腹腔镜可调控性胃束带术治疗肥胖伴2型糖尿病的机制研究

Mechanism of laparoscopic adjustable gastric banding in the treatment of obesity with type 2 diabetes mellitus

目的 探讨腹腔镜可调控性胃束带术（LAGB）治疗肥胖症伴2型糖尿病（T2DM）的相关机制.方法 采用LAGB治疗20例肥胖症伴T2DM患者.术后第1、3、6、9、12个月监测术后体质量并计算BMI;采用ELISA检测血清瘦素、胰高血糖素样肽-1（GLP-1）及生长激素释放多肽（ghrein）的水平;采用电化学发光法检测空腹血清胰岛素（FINS）、C肽、糖化血红蛋白（HbA1c）的水平;采用氧化酶法检测空腹血糖（FBG）水平;对血清瘦素、GLP-1及ghrein水平与糖尿病相关指标进行相关性检验.结果 本组20例患者LAGB术后12个月,体质量由术前的（108±18）kg降至（71±16）kg （P＜0.05）,BMI由术前的38±5降至29±6（P＜0.05）;胰岛素抵抗指数由术前的12.8±7.4降至3.4±2.0（P＜0.01）;血清ghrelin水平由术前的（7.8±1.9）μg/L升至（11.6±2.6）μg/L（P＜0.01）,血清瘦素水平由术前（24.9±13.7）μg/L降至（12.9±5.1）μg/L（P＜0.01）,GLP-1水平由术前的（0.58±0.12）μg/L升至（0.80±0.06）μg/L（P＜0.01）;血清瘦素水平与糖尿病相关指标（FBG、FINS、C肽及HbA1c）呈正相关,而血清Ghrelin和GLP-1水平则与上述糖尿病相关指标呈负相关（均P＜0.01）.结论 LAGB能有效治疗肥胖伴T2DM,其可能的机制是通过升高血清GLP-1和ghrelin水平,降低血清瘦素水平,减轻胰岛素抵抗,从而达到降低血糖的目的 .

Objective To explore the mechanism of laparoscopic adjustable gastric banding （LAGB） in the treatment of obese patients with type 2 diabetes mellitus （T2DM）. Methods A total of 20 patients with obesity and T2DM were treated with LAGB. During the postoperative 1, 3, 6, 9, 12 months, the body weight changes were monitored and body mass indices （BMI） were calculated. The serum levels of leptin, GLP-1, and ghrelin were examined preoperatively and 1, 3, 6, 9, 12 months after LAGB using enzyme-linked-immunosorbent assay （ELISA）. At the same time, the fasting serum insulin （FINS）, C-peptide, glycated hemoglobin （HbAlc） levels were examined by electrochemiluminescence and the level of fasting blood glucose （FBG） was tested with oxidase test. Results At postoperatively 12 months, all the 20 patients lost weight. The mean body weight decreased from（108±18） kg to （71 ± 16） kg （P〈0.05） and BMI decreased from 38±5 to 29±6 （P〈0.05）. The HOMA-IR decreased from （12.8±7.4） to （3.4±2.0）（P〈0.01）. The serum ghrelin level increased from（7.8±1.9）μg/L to （11.6± 2.6） μg/L（P〈0.01）. The serum leptin level declined from （24.9±13.7） μg/L to（12.9±5.1） μg/L（P〈 0.01）. The serum GLP-1 level increased from （0.58±0.12） μg/L to（0.80±0.06） μg/L（P〈0.01）. After LAGB, there were positive correlations between serum leptin level and FBG, FINS, HbAlc,and C-peptide level. Serum ghrelin and GLP-1 were negatively correlated with FBG, FINS, HbAlc,C-peptide. Conclusions LAGB is effective in treatment of obesity patients with T2DM. The mechanism may be associated with the increase of serum GLP-1 and ghrelin and the decrease of serum leptin and insulin resistance.