腹腔镜胃转流术对体质指数28˜35 kg/m2伴代谢综合征的2型糖尿病患者的疗效研究

摘要

Objective To investigate the effect of laparoscopic gastric bypass operation( GBP)on type 2 diabetic patients with body mass index ( BMI )28 -35 kg/m2 accompanied by metabolic syndrome. Methods A cohort study was conducted among 42 T2DM patients with BMI 28-35 kg/m2 hospitalized in General surgery of General Hospital of Armed Police Forces from July,2010 to March,2011. The patients were divided into Ms group(n=20)and NMs group(n=22). Glucose metabolism indicators,islet function anthropometric indicators and lipid metabolism indicators were detected preoperatively and 1,3,6 and 12 months postoperatively. Results The patientsˊ overall compliance rate was 77. 5% in 12 months after GBP. The compliance rate of glucose metabolism was 89. 5%(17/19)in the Ms group and 66. 7%(14/21)in the NMs group. The metabolic markers ( FPG, 2 hPG, HbA1c , and AUCg ), islet function ( FINs, HOMA - IR and HOMA - IsI ), anthropometric indicators( body weight,waist circumstance and BMI)and lipid metabolism indicators( TG,HDL-C) had no significant differences in time points and the interaction between the two groups( P >0. 05 );HbA1c and waist circumstance between the two groups had significant difference ( P <0. 05 );2 hPG, HOMA - IR, HOMA - IsI, body weight, waist circumstance,BMI and TG between the two groups had statistical significance at different time points(P<0. 05). Conclusion GBP has curative effect on non - morbid obesity T2DM. The weight - relieving effect was similar in two groups. The improvement of glycometabolism is better in Ms group than that in NMs group. The resolution of T2DM after GBP is independent with weight loss. The metabolic disturbance of T2DM may be one of the reserved indexes for indications of GBP.%目的：探讨腹腔镜胃转流术（ GBP）对体质指数（ BMI）为28˜35 kg/m2合并代谢综合征的2型糖尿病患者的疗效。方法选取2010年7月—2011年3月入住武警总医院普外科BMI为28˜35 kg/m2的42例2型糖尿病患者，按是否合并代谢综合征分成代谢综合征组（ MS组，n=20例）和无代谢综合征组（ NMS组，n=22例）。分别于术前和术后1、3、6、12个月时检测糖代谢指标、胰岛功能、人体测量学指标和脂代谢指标。结果 GBP术后12个月时，患者糖代谢的总体达标率为77.5%，MS组达标率为89.5%（17/19），NMS组达标率为66.7%（14/21）。两组手术前后糖代谢指标〔空腹血糖（FPG）、餐后2 h 血糖（2 hPG）、糖化血红蛋白（HbA1c）、葡萄糖曲线下面积（ AUCg）〕、胰岛功能指标〔空腹胰岛素（ FINS）、胰岛素抵抗指数（ HOMA-IR）、胰岛素敏感指数（ HOMA-ISI）〕、人体测量学指标（体质量、腰围、BMI）、脂代谢指标〔三酰甘油（ TG）、高密度脂蛋白胆固醇（ HDL-C）〕时间与组间的交互作用均无统计学意义（P＞0.05）；两组组间不同时间点HbA1c、腰围比较差异有统计学意义（P＜0.05）；两组组内不同时间点2 hPG、HOMA-IR、HOMA-ISI、体质量、腰围、BMI、TG水平间差异均有统计学意义（ P＜0.05）。结论 GBP对非病态肥胖的2型糖尿病有治疗作用，对MS组和NMS组患者的减重效果相同，MS组糖代谢改善效果优于NMS组，手术的降糖机制可能独立于减重作用，2型糖尿病代谢紊乱程度可作为 GBP适应证备选指标之一。