非肥胖性2型糖尿病患者袖状胃切除间置回肠的十二指肠空肠旁路手术后胰岛β细胞功能的改善

Improvement of islet β-cell function after sleeve gastrectomy with ileal interposition duodenojejunal bypass in non-obese type 2 diabetes mellitus

目的 探讨袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖性2型糖尿病患者胰岛β细胞功能的改善作用.方法 回顾性分析2009年3月至2011年10月间在四川省攀枝花市中心医院接受袖状胃切除间置回肠的十二指肠空肠旁路手术的54例非肥胖型2型糖尿病患者的临床资料,包括术前及术后1、3、6、12、24月进行口服葡萄糖耐量试验结果和空腹血糖、糖化血红蛋白（HbA1c）及空腹胰岛素等检测结果,并计算胰岛素抵抗指数（HOMA-IR）、稳态模型β细胞功能（HOMA-β）、早期胰岛素分泌指数（△I30/△G30）及胰岛素曲线下面积（AUCINS）.结果 术后24月,HbA1c由术前的（8.2±0.8）％降至（6.3±0.1）％,空腹血糖由（9.2±0.6） mmol/L降至（5.9±0.5）mmol/L,空腹胰岛素由（9.7±1.5） mIU/L降至（6.2±0.7） mIU/L,差异均有统计学意义（均P＜0.05）;同时,HOMA-IR较术前明显下降（0.8±0.3比2.1±0.6,P＜0.05）,HOMA-β明显升高（56.3±12.8比28.4±9.2,P＜0.05）,△I30/△G30明显升高（1.8±0.7比0.8±0.2,P＜0.05）,而AUCINS在术后1月和3月时较术前下降,但术后6、12和24月时较术前上升（P＜0.05）.相关分析结果显示,HbA1c与HOMA-β（r=-0.628,P＜0.01）、△I30/△G30（r=-0.571,P＜0.01）和AUCINS（r=-0.606,P＜0.01）呈显著负相关,与HOMA-IR呈显著正相关（r=0.784,P＜0.01）.结论 袖状胃切除间置回肠的十二指肠空肠旁路手术能改善胰岛β细胞功能,从而达到治疗糖尿病的作用.

Objective To investigate the improvement of islet β-cell function after sleeve gastrectomy with ileal interposition duodeaojejunal bypass operation in non-obese type 2 diabetes mellitus.Methods Clinical data of 54 non-obese type 2 diabetes mellitus cases undergoing sleeve gastrectomy with ileal interposition duodenojejunal bypass operation in our hospital from March 2009 to October 2011 were retrospectively analyzed.Fasting glucose,glycosylated hemoglobin （HbA1c）,fasting insulin,body mass index （BMI）,insulin resistance index （HOMA-IR）,homeostasis model β-cell function （HOMA-β）,early phase insulin secretion index （△I30/△G30） and area under curve of insulin （AUCINS） were measured before operation,and 1,3,6,12,24 months after operation with standard oral glucose tolerance test （OGTT）.Results At 24 months after operation,HbAlc decreased from preoperative （8.2 ±0.8） % to postoperative （6.3 ±0.1） % （P〈0.01）,as did the fasting glucose [（9.2±0.6） mmol/L vs.（5.9±0.5） mmol/L,P〈0.01] and HOMA-IR （2.1±0.6 vs.0.8±0.3,P〈0.01）.The postoperative BMI was not significantly different from the preoperative level.HOMA-β increased （28.4±9.2 vs.56.3±12.8,P〈0.05）.△I30/△G30 increased after surgery （0.8±0.2 vs.1.8±0.7,P〈0.01）.AUCINS was （42.6±17.1） mIU/L,（31.5± 18.6） mIU/L,（34.71±12.9） mIU/L,（49.2±16.3） mIU/L,（78.3±21.7） mIU/L,（74.8±15.2） mIU/L before operation and at postoperative 1 month,3 months,6 months,12 months,24 months,respectively,indicating an increase in AUCINS 6 months later.Linear correlation analysis showed that HbAlc was negatively correlated with HOMA-β,△I30/△G30 and AUCINS （r=-0.628,P〈0.01; r=-0.571,P〈0.01; r=-0.606,P〈0.01）,and positively correlated with HOMA-IR （r=0.784,P〈 0.01）.Conclusions Sleeve gastrectomy with ileal interposition duodenojejunal bypass can improve islet β cells function.It plays an important role in the surgical treatment of diabetes.