摘要
目的观察Roux-en-Y胃旁路术对非肥胖性2型糖尿病患者血糖和血脂代谢的影响。方法共37例非肥胖2型糖尿病患者接受Roux-en-YY胃旁路术,观察其手术前、手术后3个月和6个月的体质量指数、糖化血红蛋白、空腹血糖、胰岛素、C肽、胰岛素抵抗指数、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,并比较口服葡萄糖后2h血糖、胰岛素和c肽的变化。结果本组37例患者无严重围手术期并发症。手术前、手术后3个月和6个月体质量指数变化之间相比差异均无统计学意义(P〉0.05);手术前、手术后3个月和6个月空腹血糖[(8.8±0.9)mmol/L、(7.0±2.0)mmol/L、(6.3±0.6)mmol/L,P〈0.01]、糖化血红蛋白[(8.2%±1.2%、7.O%±0.8%、6.2%±0.7%,P〈0.01]、空腹胰岛素[(10.6±1.2)mU/L、(9.0±0.9)mU/L、(9.0±0.8)mU/I一,P〈0.05]、空腹c肽[(1.9±0.5)nmol/L、(1.2±0.6)nmol/L、(1.2±0.4)nmol/L,P〈0.01]、空腹甘油二三酯[(3.3±0.8)mmol/L、(2.7±0.9)mmol/[.、(2.6±0.7)mmol/L,P〈0.05]、空腹总胆固醇[(6.5±1.8)mmoL/L、(4.6±0.9)mmol/L、(4.2±1.0)mmol/L,P〈0.05]、空腹低密度脂蛋白『(3.6±1.2)mmol/L、(2.8±0.8)mmol/L、(2.7±0.2)mmoL/L,P〈0.01]、餐后2h血糖[(18.6±3.0)mmol/L、(12.7±2.3)mmol/L、(11.4±2.0)mmol/L,P〈0.01]、胰岛素抵抗指数[(3.2±1.7)、(2.6±1.6)、(2.5±1.3),P〈0.05]之间相比差异均有统计学意义。空腹高密度脂蛋白[(1.2±0.1)mmol/L、(1.4±0.4)mmol/L、(1.4±0.2)mmol/L,P〈0.01]、餐后2h胰岛素[(17.2±3.4)mU/L、(26.3±4.7)mU/L、(28.6±4.1)mU/L,P〈0.01l、2hC肽[(4.2±1.0)nmo]/L、(6.3±1.5)nmol/L、(6.2±1.4)nmol/L,P〈0.01]在手术后均明显升高。结论Roux-en-Y胃旁路术可改善非肥胖性2型糖尿病患者血糖和血脂代谢,且与体质量指数变化无关。
Objective To evaluate Roux-en-Y gastric bypass operation on carbohydrate and lipid metabolism in type 2 diabetes mellitus patients with BMI range of 24 - 29. Methods Thirty seven cases of type 2 diabetes mel|itus patients undergoing Roux-en-Y gastric bypass operation were studied. Body mass index ( BMI ), glycosylated hemoglobin ( GHbA1 c ), fasting glucose ( FPG ), fasting insulin ( Fins ) and C-peptide ( FC-p ), HOMA-IR, oral glucose tolerance (OGTF) including 2 hour insulin (2hIns) and C-peptide (2hC-p), plasma levels of total cholesterol(TC), triglycerides(TG), high density lipoprotein(HDL-c) and low density lipoprotein ( LDL-c ) were measured preoperatively and on 3 months, 6 months, later postoperatively. Result There was no statistically significant difference between BMI values measured preoperatively and postoperatively( P 〉 0. 05 ). Serum levels measured in pre-operative and third and sixth post-operative months were : FPG ( 8.8±0. 9, 7.0 ± 2. 0, 6. 3 ± 0.6, P 〈 0. 01 ) ( mmol,/L), GHbAI c (8.2±1.2, 7.0±0.8, 6.2±0.7, P〈0.01)(%), FIns(10.6±l.2, 9.0±0.9, 9.0±0.8, P〈0.05) (mU/L), FC-p(1.9±0.5, 1.2 ±0.6, 1.2 ±0.4, P〈0.01)(nmol/L), TG(3.3±0.8, 2.7 ±0.9, 2. 6 ± 0. 7, P 〈 0. 05 ) ( mmol/L), TC (6. 5±1.8, 4. 6± 0. 9, 4.2 ±1.0, P 〈 0. 05 ) (mmol/L) and LDL-c (3.6 ±1.2, 2. 8±0. 8, 2. 7± 0.2, P 〈 0.01 ) ( mmol/L), 2 hour glucose after OGTT(2hPG) ( 18.6 ± 3.0, 12.7±2.3, 11.4±2.0, P〈0.01)(mmol/L), HOMA-IR(3.2±1.7, 2.6 ±1.6, 2.5±-1.3, P〈 0.05). Postoperative levels of HDL-c(1.2±0.1, 1.4 ±0.4, 1.4±0.2, P〈O. 01)(mmol/L), 2bins (17.2±3.4, 26.3±4.7, 28.6±4.1, P〈0.01) (mU/L)and 2hC-p(4. 2 ± 1.0, 6.3±1.5, 6.2±1.4, P 〈 O. 01 ) ( nmol/L ) were significantly higher than that of the pre-operative values ( P 〈 0. 01 ). Conclusions Roux-en-Y gastric bypass significantly improves the metabolism of carbohydrate and lipid in type 2 diabetes patients with BMI 24-29, and the effects are not associated with weight loss.
出处
《中华普通外科杂志》
CSCD
北大核心
2011年第6期474-477,共4页
Chinese Journal of General Surgery
基金
国家自然科学基金资助项目(30801464)