胃转流术对糖尿病患者糖代谢的影响

Effect of gastric bypass on glycometabolism in patients with diabetes mellitus

目的:探讨胃转流术对糖尿病患者糖代谢的影响.方法:结合与2012-11/2013-11在川北医学院附属三台医院进行胃转流术治疗的47例糖尿病患者临床资料.观察手术之前与手术后3、6、12 mo时患者的瘦素水平、血清脂联素水平、胰岛素抵抗指数和血糖水平变化情况.结果:与手术前相比,患者的胰岛素抵抗指数、空腹血糖水平均于术后3 mo下降,空腹胰岛素升高;术后6 mo与12 mo空腹胰岛素水平未发生明显变化,胰岛素抵抗指数、空腹血糖水平则继续降低;与术前相比,术后3mo时患者的瘦素与血清脂联素水平的变化并不明显,术后6 mo瘦素水平降低,脂联素水平升高,与术前相比差异显著,术后12 mo时二者的变化更加显著.结论:采用胃转流术治疗糖尿病患者能够取的良好的临床疗效,可使其血糖水平与胰岛素抵抗指数降低,作用机制可能与瘦素和脂联素的表达有关.

AIM： To investigate the effect of gastric bypass on glucometabolism in patients with diabetes mellitus. METHODS： Clinical data for 47 diabetes patients who underwent gastric bypass at our hospital from November 2012 to November 2013 were retrospectively analyzed. The changes in leptin levels, serum adiponectin, insulin resistance index and blood glucose between before operation and 3, 6, or 12 mo after operation were monitored. RESULTS： Compared with preoperative values, insulin resistance index, fasting blood glucose, and fasting insulin levels decreased significantly 3 mo after operation. At 6 and 12 too, fasting insulin levels showed no obvious changes, and insulin resistance index and fasting blood sugar continued to decrease. Compared with preoperative levels, leptin and adiponectin levels showed no significant changes 3 mo after operation. At 6 mo, leptin levels significantly decreased and adiponectin levels significantly increased compared with the preoperative levels, and the changes were more significant at 12 too. CONCLUSION： Gastric bypass for the treatment of diabetes mellitus has good curative effect and can decrease blood glucose and insulin resistance index via mechanisms possibly associated with altering leptin and adiponectin levels.