胃转流术对2型糖尿病患者糖代谢影响的初步观察：八例临床资料分析并文献复习

Observation of curative effect of gastric bypass on type 2 diabetes： a study with eight cases and literature review

目的 观察胃转流术对2型糖尿病患者糖代谢相关指标的影响,并评价胰岛β细胞功能及胰岛素抵抗的改善情况.方法 前瞻性研究8例2型糖尿病患者合并胃癌等胃肠道疾病行胃转流术治疗,术前和术后1周、2周、1个月、3个月的空腹血糖（FPG）及糖负荷后2 h血糖（2hPG）、空腹血浆胰岛素（Fins）、糖负荷后2 h血浆胰岛素（2hIns）、空腹血浆C肽（空腹C肽）、糖负荷后2 h血浆C肽（2hC肽）、体质指数（BMI）的变化,术前、术后3个月糖化血红蛋白（HbA1c）的变化及术后3个月糖尿病的转归情况.结果 胃转流术后1周所有患者的FPG及2hPG均较术前明显下降（P＜0.05）,术后1个月Fins、2hIns、空腹C肽、2hC肽均较术前明显升高（P＜0.05）;术后3个月HbA1c水平较术前明显下降（P＜0.05）;患者术后各时间段BMI较术前均无明显变化（P＞0.05）.术后3个月8例患者均达到糖尿病治疗有效标准,其中6例患者达到临床缓解标准.结论 胃转流术能明显降低2型糖尿病患者的血糖水平,其对血糖的控制不依赖于体重的降低;胃转流术控制血糖可能与胰岛β细胞功能改善、内源性胰岛素分泌增加有关.

Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index （BMI） were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin （HbA1c） levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased （P 〈 0.05） and fasting and postprandial insulin C-peptide levels increased （P 〈 0.05） after the surgery. HbA1c levels also decreased （P 〈 0.05） after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery（P〉 0.05）. All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin.