| Some endocrine diseases and systemic lupus erythematosus(SLE) can lead to gastrointestinal motility disorders. But there were little studies using ultrasound to detect these patients with gastric involvement. This study was designed to detect diabetic patients with gastroparesis and SLE patients with gastric involvement by using multimode new ultrasonic technology.The First Part Objective. This study aimed to explore the accuracy of ultrasonic whole stomach cylinder measurement(UWSCM) on measuring gastric emptying and to analyse the normal gastric emptying and the effectiveness of UWSCM on evaluating the gastric emptying in patients with diabetic gastropathy. Methods. The gastric emptying time(ET) at 25%(T1), 50%(T2) and 75%(T3) of 92 healthy subjects were determined by UWSCM. All of them were simultaneously measured by scintigraphy, gastric antrum area measurement(GAAM) and gastric antrum volume measurement(GAVM). At the same period, ET of 36 cases patients with diabetic gastropathy were measured by UWSCM and compared with their clinical symptom scores. Result. ET of normal group measured by UWSCM showed no significant difference with scintigraphy(P > 0.05). The correlation between UWSCM and scintigraphy was good and the correlation coefficient of T3 reached 0.744(P <0.05). Meanwhile both GAAM and GAVM showed statistically significant difference with scintigraphy(P <0.05). ET of normal group extended gradually: T51%-75%(emptying the third 25% of food) > T26%-50%(emptying the second 25% of food) > T0-25%(emptying the first 25% of food). Both UWSCM and scintigraphy showed that each emptying time point in the diabetic patients is longer than the healthy subjects, and the difference was statistically significant(P <0.05). T3 in diabetic group measured by UWSCM showed the best correlation with the symptom index(r=0.469, P <0.05). Conclusion. ET measured by UWSCM, which showed more accurate than GAAM and GAVM, was similar to scintigraphy. Measuring gastric antrum area or gastric antrum volume can not substitute for measuring whole stomach volume to evaluate gasric emptying function. T3 measured by UWSCM combines the upper gastrointestinal symptoms index provide an accurate basis on clinical diagnosis of gastric emptying abnormalities.The Second Part Objective. This study aimed to explore whether Sono Vue(sulphur hexafluoride microbubbles) contrast-enhanced ultrasound(CEUS) can be applied for the evaluation of gastric blood supply and to analyse the normal gastric blood supply and the effectiveness of CEUS on evaluating the gastric blood supply in patients with diabetic gastropathy. Methods. Thirty healthy subjects and forty cases patients with diabetic gastropathy were enrolled. The parameters measured using CEUS were peak intensity(PI) and the area under the curve(AUC) of greater curvatures of the antrum(GCOA) and lesser curvatures of antrum(LCOA). And then the parameters were compared between the two groups. Results. 1. Intra-ICC values of PI measured by CEUS were 0.831~0.857 and inter-ICC values of PI were 0.803~0.823. Intra-ICC values of AUC were 0.805~0.823 and inter-ICC values of AUC were 0.813~0.815. 2. PI and AUC of GCOA in normal group were 13.14 d B±3.27 d B and 936.38 d B?S±403.28 d B?S. PI and AUC of GCOA in diabetic group were 10.77 d B±2.65 d B and 755.44 d B·S±237.45 d B·S. PI and AUC of LCOA in normal group were 12.41 d B±2.70 d B,868.40 d B·S±314.13 d B·S. PI and AUC of LCOA in diabetic group were 9.93 d B±2.88 d B and 672.84 d B·S±184.66 d B·S. In both of normal group and diabetes group, PI and AUC value of GCOA had no significant difference with those of LCOA(P > 0.05). PI and AUC of GCOA and LCOA in diabetes group were less than those in normal group(P < 0.05). Conclusions. CEUS can assess stomach wall vascularity with high repeatability and consistency. The microcirculation of antrum in diabetic gastropathy patients is poorer than that of normal group, which is consistent with the mechanisms of diabetic neuropathy. CEUS can be used to evaluate the micro blood supply in patients with the stomach wall disease.The Third Part Objective. This study aimed to evaluate the gastric motility in patients with systemic lupus erythematosus(SLE) gastropathy by 3D ultrasound and to explore the correlation among the severity of gastric wall lesion, SLE disease activity index,(SLE DAI)and upper gastrointestinal symptoms. Methods. ET at 25%(T1), 50%(T2) and 75%(T3) of 80 healthy subjects and 40 SLE patients with gastrointestinal involvement were determined by 3D ultrasound. The parameters were compared between the two groups. And the correlations among the severity of gastric wall lesion, SLE disease activity index(SLEDAI) and upper gastrointestinal symptoms were analysed. Results. 1. The manifestation of gastric involvement in SLE patients was the thickening of stomach wall and it mainly involved the second or fourth layer. The thicker the stomach wall was, the more obvious upper gastrointestinal symptoms and the more serious SLE activity were. 2. SLE activity had significant correlation with stomach wall thickness and upper gastrointestinal symptoms(r =0.928, P < 0.05; r =0.872, P < 0.05). The stomach wall thickness had significant correlation with upper gastrointestinal symptoms(r =0.848, P < 0.05). 3. ET of healthy subjects was 19.65 min±5.39 min(T1), 41.08 min±7.51 min(T2), 70.34 min±8.03 min(T3). ET of SLE patients was17.08 min±2.65 min(T1), 39.85 min±6.54 min(T2) and 83.58 min±7.12 min(T3). Compared with normal group, T1 of SLE patients were shorter(t= 3.506,P=0.001) and T3 were prolonged(t=-8.825,P=0.000). 4. T3 in SLE group had the best correlation with the symptom index(r=0.553,P= 0.000) and it was also correlated with nausea, postprandial bloating and stomach pain(r=0.446,P= 0.004;r=0.416,P= 0.008; r=0.467,P= 0.002, separately). T1 in SLE group was correlated with early satiety(r=-0.366,P= 0.020). The other symptoms, including anorexia and vomiting, had no correlation with ET. Conclusions. Ultrasound can be used to evaluate the gastric lesion and measure the gastric emptying time accurately. The manifestation of gastric involvement in SLE patients was the thickening of stomach wall and mainly involved the second or fourth layer. The gastric emptying time of SLE patients with gastric involvement was abnormal. T3 combining with the thickness of the stomach wall and upper gastrointestinal symptoms index in SLE patients can provides the accurate basis on the clinical diagnosis of gastric emptying abnormalities. |
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