影响胃癌合并2型糖尿病患者术后血糖水平的相关因素分析

Analysis of related factors affecting postoperative blood glucose level in patients with gastric cancer complicated with type 2 diabetes mellitus

目的探讨影响胃癌合并2型糖尿病患者术后血糖水平的相关因素,从而为手术时更好地选择消化道重建方式及控制术后血糖水平提供参考依据。方法回顾性分析南京中医药大学附属医院消化系肿瘤外科2008年1月-2018年12月收治的179例胃癌合并2型糖尿病患者的临床资料,对可能影响术后血糖水平的临床因素通过χ^2检验进行单因素分析,P<0.05则为相关因素,再对相关因素进行二元logistic回归分析,P<0.05则为独立影响因素。结果 179例胃癌合并2型糖尿病患者均完成了胃癌根治性切除手术,其中有4例患者手术后糖尿病治愈,122例术后糖尿病缓解,术后血糖水平改善的有效率为70.39%(126/179)。通过单因素分析显示年龄、有无冠心病、术前糖尿病治疗方式、是否切除全胃、有无胆胰分流袢、糖尿病病程以及术前空腹C肽水平与术后血糖水平相关,进一步进行二元logistic回归分析,显示有无胆胰分流袢、糖尿病病程及术前空腹C肽水平是胃癌合并2型糖尿病患者术后血糖水平的独立影响因素。结论分析结果显示有无胆胰分流袢、糖尿病病程及术前空腹C肽水平是胃癌合并2型糖尿病患者术后血糖水平的独立影响因素,临床上对于糖尿病病程较短,术前空腹C肽水平大致正常的患者,手术时通过胆胰分流的消化道重建方式可以更好地改善术后血糖水平。

Objective To explore the related factors affecting postoperative blood glucose level in patients with gastric cancer complicated with type 2 diabetes mellitus, and provide reference for better selection of digestive tract reconstruction and control of postoperative blood glucose level. Methods Retrospective analysis was made on the clinical data of 179 patients with gastric cancer complicated with type 2 diabetes mellitus admitted to Gastroenterological Oncology Surgery, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2008 to December 2018. Single factor analysis was carried out on the clinical factors that might affect the postoperative blood glucose level by chi-square test, P<0.05 was considered as the relevant factor. Binary logistic regression analysis was performed on the related factors, P<0.05 was an independent factor. Results Radical resection of gastric cancer was performed in 179 patients, 4 of them were cured of diabetes after operation, 122 patients were relieved of diabetes after operation, and the effective rate of postoperative improvement of blood glucose level was 70.39%(126/179). Single factor analysis showed that the age, coronary heart disease or not, preoperative treatment of diabetes, whether to remove the whole stomach, biliopancreatic shunt loops present or absent, duration of diabetes and preoperative fasting c-peptide level were associated with postoperative blood glucose level. Binary Logistic regression analysis showed that biliopancreatic shunt loops present or absent, duration of diabetes and preoperative fasting c-peptide level were gastric cancer combined with type 2 diabetes independent influence factors of postoperative blood glucose levels. Conclusion Analysis results show that biliopancreatic shunt loops present or absent, duration of diabetes and preoperative fasting c-peptide level are gastric cancer combined with type 2 diabetes independent influence factors of postoperative blood glucose levels. For a shorter duration of diabetes, patients with normal preoperative fasting c-peptide levels roughly, digestive tract reconstruction by bile pancreatic diversion during surgery can better improve postoperative blood glucose levels.