不同胃肠道重建方式对2型糖尿病患者术后胰岛功能的影响

Impact of techniques for gastrointestinal tract reconstruction following gastrectomy on pancreatic β-cell function in patients with type 2 diabetes mellitus

目的探讨不同胃肠道重建方式对2型糖尿病患者术后胰岛功能的影响。方法对23例胃癌合并2型糖尿病患者的临床资料进行回顾性分析．并按消化道重建方式的不同分为BillrothⅠ式组（13例）和胃肠旁路组（10例。其中毕Ⅱ式吻合4例，Roux—en—Y吻合6例）。行口服糖耐量试验（OGTr）．采用电化学发光法检测血清胰岛素水平．采用葡萄糖氧化酶法测定血糖．采用稳态模式评估法评价胰岛素抵抗指数和胰岛素分泌指数。结果胃肠旁路术组和BillorthⅠ式组术后糖尿病好转率分别为90％（9／10）和23％（3／13），差异有统计学意义（P〈0．01）。与术前相比，胃肠旁路组术后糖化血红蛋白A1c和糖化血红蛋白HbAl显著降低（P〈0．01）．而BillrothⅠ式组则无明显改善（P〉0．05）。OGTF结果显示，胃肠旁路组空腹血糖及及糖负荷后各个时间点的血糖水平均显著低于BillrothⅠ式组：在糖负荷后30min和60min．胃肠旁路术组胰岛素水平和胰岛素释放指数明显高于BillrothⅠ式组（均P〈0．05）。胃肠旁路组的胰岛素分泌指数和早期胰岛素分泌反应同样明显高于BillrothⅠ式组。结论采用胃肠旁路术进行胃切除术后消化道重建．可有效控制2型糖尿病并明显改善术后胰岛功能。

Objective To evaluate the impact of different techniques for gastrointestinal tract reconstruction on postoperative pancreatic β-cell function in patients with type 2 diabetes mellitus （T2DM）. Methods Twenty-three patients with gastric cancer and T2DM were studied. Techniques for reconstruction included Billroth I （n=13） and bypass procedures（Billroth 11 n=4 and Roux-en-Y anastomosis n=6）. Pancreatic 13-cell function was evaluated by oral glucose tolerance test （OGTY）. Serum insulin was measured by electrochemiluminescence immunoassay and blood glucose by glucose oxidase method. HOMA-IR and HOMA-β were assessed. Results T2DM remission rate was 90%（9/10） in the bypass group, and 23%（3/13） in Billroth I group （P〈0.01）. Glycosylated hemoglobin Alc and glycated hemoglobin HbA1 were improved significantly in patients after bypass procedures （P〈0.05）, but the difference in Billroth I group was not statistically significant （P〉0.05）. OGTT showed that fasting and post-glucose load plasma glucose at each time point were significantly lower in the bypass group compared to the Billroth I group. At 30 minutes and 60 minutes after glucose load, insulin levels and insulin release index were significantly higher in the bypass group compared to Billroth I group, as were levels of HOMA-β and ΔI30/ΔG30 in the bypass group （P〈0.05）. Conclusion Gastrointestinal bypass ibllowing gastrectomy may induce resolution of T2DM and improve β-cells function.