腹腔镜可调胃束带手术联合艾塞那肽治疗肥胖型2型糖尿病临床疗效分析

Clinical Curative Effect of Laparoscopic Adjustable Gastric Banding Combined with Exenatide in the Treatment of Obesity-associated Type 2 Diabetes

目的比较腹腔镜可调胃束带手术(LAGB)联合术后运用艾塞那肽与Roux-en-Y胃旁路手术(LRYGB)治疗肥胖型2型糖尿病的临床疗效。方法收集2013年1月—2015年1月宜昌市中心人民医院接受LAGB并术后联合使用艾塞那肽(LAGB+E组)和仅行LRYGB(LRYGB组)治疗的肥胖型2型糖尿病患者,每组各20例。监测术前、术后1周、术后1、3、6、12个月患者的体质量、体质指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(HbA_(1c))和空腹C肽水平,评价糖尿病疗效及术后并发症发生情况。结果治疗方法与时间在体质量、BMI、FPG、2 h PG、HbA_(1c)和空腹C肽水平上存在交互作用(P<0.05);治疗方法在体质量、BMI、FPG、2h PG、HbA_(1c)和空腹C肽水平上主效应不显著(P>0.05);时间在体质量、BMI、FPG、2 h PG、HbA_(1c)和空腹C肽水平上主效应显著(P<0.05)。LAGB+E组与LRYGB组患者体质量、BMI、FPG、2 h PG、HbA_(1c)和空腹C肽水平1年变化值比较,差异均无统计学意义(P>0.05)。LAGB+E组患者术后糖尿病疗效完全缓解8例、部分缓解11例、无效1例,LRYGB组分别为7例、13例、0例,两组比较差异无统计学意义(u=0.111,P=0.912)。LAGB+E组与LRYGB组患者术后并发症发生率比较,差异无统计学意义[5%(1/20)与25%(5/20),χ~2=1.765,P=0.184]。结论艾塞那肽可增强LAGB治疗肥胖型2型糖尿病的治疗效果,LAGB联合艾塞那肽可取得与LRYGB相当的临床疗效,且术后并发症发生率更低,但其远期疗效还有待于进一步研究。

Objective To compare the effects of laparoscopic adjustable gastric banding( LAGB) combined with exenatide administered postoperatively and laparoscopic Roux-en-Y gastric bypass( LRYGB) in the treatment of obese patients with type 2 diabetes( T2 DM). Methods Twenty obese patients with T2 DM who received LAGB combined with exenatide administered postoperatively( LAGB + E group) and other 20 obese patients with T2 DM who received LRYGB therapy( LRYGB group) alone in Central Hospital of Yichang City from January 2013 to January 2015 were recruited in this study. The changes in levels of body weight, body mass index( BMI), fasting plasma glucose( FPG), postprandial 2 h glucose( 2 h PG),glycosylated hemoglobin( HbA_(1c)) and fasting C-peptide in the two groups measured before surgery,at 1 week,1,3,6,12 months after surgery were observed. The achieved therapeutic effects and postoperative complications in both groups were assessed. Results Intervention mode and duration exerted significant interaction effects on the values of body weight,BMI,FPG,2 h PG,HbA_(1c)and fasting C-peptide( P < 0. 05). Intervention duration produced obvious main effects on the values of body weight,BMI,FPG,2 h PG,HbA_(1c)and fasting C-peptide( P < 0. 05),while intervention mode did not( P > 0. 05).The yearly change values of body weight,BMI,FPG,2 h PG,HbA_(1c)and fasting C-peptide did not differ significantly between the two groups( P > 0. 05). The complete remission,partial remission and ineffective treatment outcome were obtained in 8 cases,11 cases,1 case,respectively in the LAGB + E group,and 7 cases,13 cases,0 in the LRYGB group,which showed that the therapeutic effects achieved in both groups were similar( u = 0. 111,P = 0. 912). There was no significant difference in the incidence of postoperative complications between LAGB + E group and LRYGB group [5%( 1/20) vs. 25%( 5/20),χ~2= 1. 765,P = 0. 184]. Conclusion For obesity-associated type 2 diabetes,exenatide can improve the effect of LAGB,and the combination of the two can achieve similar effects as LRYGB does but with less postoperative complications. However,its long-term efficacy remains to be studied further.