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糖尿病胃轻瘫(diabetic gastroparesis,DGP)是糖尿病慢性并发症之一,主要临床表现为恶心、呕吐、饱腹感、腹胀、腹痛、厌食、嗳气等消化系统症状[1],DGP以排除机械性梗阻的条件下出现胃排空显著减慢为临床特点[2]。核素胃排空显像是一种在生理状态下判断胃排空功能的方法,具有无创、灵敏、可重复、符合生理、可定量等优点[3]。既往的放射性核素胃排空显像试餐种类及检查方法多样化,没有统一的判断标准,制约了其在临床的应用。我们应用99Tcm-DTPA液体试餐对正常志愿者行改良的放射性核素胃排空显像,以期为临床诊断胃排空功能损伤提供一个简便、准确的检查方法及相应的正常参考值和异常判断标准。在此基础上,进一步对糖尿病患者行胃排空显像,通过定量、定性分析,评估DGP发生率及其严重程度,指导临床诊疗。
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对对照组55名正常受检者平卧前位、平卧后位和坐立后位图像进行处理,分别得到胃区时间-放射性变化曲线(图 2~图 4)。分别计算每位受检者各体位的GET1/2和GER30 min,经统计处理后得到各指标的x±s及95%置信区间(表 1);正常对照组平卧前位、平卧后位及坐立后位GET1/2 95%置信区间分别为(8.41~17.11)、(7.35~16.67)、(5.91~13.47)min。对平卧前位和平卧后位、平卧后位和坐立后位GET1/2和GER30 min进行比较,差异均有统计学意义(t=5.35、11.20、-6.37、-9.77,均P<0.01)。其中,平卧后位及坐立后位检查易受脊柱影响,且坐立后位采集时受检者较难长时间保持体位不变,影响ROI的勾画。宜选用平卧前位采集,其GET1/2的95%置信区间上限为17.1 min。
参数 平卧前位 平卧后位 坐立后位 t值 P值 GET1/2/min 12.76±2.22 12.01±2.38a 09.69±1.93b 05.35 11.20<0.01 GER30min/% 80.14±7.12 82.54±7.33a 88.87±5.56b -6.37 -9.77<0.01 注:表中,GET1/2:胃半排空时间;GER30 min:30 min胃排空率。a是与平卧前位比较;b是与平卧后位比较。 表 1 正常对照组不同体位GET1/2和GER30 min 比较
Table 1. Comparison of GET1/2 and GER30min of different positions in the normal control group
图 2 正常人平卧前位胃排空图像(1 min/帧)及其胃区时间-放射性变化曲线
Figure 2. Image of anterior gastric emptying in a normal person in lying position (1 min/frame) and its time-radioactive change curve
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处理试验组的图像,得到平卧前位胃区时间-放射性变化曲线(图 5)。受检查时间限制,试验组糖尿病患者中存在GET1/2>30.0 min者,故不再将GET1/2作为参考指标。将对照组和试验组的平卧前位GER30 min进行比较,差异有统计学意义[(80.14±7.12)% vs.(70.16±12.86)%;t=6.22,P<0.01)],且试验组平卧前位GER30 min较对照组小。
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将试验1组和试验2组平卧前位GER30 min进行比较,差异有统计学意义[(73.99±9.82)% vs.(66.66±14.34)%];t=3.01,P<0.05),其中,试验2组平卧前位GER30 min均值较试验1组小。
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试验组患者胃排空功能相差较大,GER30 min跨度大,不能准确反映受检者胃排空功能,故将GET1/2作为评价糖尿病患者胃排空功能减退程度的指标。分别统计试验1组和试验2组GET1/2>17.1 min和GET1/2>30.0 min的例数并计算百分比(表 2)。有41%的糖尿病患者出现胃排空功能减退,其中9%的糖尿病患者胃排空功能重度受损。
组别 例数 GET1/2>17.1 min GET1/2>30.0 min 例数 比例(%) 例数 比例(%) 试验1组 048 14 29.17 2 04.17 试验2组 052 27 51.92 7 13.46 总计 100 41 41.00 9 09.00 注:表中,GET1/2:胃半排空时间。 表 2 糖尿病患者胃排空功能减退程度
Table 2. Degree of loss of gastric emptying tunction in patients with diabetes
液体试餐核素胃排空显像对糖尿病患者胃排空功能的研究
Research on gastric emptying in diabetic patients using radionuclide-labeled liquid test meal
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摘要:
目的应用放射性核素标记的液体试餐行改良的胃排空显像,选择最佳检查体位及胃排空功能评价指标;进而评估糖尿病患者胃轻瘫发生率,并为其诊断及严重程度分级提供依据。 方法55名健康志愿者(对照组)和100例2型糖尿病患者(试验组)分别口服99Tcm-DTPA液体试餐后,即刻应用SPECT仪同时行平卧前位、平卧后位动态显像。影像采集结束后,勾画胃区ROI,经计算机处理后获得时间-放射性曲线,分别计算平卧前位、平卧后位胃半排空时间(GET1/2)及30 min胃排空率(GER30min)。3 d后服用同等量放射性核素液体试餐后行坐立后位胃排空动态显像,数据采集及处理方式同前。在此基础上,进一步对正常对照组及试验组胃排空显像数据进行t检验。 结果正常对照组平卧前位GET1/2为(12.76±2.22)min,其95%置信区间上限为17.1 min(可作为胃排空功能减退的判断标准)。对照组平卧前位和平卧后位、平卧后位和坐立后位GET1/2及GER30min比较,差异均有统计学意义(t=5.35、11.20、-6.37、-9.77,均P < 0.01);对照组和试验组、试验1组(无消化系统症状糖尿病患者组)和试验2组(有消化系统症状糖尿病患者组)平卧前位GER30min比较,差异均有统计学意义(t=6.22、3.01,均P < 0.01),其中试验组平卧前位GER30min较对照组小,试验2组平卧前位GER30min较试验1组小。统计试验组GET1/2,41%胃排空功能减退,其中,9%胃排空功能重度受损。 结论液体试餐核素胃排空显像是一种简单易行、准确可靠的胃排空功能检测方法。GET1/2和GER30min可作为胃排空功能减退程度的指标,并优选平卧前位进行检查,可在临床推广应用。 Abstract:ObjectiveGastric emptying scintigraphy was performed with radionuclide-labeled liquid test meal to determine the best position and evaluation index for the clinical examination of gastric emptying. Subsequently, the incidence of gastroparesis in diabetic patients was evaluated, and the basis for its diagnosis and severity index was obtained. MethodsA total of 155 participants were divided into the control (n=55) and experimental groups (n=100). The volunteers were made to drink 99Tcm-DTPA radioactive nuclide liquid test meal and to lie down on an exam table. SPECT was utilized to dynamically and instantaneously image anterior and posterior gastric emptying in the lying position. After image acquisition, the stomach area was highlighted as the ROI. Through computer processing, the time-radioactive change curve was obtained, and then lying anterior and posterior gastric-half emptying time (GET1/2) and gastric emptying rate in 30 minutes (GER30min) were calculated. Three days later, the patients received the same amount of radionuclides in liquid test meal for the dynamic imaging of posterior gastric emptying in the sitting position. Data acquisition and processing were conducted using the previously described protocol for gastric emptying in the lying position. Imaging data from the normal control and experimental groups were compared by using t-test. ResultsIn the control group, the lying anterior GET1/2 was(12.76±2.22) min with an upper limit of 95% confidence interval of 17.1 min. This parameter could be used as a criterion for the evaluation of gastric emptying function. The GET1/2 and GER30min of the lying anterior and posterior of the normal control group were significantly different (t=5.35, 11.20, -6.37, -9.77, all P < 0.05). The lying anterior GER30min of experimental groups 1 (without digestive system symptom diabetes) and 2 (with digestive system symptom diabetes) were significantly different (t=6.22, 3.01, both P < 0.05). The lying anterior GER30min of the experimental group was lower than that of the control group, and was lower in experimental group 2 than in experimental group 1. Based on the GET1/2 of the experimental group, 41% of the patients exhibited dysfunctional gastric emptying, whereas 9% of the patients suffered from severely impaired gastric emptying. ConclusionRadionuclide-labeled liquid test meal gastric emptying imaging is a simple, accurate and reliable detection method. GET1/2 and GER30min can be used as gastric emptying function impairment degree index, and the lying anterior position was selected as a better method of radionuclide-labeled liquid test meal gastric emptying imaging which can be used in clinical extension. -
表 1 正常对照组不同体位GET1/2和GER30 min 比较
Table 1. Comparison of GET1/2 and GER30min of different positions in the normal control group
参数 平卧前位 平卧后位 坐立后位 t值 P值 GET1/2/min 12.76±2.22 12.01±2.38a 09.69±1.93b 05.35 11.20<0.01 GER30min/% 80.14±7.12 82.54±7.33a 88.87±5.56b -6.37 -9.77<0.01 注:表中,GET1/2:胃半排空时间;GER30 min:30 min胃排空率。a是与平卧前位比较;b是与平卧后位比较。 表 2 糖尿病患者胃排空功能减退程度
Table 2. Degree of loss of gastric emptying tunction in patients with diabetes
组别 例数 GET1/2>17.1 min GET1/2>30.0 min 例数 比例(%) 例数 比例(%) 试验1组 048 14 29.17 2 04.17 试验2组 052 27 51.92 7 13.46 总计 100 41 41.00 9 09.00 注:表中,GET1/2:胃半排空时间。 -
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