代谢手术改善糖尿病患者血管舒张功能及相关机制

Effects of metabolic surgery on vasodilatation in obese with type 2 diabetes and underlying mechanisms

目的探讨代谢手术(metabolic surgery)对肥胖合并2型糖尿病患者血管舒张功能(vascular dilation)的影响及发生机制。方法 105例健康成人作为正常组,将31例肥胖合并2型糖尿病患者中11例未手术患者作为非手术组,20例代谢手术后患者作为代谢手术组。用高频超声检测所有观察对象安静状态下肱动脉内径(D1)、血流阻断后肱动脉内径(D2)及含服硝酸甘油后肱动脉内径(D3),计算出血流介导的血管舒张反应(flow-mediated dilation,FMD)及硝酸甘油介导的血管舒张反应(nitroglycerin-mediated dilation,NMD);测量20例代谢手术前后患者体质量、体质指数(BMI)、血压、血脂、空腹血糖、糖化血红蛋白、血清胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)及二肽基肽酶-4(dipeptidyl pepti-dase-4,DPP-4)。结果代谢手术组与非手术组相比,血管舒张功能(FMD、NMD)具有显著差异(P<0.01),与正常组血管舒张功能(FMD、NMD)相比,差异无统计学意义(P>0.05);而非手术组与正常组相比,血管舒张功能(FMD、NMD)具有显著差异(P<0.01);与代谢手术组术前相比,术后GLP-1明显升高(P<0.05),DPP-4明显降低(P<0.05)。结论肥胖合并2型糖尿病患者血管舒张功能明显低于正常人,肥胖合并2型糖尿病患者通过代谢手术治疗,体质量、BMI、血脂、血压、GLP-1、DPP-4较术前明显改善,而使血管舒张功能得到改善。

Objective To determine the effect of metabolic surgery on vasodilatation and investigate the underlying mechanisms in obese with type 2 diabetes. Methods A l^trospective study was carried out among 105 health individuals （normal control） and 31 obese with type 2 diabetes who wel~ followed up in our department form May 2010 to June 2012. The 31 obese with type 2 diabetes were divided into 2 groups accord- ing to the patients＇ will, that is, metabolic surgery group （ n = 20） and non-surgical group （ n = 11 ）. High frequency uhrasonography was used to measure the dilation of brachial artery （ D1 ） , dilation of postocclusion brachial artery （D2）, and nitroglycerin mediated dilation （D3） of all patients at rest, in order to calculate flow-mediated dilation （FMD） and nitroglycerin mediated dilation （NMD） [ FMD = （ （ D2 - D1 ）/DI ） x 100%, NMD = （ （ D3 - D1 ）/D1 ） x 100% ]. Body weight, body mass index （ BMI）, blood pressure, blood lipids, fasting glucose, glycosylated hemoglobin, serum glucagon-like peptide-1 （GLP-1） and dipeptide pepti- dase-4 （DPP-4） were measured in the 20 patients before and after metabolic surgery. Results Metabolic surgery group had an extremely improvement in vasodilatation （ FMD and NMD） compared to non-surgical group （ P 〈 0. 01 ） , and even had no significant difference with that of normal group （P 〉0. 05 ）. Compared to normal group, there was an obviously decline in vasodilatation in non-surgical group （P 〈 0.01 ）. Metabolic surgery resulted in obviously increased GLP-1 and decreased DPP-4 compared with preoperative data （P 〈 0.05 ）.Conclusion Obese with type 2 diabetes has worse vasodilatation compared to normal people. Metabolic surgery exerts great effect on the body weight, BMI, blood lipids, blood pressure, GLP-1, and DPP-4 in obese with type 2 diabetes, and significantly improves vasodilatation in obesity with type 2 diabetes.