袖状胃切除间置回肠的十二指肠空肠旁路术后早期胰岛素抵抗的变化

Early postoperative insulin-resistance changes after sleeve gastrectomy with ileal interposition duodenojejunal bypass operation

目的评价袖状胃切除间置回肠的十二指肠空肠旁路术后早期胰岛素抵抗的变化。方法2010年6月至2011年9月四川省攀枝花市中心医院普外科实施袖状胃切除间置回肠的十二指肠空肠旁路手术37例，男23例，女14例；平均年龄（45．2±2．4）岁；平均体重指数（body mass index，BMI）（21．7±1．8）kg／m2。所有患者术前和术后10、20、30、60d检测以下指标：空腹血糖（fasting plasma glucose，FPG）、空腹血清胰岛素（fasting insulin，Fins）、胰岛素抵抗指数（HOMA—IR）和BMI。结果术后10、20、30d的FPG（6．8±0．7）、（7．2±0．6）、（6．9±0．3）mIU／L均低于术前FPG（10．2±0．4）mIU／L），差异有统计学意义（P〈0．05）。术后10、20、30d的Fins（6．3±1．1）、（7．1±1．3）、（7．3±1．6）mIU／L均低于术前Fins（12．6±1．4）mIU／L，差异有统计学意义（P〈0．05）。术后10、20、30d的lnHOMA—IR为（0．7±0．2）、（0．9±0．5）、（0．8±0．4），均低于术前（1．8±0．6），差异有统计学意义（P〈0．05）。但术后10d、20d、30d的BMI与术前相比变化不明显（P〉0．05）。术后60dFPG、Fins、lnHOMA—IR、BMI与术前相比明显降低，差异有统计学意义（均P〈0．05）。结论袖状胃切除间置回肠的十二指肠空肠旁路术后早期胰岛素抵抗的改善迅速，胰岛素抵抗的改善与BMI的关系不大。

Objective To evaluate the early effects on insulin resistance following sleeve gastrectomy with ileal interposition duodenojejunal bypass operation. Methods From Jun. 2010 to Sep. 2011, 37 cases of type 2 diabetes mellitus patients [ 23 male, 14 female ; mean age （45.2 ± 2. 4 ） years, mean BMI （ 21.7 ± 1.8 ） kg/m2 ] un-derwent sleeve gastrectomy with ileal interposition duodenojejunal bypass operation. Fasting plasma glucose（ FPG）, fasting insulin（ Fins）, body mass index（BMI）, and homeostatic model assessment for insulin resistance （HOMA-IR） were detected before surgery and on the 10th, 20th, 30th, and 60th day after surgery. Results The level of FPG was （ 6. 8 ± 0. 7 ） retool/L, （7.2 ± 0. 6） retool/L, （6. 9 ± 0. 3 ） mmol/L respectively on the 10th, 20th, and 30th day after surgery, significantly lower than that before surgery [ （10. 2 ± 0. 4）mmol/L]. The difference had statistical significance（P 〈0. 05）. The level of Fins was（6.3 ± 1. 1 ） mIu/L, （7. 1 ± 1.3） mIu/L,and （7.3 ± 1. 6） mIu/L respectively on the 10th, 20th, and 30th day after surgery, significantly lower than that before surgery[ （ 12. 6 ± 1.4） mIu/ L]. The difference had statistical significance（P 〈0. 05）. The level of lnHOMA-IR was 0. 7 ±0. 2, 0. 9 ±0. 5, and 0. 8 ±0. 4 respectively on the 10th, 20th, and 30th day after surgery, significantly lower than that before surgery （ 1.8 ± 0. 6）. The differenc had statistical significance （ P 〈 0. 05 ）. However, the change of BMI was not obvious between before surgery and on the 10th, 20th, and 30±h day after surgery. The difference had no statistical significance （ P 〉 0. 05 ）. on the 60th day after surgery, the level of FPG, Fins, lnHOMA-IR and BMI was significantly reduced compared with that before surgery. The difference had statistical significantce （P 〈 0. 05 ）. Conclusion Af- ter sleeve gastrectomy with ileal interposition duodenojejunal bypass operation, the early improvement of insulin resistance occurs rapidly and it is independent of the loss of BMI.