腹腔镜袖状胃切除术对2型糖尿病合并肥胖患者胰岛素抵抗及血浆致动脉硬化指数的影响

Effect of LSG on insulin resistance and atherogenic index of plasma in patients with type 2 diabetes mellitus complicated with obesity

目的通过比较2型糖尿病(type 2 diabetes mellitus,T2DM)合并肥胖患者腹腔镜袖状胃切除术(laparoscopic sleeve gastectomy,LSG)前后代谢参数的变化,计算胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR)、血浆致动脉硬化指数(atherogenic index of plasma,AIP),评估代谢手术(metabolic surgery)对T2DM合并肥胖患者胰岛素抵抗(insulin resistance,IR)及动脉粥样硬化的影响。方法回顾性分析LSG治疗的54例T2DM合并肥胖患者,检测术前及术后1月、6月的空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C),测量血压、体重,计算体重指数(body mass index,BMI),并根据胰岛素稳态评估模型和公式计算HOMA-IR和AIP。手术前后比较采用配对t检验,相关性行Pearson相关分析及多元逐步回归分析。结果术后1月、6月FPG、FINS、TG、HOMA-IR和AIP分别为(6.38±2.03)mmol/L和(5.36±1.33)mmol/L、(20.42±25.77)μU/ml和(11.22±3.62)μU/ml、(1.94±2.81)mmol/L和(1.70±2.33)mmol/L、(5.60±7.52)和(2.58±0.80)及(0.15±0.27)和(0.08±0.25),较术前显著降低(P<0.05)。术后1月、6月HDL-C分别为(1.04±0.20)mmol/L和(1.10±0.18)mmol/L,较术前升高(P<0.05)。术前相关分析表明,AIP与FPG、TG、HOMA-IR呈正相关(P<0.05),与HDL-C呈负相关(P<0.05)。多元逐步回归分析结果显示,FPG、TG、HDL-C是AIP的独立影响因素(P<0.05)。结论LSG手术可有效降低T2DM合并肥胖患者的血糖、血脂,改善IR,降低AIP。

Objective By comparing the changes of metabolic parameters before and after laparoscopic sleeve gastectomy(LSG)in patients with type 2 diabetes mellitus(T2DM)and obesity,the insulin resistance index(HOMA-IR)and atherogenic index of plasma(AIP)were calculated to evaluate the effect of metabolic surgery on insulin resistance and atherosclerosis in patients with type 2 diabetes mellitus(T2DM)and obesity.Methods LSG treatment were retrospectively analyzed in 54 patients with type 2 diabetes mellitus and obesity,detection of preoperative and postoperative 1 month,6 month of fasting plasma glucose(FPG),fasting insulin(FINS),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),measuring blood pressure,body weight,calculating body mass index,and according to the steady state evaluation model and the formula for calculating HOMA-IR and AIP.Before and after surgery,paired t test was used,and Pearson correlation analysis and multiple stepwise regression analysis.Results FPG,FINS,TG,HOMA-IR and AIP were(6.38±2.03)mmol/L and(5.36±1.33)mmol/L,(20.42±25.77)uU/mLand(11.22±3.62)uU/mL,(1.94±2.81)mmol/Land(1.70±2.33)mmol/L,(5.60±7.52)and(2.58±0.80),(0.15±0.27)and(0.08±0.25),which were significantly lower than those before surgery(P<0.05),HDL-C was(1.04±0.20)mmol/L and(1.10±0.18)mmol/L at 1 and 6 months after operation,respectively,which was higher than that before operation(P<0.05).Preoperative correlation analysis showed that AIP was positively correlated with FPG,TG and HOMA-IR(P<0.05),and negatively correlated with HDL-C(P<0.05).The results of multiple stepwise regression analysis showed that FPG,TG and HDL-C were independent influencing factors of AIP(P<0.05).Conclusion LSG surgery can effectively reduce the blood glucose and lipid levels in patients with type 2 diabetes complicated with obesity,improve insulin resistance and reduce the plasma atherosclerosis index.