＜ 0.05）；T2DM组2hPG与20 min近端GER、20 min远端GER、30 min近端GER和30 min远端GER均呈正相关（均P ＜ 0.05）。
    结论  T2DM患者血糖超过阈值（FPG ＞ 10 mmol/L、HbA1c ＞ 8.5%）胃动力损伤程度加重，胃排空功能较健康人群普遍延迟。T2DM患者胃动力参数与血糖水平的量化关联模型为个体化控糖策略中联合应用胃动力调节药物提供了新的潜在靶点。

     

    Abstract:
    Objective To investigate, using gastric filling contrast-enhanced ultrasonography, the association between blood glucose levels and gastric motility impairment in patients with type 2 diabetes mellitus (T2DM), and to establish a quantitative evaluation model linking gastric motility parameters with blood glucose levels.
    Methods A case-control study design was adopted. A total of 56 patients with T2DM who visited the Affiliated Hospital of North Sichuan Medical College between January and June 2024 were enrolled, along with 62 healthy controls matched for gender, age and BMI during the same period. For T2DM patients, medical history and clinical indices including glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour postprandial glucose (2hPG) were collected. After all participants ingested 500 mL of a gastrointestinal contrast agent, gastric motility parameters, including the cardia, gastric emptying rate (GER), gastric wall strain rate, gastric peristaltic velocity, and the gastric motility index (GMI), were observed and analyzed.
    Results In the T2DM group, immediate peristaltic velocity, gastric wall strain rate, GMI, proximal gastric short-axis transverse diameter, and gastric contractile strength were all lower than those in the control group, and GER at 10-40 minutes was also lower (all P ＜ 0.05). Among T2DM patients, those with complications had lower distal GER at 10 minutes and lower antral GER at 30 minutes than those without complications (all P ＜ 0.05). Among T2DM patients, those with FPG ≤10 mmol/L had higher antral GER at 10 and 20 minutes than those with FPG ＞ 10 mmol/L (all P ＜ 0.05). Those with HbA1c ≤8.5% had higher distal GER at 10 minutes and higher antral GER at 20 minutes than those with HbA1c ＞ 8.5% (all P ＜ 0.05). In the T2DM group, 2hPG was positively correlated with proximal GER at 20 minutes, distal GER at 20 minutes, proximal GER at 30 minutes, and distal GER at 30 minutes (all P ＜ 0.05).
    Conclusions When blood glucose levels exceed thresholds (FPG ＞ 10 mmol/L; HbA1c ＞ 8.5%), gastric motility impairment in T2DM patients worsens, and gastric emptying is generally delayed compared with healthy individuals. A quantitative correlation model between gastric motility parameters and blood glucose levels may provide new potential targets for the combined application of gastric motility-modulating agents within individualized glycemic control strategies.

     

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