三种消化道重建术对非肥胖性2型糖尿病患者糖脂代谢的影响

Impact of 3 kinds of digestive tract reconstruction on carbohydrate and lipid metabolism in non-obese type 2 diabetes mellitus patients

目的:探讨三种消化道重建术对非肥胖性2型糖尿病患者糖脂代谢的影响.方法:回顾性分析2008-02/2011-05在甘肃省人民医院普外科接受BillrothⅠ术(10)、BillrothⅡ术(13)和Roux-en-Y术(16)治疗的39例合并有2型糖尿病患者临床资料,比较3组手术治疗非肥胖性2型糖尿病的临床结局.结果:39例患者术后均无严重并发症,3组术式术前与术后检测指标比较空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯和低密度脂蛋白下降分别为2.6mmol/L±0.7mmol/L、2.1%±0.7%、1.5mmol/L±0.5mmol/L、0.8mmol/L±0.3mmol/L和1.0mmol/L±0.4mmol/L,高密度脂蛋白、空腹胰岛素和空腹C肽增高分别为0.3mmol/L±0.07mmol/L、6.1mU/L±3.2mU/L、0.28nmol/L±0.06nmol/L.3组术式组内比较差异有统计学意义(P<0.05).3组术式组间比较,Roux-en-Y术组术后空腹血糖、糖化血红蛋白、甘油三酯和低密度脂蛋白均降至正常,与其他两组组间比较差异有统计学意义(P<0.05).术后在不需要药物和饮食控制的情况下BillrothⅠ术、BillrothⅡ术和Roux-en-Y术改善患者糖脂异常的有效率分别为40.0%、69.2%和81.3%.结论:三种消化道重建术可改善非肥胖性2型糖尿病患者糖脂代谢异常,机制尚不完全明确.

AIM： To evaluate the effect of three digestive tract reconstruction procedures on carbohydrate and lipid metabolism in non-obese patients with type 2 diabetes mellitus （T2DM）. METHODS： Clinical data for 39 patients who underwent Billroth I anastomosis （10 cases）, Billroth II anastomosis （13 cases） or Roux-en-Y anastomosis （13 cases） in the Department of General Surgery, Gansu Provincial People＇s Hos- pital from July 2008 to May 2011 were reviewed.Clinical outcomes were assessed and compared between the three groups. RESULTS： All patients recovered without major complications. Compared to preoperative lev- els, postoperative levels of FPG, GHbAlc, TG, TC and LDL-c decreased by 2.6 mmol/L± 0.7 mmol/L, （2.1±0.7）%, 1.5 mmol/L± 0.5 mmol/L, 0.8 mmol/L ± 0.3 mmol/L, and 1.0 mmol/L± 0.4 mmol/L, respectively, while postoperative levels of HDL-c, Fins and FC-p increased by 0.3 mmol/L ±0.07 mmol/L, 6.1 mU/L ± 3.2 mU/L and 0.28 nmol/L ± 0.06 nmol/L. Postoperative levels of FPG, GHbAlc, TG and LDL-c in pa- tients undergoing Roux-en-Y anastomosis were much lower than those in other two groups （all P 〈 0.05）. Without any drug treatment and spe- cial diet, Billroth I anastomosis, Billroth II anas- tomosis and Roux-en-Y anastomosis improved glycolipid abnormality in 40%, 69.2% and 81.3% of patients, respectively. CONCLUSION： All three digestive tract recon- struction procedures can improve carbohydrate and lipid metabolism in non-obese T2DM pa- tients.