代谢手术对肥胖伴或不伴2型糖尿病的疗效分析被引量：2

Curative effect analysis of metabolic surgery for obesity with or without type 2 diabetes mellitus

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摘要目的探讨代谢手术治疗肥胖伴或不伴2型糖尿病的疗效。方法回顾性分析2013年1月至2014年12月在复旦大学附属中山医院接受代谢手术治疗的26例患者的临床资料。其中男11例，女15例；年龄19-64岁。16例被诊断为肥胖合并2型糖尿病；5例被诊断为糖尿病前期（空腹血糖受损及糖耐量减低）；5例被诊断为单纯性肥胖症。收集并对比26例患者手术前后的代谢参数指标。结果分别有16例、13例和10例患者完成术后3个月、6个月和1年随访。术后患者体重与BMI呈下降趋势（P＜0.05）。术后3个月空腹血糖（5.5±1.3）mmol/L，餐后2小时血糖（8.6±3.8）mmol/L，糖化血红蛋白（6.46±0.76）%；术后6个月空腹血糖（4.8±0.7）mmol/L，餐后2小时血糖（7.2±3.4）mmol/L，糖化血红蛋白（5.56±0.49）%；术后1年血糖水平高于术后6个月。术后3个月、6个月和1年，肝脏脂肪含量平均下降分别为21.6%、25.1%和25.1%。结论代谢手术能明显降低患者体重、改善糖代谢情况。对于重度单纯性肥胖伴或不伴2型糖尿病患者，手术治疗是减轻体重及肝脏脂肪含量、治疗糖尿病行之有效的手段。 Objective To explore the curative effect of metabolic surgery for obesity with or without type 2 diabetes mellitus.Methods Clinical data of 26 patients undergoing metabolic surgery in Zhongshan Hospital of Fudan University from January 2013 to December 2014 was retrospectively analyzed. Among them, 11 were males and 15 were females, with the age ranging from 19 to 64 years old. 16 cases were diagnosed as obesity combined with type 2 diabetes; 5 cases were diagnosed as prediabetes （impaired fasting glucose and glucose tolerance）; 5 cases were diagnosed as simple obesity. Metabolic parameters of these 26 patients before and after surgery were collected and compared.Results Sixteen patients were followed up postoperatively for 3 months, 13 patients for 6 months and 10 patients for 1 year. Weight and BMI decreased over time after surgery （P〈0.05）. At the 3 months postoperatively, average fasting blood glucose level was （5.5±1.3） mmol/L, 2-hour postprandial blood glucose was （8.6±3.8） mmol/L and HbA1c was （6.46±0.76）%. At the 6 months postoperatively, average fasting blood glucose level was （4.8±0.7） mmol/L, 2-hour postprandial blood glucose was （7.2±3.4） mmol/L and HbA1c was （5.56±0.49）%. Blood glucose level at 1 year after surgery was higher than that at 6 months. Averagedecline of liver lipid content were 21.6%, 25.1% and 25.1% respectively at 3 months, 6 months and 1 year after surgery.Conclusions Metabolic surgery can significantly reduce weight and improve blood glucose metabolism. For severe simple obesity with or without type 2 diabetes mellitus, surgical treatment is an effective method to reduce weight, liver lipid content and treat diabetes.