胃转流术对非肥胖型2型糖尿病治疗作用的临床研究

Effects of gastric bypass on non-obese type 2 diabetes mellitus

目的观察胃转流术（GBP）对非肥胖型2型糖尿病（T2DM）患者的治疗作用。方法前瞻性纳入2008年6月至2010年4月南京军区福州总医院合并非肥胖型T2DM的胃部病变行GBP47例，其中全胃切除Roux-OIl-Y式20例、胃大部切除Roux-e13-Y式13例和毕Ⅱ式14例。测量术前（0周），术后1周、2周和1、3、6个月体质量指数（BMI）、空腹血糖及胰高血糖素样肽一1（GLP一1）水平，检测术前、术后3、6个月糖化血红蛋白（HbAlc），术后糖尿病转归情况。结果与术前比较，3组术后1周至6个月空腹血糖均显著降低（P〈0．01），GLP一1水平术后升高（P〈0．01或P〈0．05）；术后3至6个月HbAlC显著降低（P〈0．01或P〈0．05），其中胃大部切除及全胃切除Roux—en—Y式组上述指标变化幅度显著〉毕Ⅱ式组（P〈0．05）。术后6个月，毕Ⅱ式和胃大部切除及全胃切除Roux．en—Y式组糖尿病手术总有效率分别为78．5％（11／14）、100％（13／13）和100％（20／20），其中Roux—en．Y式组总有效率显著高于毕Ⅱ式组（P〈0．05）。3组术后1月至6个月体质量指数均显著低于术前（P〈0．05），组间差异无统计学意义（P〉0．05）。结论3种胃肠道重建术均有降糖效果，其中Roux-en-Y式GBP对T2DM的疗效优于毕Ⅱ式，且并不依赖于体质量的降低。

Objective To observe therapeutical effects of gastric bypass on non-obese type 2 diabetes patients. Methods From June 2008 to April 2010, data of 47 patients with both gastric lesions and non-obese type 2 diabetes mellitus undergoing gastric bypass in the Institute of General Surgery were studied. The patients were divided into 3 groups according to the operation type： total stomach resection plus Roux-en-Y anastomosis （n = 20）, partial stomach resection plus Roux-en-Y anastomosis （n = 13 ） and Billroth lI gastrectomy （n = 14）. They were followed for 6 months after surgery. Level of body mass index （ BMI）, fasting blood glucose （FBG） and GLP-1 was measured before operation and on the 1st week, 2nd week, 1 st month, 3rd month, and 6th month after operation. The level of glycosylated hemoglobin was measured before operation and on the 3rd and 6th month after operation. The prognosis of the patients on the 6th month after surgery was evaluated. Results Compared with preoperative level, FBG level in all the 3 groups significantly decreased on the 1 st week after surgery and maintained a similar level during the follow-up period （ P 〈 0.01 ）. GLP-1 level was elevated after operation （ P 〈 0.01 or P 〈 0.05 ）. On the 3rd and 6th month after operation, glycosylated hemoglobin level in all the 3 groups significantly decreased （P 〈 0.01 or P 〈 0.05）. The change of the above parameters was greater in groups under- going Roux-en-Y anastomosis than in Billroth II group （P 〈 O. 05）. The control rate of T2DM for Billroth 11, partial stomach resection plus Roux-en-Y anastomosis and total stomach resection plus Roux-en-Y anastomosis was 78.5%（11/14）, 100% （13/13） and 100% （20/20） respectively on the 6th month after surgery, indicating Roux-en-Y gastric bypass had better effect of blood glucose control than Billroth II（ P 〈 O. 05 ）. Postoperative BMI decreased significantly in all groups （ P 〈 0.05 ） and there was no statistical differ- ence between all the groups （ P 〉 0.05 ）. Conclusions All groups of gastric bypass are effective in terms of glucose control. Roux-en-Y gastric bypass is more effective than Billroth I on diabetes control and its therapeutic effect is independent of weight loss.