不同体质指数2型糖尿病患者胃旁路术后不良事件的随访

Follow-up of adverse events after Roun-en-Y gastric bypass surgery in type 2 diabetic patients withdifferent body mass index

目的随访观察不同体质指数（BMI）的2型糖尿病患者在胃旁路术后不良事件的发生情况。 方法观察2010年5月至2017年12月在我院行腹腔镜下胃旁路术的100例2型糖尿病患者，纳入其中随访资料完整的87例作为研究对象。随访术前、术后的体质指数、血糖、血脂、血压、不良事件情况。以BMI 27.5 kg/m2为切点，将BMI≥27.5 kg/m2归为高BMI组，将BMI〈27.5 kg/m2归为低BMI组。比较两组代谢指标转归和不良事件发生的差异。组间比较采用t检验和方差分析，率的比较采用χ2检验。 结果低BMI组（33例）术后1年BMI、糖化血红蛋白（HbA1c）、血清总胆固醇、血清甘油三酯（TG）、收缩压（SBP）、舒张压（DBP）较术前下降（t=2.1~6.8，均P〈0.05）。高BMI组（54例）术后1年BMI、空腹血糖（FPG）、HbA1c、TG、低密度脂蛋白胆固醇、SBP、DBP较术前下降（t=2.0~7.6，均P〈0.05）。两组术后1年、3年胃肠道（吻合口、倾倒综合征、吸收不良）相关不良事件发生率[分别为27.3%（9/33）比20.4%（11/54）、12.1%（4/33）比5.6%（3/54）、6.1%（2/33）比3.7%（2/54）、6.1%（2/33）比0、12.1%（4/33）比16.7%（9/54）、12.1%（4/33）比11.1%（6/54），χ2=0~1.1，均P〉0.05]、营养不良相关（贫血、锌缺乏、低蛋白血症）发生率差异无统计学意义（分别为13.3%比13.3%、25%比0、0比26.6%、22.2%比14.2%、13.3%比15.0%、10%比0，χ2=0~2.9，均P〉0.05）。按照不良事件发生的数量，将患者分为术后发生了1种、2种和3种及以上不良事件三组，发生2种不良事件组术后1年HbA1c较术前下降（t=2.4，P〈0.05）。发生3种及以上不良事件组术后1年FPG、HbA1c、TG、SBP、DBP较术前下降（t=2.2~2.9，均P〈0.05）。 结论胃旁路手术对2型糖尿病近远期效果显著，术后不良事件的发生与术前BMI无显著相关。

ObjectiveTo investigate the incidence of adverse events in type 2 diabetic patients with different body mass indexes （BMI） after Roun-en-Y gastric bypass （RYGB） surgery. MethodsFrom May 2010 to December 2017, a total of 100 patients with type 2 diabetes mellitus （T2DM） underwent laparoscopic RYGB in Daping Hospital. BMI, blood glucose, blood lipid, blood pressure and adverse events were followed-up before and after RYGB surgery. By using 27.5 kg/m2 of BMI as a cut-point, patients with BMI≥27.5 kg/m2 were as the high BMI group, and those BMI〈27.5 kg/m2 were as the low BMI group. The outcome differences of metabolic indexes and the incidences of adverse events between these two groups were compared, and the corresponding treatment measures were reviewed. Data were analyzed by t test and analysis of variance, the rate of comparison was analyzed by χ2 test. ResultsAt one year after surgery, BMI, glycosylated hemoglobin （HbA1c）, serum total cholesterol （TC）, serum triglyceride （TG）, systolic blood pressure （SBP） and diastolic blood pressure （DBP） were significantly decreased in the low BMI group （t=2.1-6.8, all P〈0.05）. Meanwhile, BMI, fasting blood glucose （FPG）, HbA1c, TG, LDL-C, SBP and DBP were significantly decreased in the high BMI group （t= 2.0-7.6, all P〈0.05）. No significant difference was found in the incidence of anastomotic leakage, dumping syndrome and malabsorption of the two groups at one year and three years after surgery [27.3%（9/33） vs 20.4%（11/54）, 12.1%（4/33） vs 5.6%（3/54）, 6.1%（2/33） vs 3.7%（2/54）, 6.1%（2/33） vs 0, 12.1%（4/33） vs 16.7%（9/54）, 12.1%（4/33） vs 11.1%（6/54）, χ2=0-1.1, all P〉0.05]. Nor was the incidence of anemia, zinc deficiency or hypoproteinemia, either （13.3% vs 13.3%, 25% vs 0, 0 vs 26.6%, 22.2% vs 14.2%, 13.3% vs 15.0%, 10% vs 0, χ2=0-2.9, all P〉0.05）. Furthermore, according to the number of adverse events at one year after surgery, patients with two kinds of adverse events had significant decrease in HbA1c （t=2.4, P〈0.05）, and patients with 3 or more kinds of adverse events had significant differences in FPG, HbA1c, TG, SBP and DBP （t=2.2-2.9, all P〈0.05）. ConclusionThe short and long term effects of gastric bypass surgery on type 2 diabetic patients are significant. There is no significant correlation between postoperative adverse events and preoperative BMI in type 2 diabetic patients with RYGB surgery.