胃转流术治疗2型糖尿病的近期效果

Short term results of gastric bypass in the treatment of type 2 diabetes mellitus

目的研究胃转流术（gastricbypass，GBP）对2型糖尿病（type2diabetesmellitus，T2DM）的治疗作用。方法分析2009年9月至2010年9月在第四军医大学西京医院住院的32例T2DM患者接受GBP的临床资料，比较手术前后空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAlc）及体质量、血压和脂肪肝的变化。结果本组32例患者在GBP后无严重并发症。术后1、6、12个月的FBG[（7．8±2．2）mmol／L、（7．7±2．2）mmol／L、（7．2±1．8）mmol／L]均低于术前的PBG[（11．1±2．7）mmol／L]，P〈0．05；术后1、6、12个月的2hPG[（10．2±2．6）mmol／L、（10．5±2．8）mmol／L、（10．5±3．1）mmol／L]均低于术前的2hPG[（14．0±3．5）mmol／L]，P〈0．05；术后1、6、12个月的HbAlc[（7．6％±1．4％）、（7．5％±1．7％）、（7．1％±1．9％）]均低于术前的HbAlc[（9．0％±2．3％）]，P〈0．05。BMI〈25kg／m^2的非超重者的术后12个月FBG[（6．9±1．5）mmol／L]、2hPG[（10．0±3．2）mmol／L]、HbAlc[（6．9％±1．9％）]均低于术前的FBG[（10．7±2．9）mmol／L]、2hPG[（14．3±4．1）mmol／L]、HbAlc[（8．8％±2．0％）]，P〈0．05；BMI≥25ks/m^2的非超重者的术后12个月FBG[（7．5±2．3）mmol／L]、2hPG[（11．3±2．9）mmol／L]、HbAlc[（7．3％±1．9％）]均低于术前的FBG[（11．7±2．3）mmool／L]、2hPGE（13．5±2．4）mmol／L]、HbAlc[（9．2％±2．7％）]，P〈O．05。6例合并有高血压的T2DM患者术后1年血压正常5例。17例合并有脂肪肝的T2DM患者术后1年脂肪肝减轻8例。结论GBP对T2DM患者的糖代谢失常殛合并痒右明岛的治疗作用．

Objective To evaluate gastric bypass on relieving type 2 diabetes mellitus. Methods From September 2009 to September 2010, Thirty two cases of type 2 diabetes mellitus patients underwent gastric bypass operation in Xijing Hospital. Preoperative FBG,2hPG, HbAlc ,weight, blood pressure and fatty liver were compared with that on 1 month, 6 months, 12 months after operation. Result There was no significant postoperative complications. FBG on 1 month,6 months,12 months postop and preoperative level was respectively 7. 8 ~2. 2,7.7 ~2. 2,7.2± 1.8 and 11.1 ±2. 7 （mmolfL） ,P 〈0.05. 2hPG was 10. 2± 2.6,10.5 ±2.8,10.5 ±3.1 and 14.0±3.5 （mmol/L）,P〈0.05. HbAlc was 7. 6% ±1.4%,7.5% ± 1.7%,7.1% ±1.9% and9.0% ~2.3%,P〈0.05. FBG[（6.9±1.5） mmol/L],2hPG[（10.0±3.2） mmol/L] and HbAlc[ （6. 9% ± 1.9% ） ] on 12 months after operation were lower than preoperative[ FBG （ 10. 7 ± 2. 9 ） mmol/L, 2hPG （ 14. 3±4. 1 ） mmol/L, HbAlc （ 8. 8% ± 2. 0% ） ] in patients with BMI 〈 25 kg/m^2 （ P 〈 0. 05 ）. In patients with preoperative BMI ≥ 25 kg/m^2, FBG （ 7. 5± 2. 3 ） mmol/L, 2hPG （11.3 ±2. 9） mmol/L HbAlc （7. 3% ± 1.9% ）, 12 mos post were lower than that of preoperative levels of [FBG（11.7 ±2.3） mmol/L, 2hPG（13.5 ±2.4） mmol/L, HbAlc（9.2% ±2.7%）] （P 〈0.05）. Postoperative blood pressure became normal in 5 out of 6 patients complicating preoperative high blood pressure as evaluated on 12 months after operation. Fatty liver ameliorated in 8 out of 17 patients. Conclusions Gastric bypass significantly improves glycometabolism and comorbidity in type 2 diabetes patients.