摘要
目的观察Roux-en-Y胃肠道重建对非肥胖性糖尿病胃癌患者血糖和血脂代谢的影响。方法非肥胖性糖尿病胃癌患者57例行根治性远端胃切除术,其中35例行Roux-en-Y胃肠道重建,22例行Billroth I式胃肠道重建。观察手术前、手术后3个月和6个月两组体质量指数、糖化血红蛋白、空腹血糖、胰岛素、C肽、甘油三酯、总胆固醇、高密度脂蛋白和低密度脂蛋白含量的变化,并检测口服葡萄糖后2h血糖、胰岛素和C肽的变化。结果手术前两组各检测指标之间相比差异均无统计学意义(P〉0.05)。手术后两组体质量指数变化之间相比差异无统计学意义(P〉0.05);术前、手术后3个月和6个月Roux—en—Y胃肠道重建组空腹血糖为(9.3±0.9)mmol/L比(7.2±2.1)mmol/L比(7.1±0.8)mmol/L,P=0.000;糖化血红蛋白为(9.2±1.2)%比(7.3±1.2)%比(7.2±1.1)%,P=0.000;空腹甘油三酯为(3.21±0.88)mmol/L比(2.12±0.97)mmol/L比(2.02±0.09)mmol/L,P=0.000;空腹总胆固醇为(6.4±1.9)mmol/L比(4.3±1.0)mmol/L比(4.1±1.0)mmol/L,P=0.000;空腹低密度脂蛋白为(3.61±1.05)mmol/L比(2.77±0.68)mmol/L比(2.71±0.18)mmol/L,P=0.000;2h血糖为(17.6±2.5)mmol/L比(12.1±1.9)mmol/L比(11.6±2.3)mmol/L,P=0.000,含量较手术前明显下降(P〈0.01)。空腹胰岛素为(98±11)pmol/L比(120±9)pmol/L比(122±8)pmol/L,P=0.000;空腹C肽为(0.21±0.08)mmol/L比(O.30±0.01)mmol/L比(0.30±0.01)mmol/L,P=0.000;空腹高密度脂蛋白为(1.08±0.10)mmol/L比(1.61±0.34)mmol/L比(1.62±0.09)mmol/L,P=0.000;2h胰岛素为(410±19)pmol/L比(446±19)pmol/L比(459±18)pmol/L,P=0.000;2hC肽为(0.87±0.17)mmol/L比(1.22±0.14)mmol/L比(1.19±0.15)mmol/L,P=0.000。Billroth I式胃肠道重建组糖化血红蛋白为(9.2±1.2)%比(8.4±1.6)%比(8.3±1.1)%,P=0.046。结论Roux—en—Y胃肠道重建术可改善非肥胖性糖尿病胃癌患者血糖和血脂代谢,且与体质量指数变化无关。
Objective To observe the effects of Roux-en-Y gastrointestinal reconstruction (RYGR) on carbohydrate and lipid metabolism in non-obese patients with type 2 diabetes and gastric carcinoma. Methods Fifty seven gastric cancer cases who underwent radical distal gastrectomy were studied and among them 35 patients had Roux-en-Y gastrointestinal reconstruction (RYGR group) and 22 had Billroth-I gastrointestinal reconstruction (B-I GR group ). Both groups were subjected to the measuring of preoperative and postoperative third, sixth months values of body mass index ( BMI), glycosylated hemoglobin (GHbAlc), fasting glucose (FPG), fasting insulin (Fins)and C-peptide (FC-P), oral glucose tolerance (OGTT) including 2 hour insulin (2bins) and C-peptide (2hC-P), plasma levels of total cholesterol ( TC), triglycerides(TG), high density lipoprotein(HDL-c) and low density lipoprotein(LDL-c). Result There was no sianificant difference between the two zrouns in nreonerariw values (P〉0.05). There was no statistically significant difference in BMI values measured postoperatively ( P 〉 0.05 ). In RYGR group, preoperative FPG and that of third and sixth month postoperatively was ( 9. 3 ±0. 9 ) mmol/L vs. ( 7.2± 2.1) mmol/Lvs. (7.1+0.8) mmol/L, P=O. 000, GHbAlcwas (9.2±1.2)% vs. (7.3±1.2)% vs. ( 7.2±1. 1)%, P=O. 000, TGwas (3.21 ±0.88) mmol/Lvs. (2.12±0.97) mmol/Lvs. (2.02±0.09) mmol/L, P=0.000, TC was (6.4±1.9) mmol/L vs. (4.3±1.0) mmol/Lvs. ( 4.1 ±1.0) mmoL/L, P =0.000 and LDL-c was (3.61 ±1.05) mmol/L vs. ( 2.77 ±0.68) mmol/L vs. (2.71 ±0. 18 ) mmol/L, P = 0. 000, 2 hour glucose after OGTr(2hPG) was (17.6 + 2. 5 ) mmol/L vs. (12. 1 ±1.9) mmol/L vs. ( 11.6 ± 2. 3 ) mmol/L, P = 0. 000. Levels of Fins was (98 ± 11 ) pmol/L vs. ( 120 ± 9 ) pmol/L vs. ( 122 ±8) pmol/L, P = 0. 000, FC-P was (0.21 ±0.08) mmol/L vs. (0. 30 ± 0. 01 ) mmol/L vs. (0.30±0.01) mmol/L, P=0.000, HDL-cwas (1.08±0.10) mmol/Lvs. (1.61 ±0.34) mmol/L vs. (1.62 ±0.09) mmo//L, P=O. O00, 2 h Ins was (410 ± 19) pmo//L vs. (446 ± 19) pmo//L vs. (459 ± 18 ) pmol/L, P = 0. 000 and 2 h C-P was (0. 87 ± 0. 17 ) mmol/L vs. ( 1.22 ±0. 17) mmol/L vs. (1. 19 ±0. 15) mmol/L, P=0. 000. In B-I GR group, preoperative and third and sixth postoperative month valuesof GHbAlc were (9.2 ± 1.2)% vs. (8.4 ±1.6)% vs. (8.3 ± 1.1)%, P = 0.046. Conclusion Roux-en-Y gastric bypass can significantly improve the metabolism of carbohydrate and lipid in non-obese patients with type 2 diabetes and gastric carcinoma, and the effects are not related with postoperative weight loss.
出处
《中华普通外科杂志》
CSCD
北大核心
2010年第1期4-8,共5页
Chinese Journal of General Surgery
基金
国家重点基础研究发展计划项目(2007CB512700)
关键词
糖尿病
2型
吻合术
ROUX-EN-Y
糖代谢障碍
脂代谢障碍
胃肿瘤
Diabetes mellitus, type 2
Anastomasis, Roux-en-Y
Carbohydrate metabolism disorders
Lipid metabolism disorders
Stomach neoplasms