| Background:Diabetic gastroparesis(DGP) is one of chronic complications of diabetes,its main clinical manifestations are:nausea,early satiety,postprandial abdominal distension,Decline in food intake,vomiting,abdominal pain,weight loss and delayed gastric emptying.The high incidence of DGP,has seriously affected the quality of life of patients and may promote the occurrence of chronic complications of diabetes and development,therefore,the athogenesis and treatment of DGP is the hot spots in recent years study.At present,DGP' s pathogenesis has not been clear,such as the factors of:neuropathy, vascular disease,the change of gastrointestinal hormone,high blood sugar are studied in relevant with DGP.Western medicine treatment of DGP is limited,there is no specific drug,but with side effects.The treatment of DGP in Chinese medicial have a certain advantage,there are higher efficiency, especially in improving the symptoms have their special advantages and fewer side effects.It is very necessary to explore an effective Chinese medicine to treat DGP.Objective:In this experiment through clinical research,we use Jiawei Zhishi Xiaopi Tang to treat the patients who with diabetic gastroparesis,to observe the clinical efficacy,the changes in gastric emptying and gastrointestinal hormones.At the same time to explore the pathogenesis of its efficacy,the evaluation of Jiawei Zhishi Xiaopi Tang in the treatment of Diabetic gastroparesis,so as to provide the basis for developing the treatment of diabetic gastroparesis in Chinese medicinal.Methods:In Chinese medicine hospital in Guangzhou City of Endocrinology, digestion wards and out-patient,we collected 68 cases of patients,who with a history of diabetes,in line with the internationally recognized functional dyspepsia and delayed gastric emptying RomeⅢstandard X-ray inspection impenetrable markers remain in the stomach＞5hours.We also enlist 10 wolenteers to compare with them.A random number table will be incorporated into the 63 experiments were randomly divided into treatment group and control group. Treatment group caplendus Jiawei Zhishi Xiaopi Tang,the control group caplendus domperidone.By observing the symptom score in patients before and after treatment,gastric emptying rate and gastrointestinal hormones change,to investigate the pathogenesis of Jiawei Zhishi Xiaopi Tang for the treatment of Diabetic gastroparesis.The results:①In Clinical efficacy:A total of 36 cases in the treatment group,3 cases have lossed,33 cases have been actual entry.And 5cases were cured,the cure rate is 15.15%;19 cases were markedly effective,effective rate is 57.58%;6 cases were effective and efficient rate is 18.18%;3 cases were ineffective,inefficient rate is 9.09%;the total effective rate is 90.91%.A total of 32 cases in the control group,2cases have lossed,the actual recorded 30 cases.And 2 cases were cured,the cure rate is 6.67%;11 cases were markedly effective,the rate is 36.67%;8cases were effective and efficient rate is 26.67%;9cases were ineffective,efficiency rate is 30.00%;the total effective rate is 70.00%.There was a significant difference in the therapeutic effect of two groups by Ridit analysis(P=0.0128).There was no significant difference (χ~2=0.1359,P=0.7124) in the cure rate of the two groups;in the markedly effective rate of the two groups,the treatment group campare with the control group,there was a significant difference(χ~2=5.6017,P=0.0179);in the total efficiency rate of the-two groups,the difference was significant(χ~2=4.4555, P=0.0348),the treatment group batter than the control group.②At the rate of improvement of gastric emptying:gastric emptying rate of pretreatment had no statistically difference(P=0.8332);Gastric emptying rate of the two groups after treatment both better than pretreatment(treatment group:P=0.0000,control group:P=0.0000),and the treatment group better than the control group(P=0.0145).③At the Gastrointestinal hormone:Before the treatment two groups of patients with MOT and GAS in blood,compared with the normal average,the diffeence was not statistically significant(treatment group:MOT:P=0.7383,GAS: P=0.4962;controlgroup:MOT:P=0.6134,GAS:P=0.7256),a-nd there is no significant change after treatment,the difference between two groups was not statistically significant(MOT:P=0.6058,GAS:P=0.1749).Two groups of patients with pre-treatment of SS,VIP and LEP were higher than normal average,the difference was statistically significant(treatment group:SS:P=0.0005,VIP:P=0.0410, LEP:P=0.0000;control group:SS:P=0.0000,VIP:P=0.0112,LEP:P=0.0000);And they was decreased after treatment(treatment group:SS:P=0.0000,VIP:P=0.0003, LEP:P=0.0000;control group:SS:P=0.0001,VIP:P=0.0211,LEP:P=0.0000).However, three types hormones of control group,the average level was still higher than normal(SS:P=0.2807,VIP:P=0.7854,LEP:P=0.5006).The three types hormone of treatment group was reduced to the average level of normal,the differece was significantly(SS:P=0.0001,VIP:P=0.0112,LEP:P=0.0000).The treatment group compared with the control group in the efficacy,the difference was statistically significant(SS:P=0.0000,VIP:P=0.7854,LEP:P=0.0000).Conclusion:Jianwei Zhishi Xiaopi tang can be effective in improving Diabetic Gastroparesis patients with clinical symptoms.Its mechanism may be to reduce the level of gastrointestinal hormones in patients,such as:SS,VIP and LEP,to promote gastric emptying.It is worthy to study further and use to treat the patient who with DGP.From the present study with the five gastrointestinal hormones,We can conclus that:the inhibit of gastrointestinal hormones may play a major role in the pathogenesis of DGP.
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