摘要
目的通过病例自身对照研究，评价改良Roux—en—Y胃转流术（RYGP）治疗非肥胖型2型糖尿病（T2DM）的1年效果，并探讨合理的手术择入标准。方法2009年5月至2010年6月72例T2DM患者接受改良RYGP，其中男性45例，女性27例；年龄22～69岁，平均年龄（47±10）岁。术前体质量指数（BMI）18．69～31．22kg／m^2，平均（26±4）kg／m^2。分别在术前以及术后1、3、6、12个月检测空腹血糖、餐后2h血糖（2hPG）、体质量、BMI和用药情况，在术前以及术后6、12个月检测糖化血红蛋白、空腹胰岛素（Fins）、空腹C肽和胰岛素抵抗指数。比较手术前后的各项指标。结果改良RYGP后1、3、6、12个月与术前相比，空腹血糖、2hPG、体质量和BMI明显改善（t=7．014～10．254，P=0．000）；术后6、12个月与术前相比，糖化血红蛋白、空腹C肽和胰岛素抵抗指数明显改善（t=1．782～7．789，P=0．000～0．103），Fins变化差异无统计学意义（P〉0．05）。术后1、3、6、12个月的手术完全缓解率分别为22．2％、27．8％、36．1％、60．6％，1年时缓解率为94．3％。术后1年完全缓解与术前空腹c肽正常、胰岛素抗体阴性和口服降糖药有关（χ^2=11．730，P：0．003；χ^2=7．131，P=0．028；χ^2=6．149，P=0．046）。结论改良RYGP治疗非肥胖的T2DM安全、有效，术后胰岛细胞功能明显改善。术前空腹C肽正常、胰岛素抗体阴性的T2DM患者术后1年手术完全缓解率较好。
Objective To evaluate the one year effect of modified Roux-en-Y gastric bypass （RYGP） in the treatment of non-obese type 2 diabetes and to investigate the reasonable indications for surgery. Methods Totally 72 patients diagnosed as type 2 diabetes underwent RYGP from May 2009 to June 2010. There were 45 male and 27 female patients, with an average age of （47 ± 10） years. Preoperative body mass index （BMI） of the patients was 18.69 to 31.22 kg/m：, average （26 ±4） kg/m2. The follow-up data included fasting plasma glucose （FPG） , 2 h plasma glucose after oral glucose challenge （2hPG）, weight, BMI and medication usage in 1, 3, 6 and 12 months postoperative; hemoglobin Alc （HbAle） , fasting C-peptide （C-P）, fasting serum insulin （Fins） and homeostasis model assessment of insulin resistance index （HOMA-IR） in 6 and 12 months postoperative, respectively. Results Compared with the preoperative, FPG, 2hPG, weight and BMI in 1, 3, 6 and 12 months after surgery were improved （t =7. 014 to 10. 254, P = 0. 000）, while HbAle, C-P and HOMA-IR in 6 and 12 months after surgery were improved （t = 1. 782 to 7. 789, P = 0. 000 to 0. 103 ） and there was no significant difference in Fins （P〉0.05）. The rates of complete remission in 1, 3, 6 and 12 months after surgery were gradually improved to 22.2% , 27.8% , 36. 1% and 60. 6% , respectively, and the rate of remission in 1 year was 94. 3%. The complete remission of 1 year after surgery was associated with normal C-P,insulin antibody and oralantidiabetic drugs （χ^2 = 11.730, P =0.003; χ^2 =7.131, P =0.028;χ^2 =6.149,P =0.046）.Conclusions Modified RYGP is safely and effectively in the treatment of no-obese type 2 diabetes patients. The function of islet ceils is significantly improved after operation. Especially for the patients of whom C-P is normal, insulin antibody is negative before surgery, the rate of complete remission after 1 year is better.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第10期879-882,共4页
Chinese Journal of Surgery
关键词
糖尿病
2型
胃旁路
随访研究
Diabetes mellitus, type 2
Gastric bypass
Follow-up studies
