| Part One The study of gastric capacity,introgastric pressure and gastric compliance,visceral sensitivity of obese peopleObjective: To compare gastric capacity,introgastric pressure and gastric compliance,visceral sensitivity between different the obese and non-obese healthy subjects with mechanical gastric distension.Methods1. Standards of subjects selected:normal healthy volunteers'body mass index (BMI)≤24.9kg/m2;simple obesity volunteers'BMI≥30 kg/m2;without gastrointestinal diseases and operation history; without adminstration of any drugs; Females are tested three days after end of menses and have no history of taking contraceptives within two weeks.2 Standards of subjects rulled out:①Secondary obesity from many diseases on the basis of neuroendocrine-metabolic disorders: hypothalamus diseases, pituitary disease , pancreatic islet diseases , hypercortisolism , hypohthyroidism, water and sodium retention,diabetes melitus comlicated with gastric paralysis.②Upper gastrointestinal organic diseases such as esophagitis,esosive gastritis,atrophic gastritis,gastrointestinal ulcer through gastroscopy.③Dysphagia for example achalasia.④Females during pregnancy or breastfeeding period.⑤age<18 years old.3.Reseach group: 67 obese volunteers (35 males,32 females,age 23.62±6.24 years old, BMI≥30 kg/m2),divided into three groups: A group (obesity with binge eater) , B group (obesity with normal diet) , C group(obesity with FD)and 32 non-obese healthy volunteers(D group,15 males, 17 females,age 22.56±6.23,BMI≤24.9 kg/m2) were studied with Barostat. 4.Reseach methods:All subjects are tested with Barostat at eight in the morning twelve hours after fasting.Before the experiment,the subjects are demanded to discharge urin and stool,then the balloon catheter are inserted into stomache through the mouth and gastric fundus are pressed by filling gas balloon.Pour 30ml gas into balloon to record minimal distention pressure(MDP).Then stepping isovolume methods were taken to increase 50ml gas and lasted two minutes every time.Simutaneously gastric capacity , intragastric pressure,gastric compliance,and visceral sensitivity (initial satiety,maximal tolerance) in response to mechanical distension were recorded.Results1 Gastric capacity changes: The initial volume(IV) and maximal tolerance volume(MV) in obese group were significantly larger than those in control group (459.25±174.53ml vs 263.44±126.89ml,791.70±261.79 ml vs 500±156.02 ml),p <0.01.2 Intragastric pressure changes: MDP,initial intragastric pressure(IP) and the maximal tolerance pressure(MP) in obese group were not different from the control's(5.15±1.48mmHg vs 5.07±1.58mmHg,9.25±1.94mmHg vs 9.17±4.01mmHg,10.50±2.84 mmHg vs 10.44±3.31mmHg), P>0.05.3 Gastric compliance changes: The initial gastric compliance(IC), maximal tolerance compliance(MC) in obese group were significantly larger than those in control group (62.28±21.45 vs 34.56±13.76,92.92±39.61 vs 52.47±24.95), p <0.01. At MDP state, gastric compliance of obese group was similar to control's(9.25±4.19 vs 9.25±2.96),p>0.05.4 Gastric capacity changes in different obese groups:IV and MV were 550.72±204.45ml, 900.50±402.74ml in A group , which were significantly larger than those in D group (263.44±126.89 ml,500±156.02 ml), p <0.01;In B group, IV and MV were 305.12±98.78ml, 548.76±139.25ml ,compared with the control's,difference were not significant, P>0.05;In C group,above parameters were 156.25±37.86 ml,410.00±102.24ml, which were less than those in D group,P<0.05. 5 Intragastric pressure changes in different obese groups: in A group, MDP,IP and MP were 5.05±1.08 mmHg,9.05±2.06 mmHg,10.89±3.76 mmHg respectively and in B group,MDP,IP,MP were 4.87±1.86 mmHg,9.09±3.25 mmHg,11.37±3.28 mmHg,which were not different from the control's(5.07±1.58 mmHg,9.17±4.01 mmHg和10.44±3.31 mmHg),P>0.05;In C group,above parameters were5.67±1.91 mmHg,7.16±0.81mmHg,8.78±0.78mmHg;IP and MP were less than those in D group,P<0.05.6 Gastric compliance changes in different obese groups:IC,MC were 66.86±19.45 and 99.29±39.66 in A group,which were higher than those in D group(34.56±13.76,52.47±24.95), P<0.01;In B group,IC,MC were 38.95±14.82,62.36±30.28,which were similar to control's,p>0.05;In C group,above parameters were 24.08±16.04,38.07±10.82,which were less than those in D group, P<0.05.At MDP state, gastric compliance of A,B,C groups were similar to control's,p>0.05.Conclusion1 Gastric capacity and compliance increased and accommodation enlarged in obese people cause an increase in food intake and satiety occurence delayed ,which play an important role in pathogenesis of simple obesity.2 Only gastric capacity and compliance increased and accommodation enlarged in A group ;In C group ,gastric capacity and compliance indicate decrease tendence ; Gastric capacity , compliance and accommodation enlarged cause an increase in food intake and satiety occurence delayed may be one of main mechanisms of obesity with binge eater.Part Two The study of gastric myoelectrical activity of obese peopleObjective: to explore the characteristics of gastric myoelectrical activity induced by mechanical distension and by meal in obese people;to discuss the relation between gastric myoelectrical activity and gastric motility.Methods: 1 Standards of subjects selected and rulled out are the same as above those of Part one2Reseach methods:2.1 Electrogastrogram was recorded during mechanical distension:67 obese (35 males, 32 females,BMI 31.05±1.55 kg/m2, age23.62±6.24yr)and 32 non-obese healthy volunteers (15 males, 17 females,BMI 21.28±1.84kg/m2,age22.56±6.23yr) were studied with Barostat and Digitrapper electrogastrography equipments.Following an overnight fast, a polyethylene bag attached at the end of a catheter was placed in the proximal stomach.;surface bipolar electrodes were placed on the abdomen to record gastric myoelectrical activity before and during mechanical distension of the proximal stomach.By filling the gastric balloon with air, different visceral sensation (initial satiety and maximal tolerance) prouduced and electrogastrogram was recorded simultaneously for 15 minutes. EGG data analysis were dealed with Synetic software-frequency and power spectrum analysis.2.2 Electrogastrogram was recorded before and after test meal:41 cases of obese subjects(18 males, 23 females,BMI:32.29±2.36kg/m2 ,age 26.86±8.47years old)and 32 healthy volunteers with normal BMI(15males,17females,BMI: 22.34±2.17kg/m2 ,age 24.73±7.15years old)as control were investigated with Digitrapper electrogastrography(EGG) 30 minutes before and after test meal twelve hours after fasting(test meal:Kangshifu convenient noodles127g: carbohydrate 88g,fat 25g, protein 14g,total kalorie 633Kcal) , EGG data analysis were dealed with Synetic software-frequency and power spectrum analysis.RESULTS1 Gastric myoelectrical activity during mechanical distension1.1Gastric myoelectrical activity at the state of baseline: the dominant frequency(DF) and the dominant power(DP) in obese people were similar to those in normal non-obese volunteers(3.06±0.34cpm vs 3.0±0.31cpm, 30.85±4.91 vs 29.84±4.29), P>0.05; The percentage of normal slow wave(N%) in obese people was lower than that in control subject(54.65±15.92% vs 70.02±16.12%),P<0.01; The percentage of Bradygastria (B%) in the obese was higher than that in the control(19.87±11.56% vs 9.88±8.32%),P<0.05; The percentage of Arhythmia (AR%) in the obese was higher than that in the control(9.91±6.95% vs 5.58±5.48%),P<0.01; The dominant power instability coefficient(ICP) and dominant power standard deviation(SDP) were higher than those in the control,P<0.01.1.2Gastric myoelectrical activity at the state of initial satiety: DF in both groups decreased and no significant difference existed(2.96±0.23cpm vs 2.94±0.27cpm), P>0.05; DP in both groups increased and significant difference existed(33.78±4.65 vs 31.62±4.72), P<0.05; ICP, SDP in the obese was higher than that in the control, p<0.01.1.3 Gastric myoelectrical activity at the state of maximal tolerance satiety: DF in both groups decreased continuously and no significant difference existed(2.78±0.35cpm vs 2.80±0.32cpm ), P>0.05; DP in both groups increased continuously and significant difference existed(36.05±5.95 vs 32.57±7.78), P<0.05; N% in the obese was lower than that in control subject(49.03±14.02% vs 57.22±17.73%);ICP,SDP in the obese was higher than that in the control,p<0.01.1.4 The increasement of dominant power in the obese were higher than those in the control at the state of initial satiety and maximal tolerance satiety(5.99±4.53 vs 4.00±3.37,7.56±2.92 vs 4.28±4.19),P<0.05 and P<0.01.2 Gastric myoelectrical activity before and after test meal:2.1 Before meal,N% in obese group was lower than that in control subjects(55.52±15.7 vs 70.83±14.31, P<0.05); B% , AR% in obese group were higher than those in control group respectively (17.07±10.88 vs 11.46±8.86, 9.70±5.7 vs 5.75±4.14),P<0.05 and P<0.01;ICP, SDP in the obese were higher than those in the control, p<0.01.2.2 After meal, DP and T% in the obese were higher than those in control group respectively (36.50±4.86 vs 32.24±6.25, 19.93±11.62 vs 12.94±11.72,P<0.01 and P<0.05;N% in the obese was lower than that of the control group (53.19±17.77 vs 64.34±22.63, P<0.05);ICP, SDP in the obese were higher than those in the control, p<0.01.2.3 The increasemen of DP after meal and the power ratio (PR)in the obese were significantly higher than those in control group (7.88±3.87 vs5.18±3.68,1.28±0.27 vs 1.15±0.21),P<0.01 and P<0.05.Conclusion1 Mechanical gastric distention induced gastric accommodated dilatation and adaptive dilatation.Obese people have remarkable abnormalities in gastric myoelectrical activity, N% was lower than that of the control and B%,AR% were higher than those in the control. Mechanical gastric distension resulted in an remarkable increasement of DP in the obese than in the control because gastric distension brings the stomach closer to the recording electrodes.Gastric compacity,accommodation and compliance increase in obese people perhaps play much more important role in above changes of gastric myoelectrical activity.2 At fasting state and post-meal state, obese people have abnormalities in gastric myoelectrical activity. N% decrease and B% increase at fasting state and DP'significant increase after meal may be electrophysiological basis of gastric hypermotility in obese people.Part Three The study of autonomic nervous function of obese peopleObjective: To explore the characteristics of autonomic activity in obese people during mechanical gastric distension,24 hours,before and after three meals;to discuss the relation between autonomic nervous function and gastric motility.Methods1. Standards of subjects selected and rulled out are the same as above those of Part one2.Reseach methods:2.1 Electrocardiogram was recorded during mechanical distension:67 obese subjects (BMI 31.05±1.55 kg/m2, age 23.62±6.24yr)and 32 normal controls (BMI 21.28±1.84kg/m2,age22.56±6.23yr) were studied with Barostat and HS9616 electrocardiography equipments.Following an overnight fast, a polyethylene bag attached at the end of a catheter was placed in the proximal stomach.;surface twelve polar electrodes were placed on the abdomen to record myocardial electrical activity before and during mechanical distension of the proximal stomach.By filling the gastric balloon with air, different visceral sensation (initial satiety and maximal tolerance) prouduced and electrocardiogram was recorded simultaneously for 15 minutes.2.2 24 hour dynamic electrocardiography test:47 obese subjects (23 males, 24 females, BMI 34.15±2.75 kg/m2, age 26.82±16.34yr)and 29 normal controls (15 males, 14 females,BMI 23.05±0.95kg/m2,age25.62±5.34yr) were studied with 24 hour dynamic electrocardiography (PI,American products)and HRV analysis was performed.The electrocardiogram started to record at 16:00 in the afternoon and ended at the same time next day.Three meals'time were 7:00(breakfast) in the morning,12:00(lunch) at noon,19:00(supper) in the afternonn respectively.All subjects were demanded to avoid severe activity and decrease activity of upper limbs.Smokoing and drinking alcohol were forbidden.1h before and after three meal all subjects were demand to keep rest state .Results1. Autonomic nervous activity during mechanical distension:1.1 Autonomic nervous activity at the state of baseline: Total power(TP),ultro-low frequency (ULF), low frequency(LF), high frequency(HF) in obese subjects were significantly higher than those in the control(6537.68±2071.6 vs 4613.05±1848.21 , 3774.47±2301.66 vs 2532.13±2378.00,1464.2±801.94 vs 900.24±487.23,1110.62±541.83 vs 816.72±379.56), p<0.01. LF/HF ratio in obese people was similar to control's(1.30±0.56 vs 1.11±1.09), P>0.05.1.2 Autonomic nervous activity at the state of initial satiety:TP,ULF,LF, HFdecreased in both groups and no significant difference existed between two groups(3254.03±1892.6 vs 3272.34± 2415.13,1854.63±1253.62 vs 1925.72±1545.9,704.49±302.55 vs 576.33±543.8,596.09±497.24 vs 536.77±483.0),P>0.05,but decrease levels of TP,ULF,LF, HF in the obese were significant higher than those in the control(2283.65±892.6 vs 1340.71±415.13,1919.74±435.67 vs 606.41±135.67,749.72±302.55 vs 323.91±143.82,614.53±297.24 vs 279.95±189.23),p<0.01;LF/HF ratio in obese people was similar to control's(1.05±0.52 vs 1.27±1.02), P>0.05.1.3 Autonomic nervous activity at the state of maximal tolerance satiety:Compared with autonomic nervous activity at the state of initial satiety,TP,ULF increased in both groups and no significant difference existed between two groups, (4393.91±1998.18 vs 3965.83±1799.02,3104.05±2957.99 vs 2428.64±2367.8),P>0.05;LF, HF decreased continously in both groups and no significant difference existed between two groups, (679.93±530.89 vs 522.96±340.43,561.82±310.58 vs 504.51±216.34),P>0.05;but decrease levels of TP,ULF,LF, HF in the obese were significant higher than those in the control(2283.65±892.6 vs 1340.71±415.13,670.42±209.99 vs 103.49±67.09,784.27±230.18 vs 377.28±143.9,608.80±210.65 vs 312.21±112.37) , p<0.01;LF/HF ratio in obese people was similar to control's(1.03±0.58 vs 1.20±0.67), P>0.05.2. Autonomic nervous activity within 24 hour :2.1Time domain analysis:compared with control group,the parameters of 24 hour standard deviation of all normal to normal R-R intervals(SDNN),mean of the standard deviation of all NN intervals for 5 minute segments of 24 hour(SDNNindex),the root mean square of successive differences between adjacent normal cycles(rMSSD) in the obese increased significantly (167.71±43.75 vs 139.67±21.86,80.29±28.54 vs 54.67±11.28,107.59±67.19 vs 40.44±10.15) , p<0.01.HR and HRV in obese people was similar to control's(74.82±4.93 vs 76.11±7.88,37.82±10.48 VS 34.22±8.5), P>0.05.2.2 Frequency domain analysis: compared with control group, the parameters of 24 hour ULF,VLF,LF,HF increased significantly(328755.7 ±32083.9 VS 275874.9±25615.2,791136.7±436523.8 vs 506446.0±267006.0 , 604662.8±566717.3 vs 228403.0±215454.7 , 954128.6±146361.1 vs 251121.4±205995.8);③LF/HF ratio in obese people was similar to control's(0.82±0.43 vs 0.97±0.32), P>0.05.3 Autonomic nervous activity before and after mealIn normal control group,compared with pre-meal,SDNNindex,ULF of post-meal increased significantly,p<0.01;SDNN,VLF,LF,HF decreased remarkably,p<0.01 and p<0.05;LF/HF increased significantly,p<0.01;in obese people, after meal SDNN,SDNNindex,ULF,VLF decreased and LF,HF increased significantly,p<0.01;LF/HF was not different betweenp pre-meal'and post-meal,p>0.05。4 Autonomic nervous activity at day time and at night timeSDNN,SDNN index,rMSSD,ULF,VLF,LF,HF in the obese were higher than those in the control no matter what was day time or night time ,p<0.01 and p<0.05,at day time LF/HF in the obese was lower than thecontrol's,(0.94±0.67 vs 1.34±0.85),p<0.05;At night no difference of LF/HF between two groups was discovered(0.84±0.29 vs 0.81±0.34),p >0.05; in the control,LF/HF at night was lower than at day time,(0.84±0.29 vs 1.34±0.85),p<0.05,while in the obese,LF/HF at night was similar to that at day time(0.81±0.34 vs 0.94±0.67),p >0.05。Conclusion1 The decrease level of vagal activity and sympathetic activity in the obese were higher than those in the control during mechanical distension,which indicate abnormal autonomic nervous function has closed relation to large gastric capacity and high gastric accommadation and compliance.2 In term of the whole day, HR and HRV in the obese were not different from the control's; SDNN,SDNNindex,rMSSD, ULF,VLF, LF,HF in the obese were significantly higher than those in the control,but LF/HF in the obese was similar to that in the control,which indicate vagal activity and sympathetic activity in obese people were higher than those in control subjects but sympathovagal balance was kept normal. 3 After meal,in normal subjects, sympathetic activity increased and vagal activity decreased,while in the obese, sympathetic activity decreased and vagal activity increased,which suggested abnormal autonomic nervous function may be one mechnism of appetite hyperfunction and highmotility of obesity.4 In normal subjects, vagal activity is dominant at night and sympathetic activity is dominant at day time; in the obese, vagal activity is dominant no matter what was at day time or at night;At day time, LF/HF in the obese was lower than that in the control;At night, LF/HF in the obese was similar to the control's,which indicate disorder of sympathovagal balance function occurred mainly at day time.Part Four The study of hormon correlated with gastric motility of obese peopleObjective: To detdect serum Motilin,Leptin,Ghrelin,Glucogan-like peptide-1 in the obese and in the normal controls;to explore the relationship between serum MTL,Leptin,Ghrelin ,GLP-1 and gastric motility of obese people .Methods1 Standards of subjects selected and rulled out are the same as above those of Part one2 38 obese volunteers(20 males,18 females, BMI 34.17±2.14kg/m2,age24.06±5.42 years old) and 20 normal controls(11 males,9 females, BMI 22.17±1.65kg/m2,age21.08±3.54 years old) were enrolled.Twelve hours after fasting at 8:00 in the morning venous blood was collected and 30 minutes after meal(Kangshifu convenient noodles127g:carbohydrate 88g,fat 25g,protein 14g,total kalorie 633Kcal)venous blood was recollected and stored at -70℃;serum Serum Ghrelin,GLP-1 were detected with ELISA method; MTL,Leptin were detected with RI method.Results 1 Before and after meal, Serum Leptin in obese people were higher than those in the control,(7.42±4.66ng/ml vs 1.33±0.51ng/ml,7.53±4.98 ng/ml vs 3.21±0.55ng/ml),p<0.01;Post-meal Leptin level was higher than pre-meal Leptin level in obese group,p<0.05. Post-meal Leptin level was similar to pre-meal Leptin level in control group ,p>0.05.2 Before and after meal,Serum MTL in obese people were higher than those in the control(283.95±83.84pg/ml vs 125.76pg/ml±33.09pg/ml;338.80±137.5pg/ml vs 276.8±50.55pg/ml),p<0.01;Compared with pre-meal MTL,post-meal MTL increased significantly in both groups,p<0.01.3 Before and after meal,Serum Ghrelin in obese people was lower than those in the control,(3.23±1.24pg/ml vs 9.72±7.10pg/ml,1.45±0.96pg/ml vs 3.36±2.38pg/ml),p<0.01; Compared with pre-meal Ghrelin,post-meal Ghrelin decreased significantly in both groups,p<0.01.4 Before and after meal, Serum GLP-1 in obese people were lower than those in the control,(1.67±0.36pg/l vs 3.64±1.42pg/l, 1.08±0.81pg/l vs 6.59±1.23pg/l), p<0.01;Compared with pre-meal GLP-1,post-meal GLP-1 increased significantly in the control,p<0.01,while in the obese, post-meal GLP-1 secretion decreased,p<0.05.Conclusion1 Before and after meal, Serum Leptin and MTL in obese people were higher than those in the control;Leptin resistance existed in the obese so that the role of inhibition eating can not work; MTL level increase maybe the main cause which result in gastric hypermotility and fast emptying of stomach of obese people.2 Before and after meal, Serum Ghrelin in obese people were lower than that in the control. Obese people have resistance to leptin and expression of Ghrelin was down-regulation.So that Ghrelin level decreased was not the cause of abnormal gastric motility of obese people,perhaps was adaptive reaction to obesity.3 Before and after meal, Serum GLP-1 in obese people were lower than those in the control. Serum GLP-1 level decreased resulted in gastric hypermotility, fast empting of stomach, visceral sensitivity obtuse and satiety occurence delayed.
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