腹腔镜减重手术对2型糖尿病患者胰高血糖素样肽-1及Ghrelin水平的影响  

Impacts of laparoscopic bariatric surgery on GLP-1 and Ghrelin level in patients with type 2 diabetesmellitus

作　　者：郭翔[1] 印慨[1] 陈丹磊[1] 常绪生[1] 曾朋[2] 郑成竹[1] 

机构地区：[1]第二军医大学长海医院微创外科,上海200433 [2]第二军医大学长海医院乳腺外科,上海200433

出　　处：《中华外科杂志》2013年第4期323-327,共5页Chinese Journal of Surgery

摘　　要：目的探讨腹腔镜减重手术对2型糖尿病（T2DM）患者空腹血胰高血糖素样肽-1（GLP-1）、Ghrelin水平的影响及其治疗T2DM的可能机制。方法2010年3月至2011年8月间对44例T2DM患者行腹腔镜减重手术，其中腹腔镜“Y”型胃肠短路术（LRYGB）14例，腹腔镜简易型胃肠短路术（LMGB）11例，腹腔镜管状胃切除术（LSG）9例，可调节胃绑带术（LAGB）10例，回顾性分析手术对T2DM的疗效、患者代谢及胃肠激素的影响。结果术后6个月时LRYGB、LMGB、LSG、LAGB组患者术后6个月临床完全缓解者分别为11、8、6、3例，部分缓解者分别为3、3、2、4例，LSG、LAGB组无效者分别为1、3例，组间差异有统计学意义（x。=8．162，P〈0．05）。4组患者术后6个月内体重指数（F=275．29）、胰岛素抵抗指数（F=40．09）都呈下降趋势（P〈0．01），但下降的幅度差异无统计学意义。术后1个月时LRYGB组、LMGB组GLP-1水平[分别为（1164-33）和（103±22）ng／L]较术前[分别为（664-20）、（65±16）ng／L]升高（F=21．76、139．21，P〈0．05）；LSG组及LAGB组术前、术后及组间差异无统计学意义（P〉0．05）。术后1周LRYGB、LMGB、LSG组患者Ghrelin水平分别为（208±79）、（275±102）和（258±91）ng／L，较术前[分别为（398±114）、（4394-96）和（446±105）n∥L]下降（F：55．08、49．96、46．47，P〈0．01）；术后1～6个月LRYGB、LMGB组Ghrelin水平出现反弹，LSG组Ghrelin保持较低水平；而术后1周开始LAGB组Ghrelin水平则保持较术前高的水平（F=29．24，P=0．001）。结论不同减重手术对T2DM的疗效及胃肠激素的影响存在差异，手术治疗T2DM的机制可能与其对胃肠道激素的改变有关。Objectives To investigate the impacts of laparoscopic bariatric surgery on fasting glucagon-like peptide-1 （ GLP-1 ） and Ghrelin level in patients with type 2 diabetes mellitus （ T2DM ）, and the mechanism in surgical treatment of T2DM. Methods From March 2010 to August 2011, 44 patients with T2DM underwent laparoscopic bariatric, including laparoscopic Roux-en-Y gastric bypass （LRYGB, n = 14）, laparoscopic mini-gastric bypass （ LMGB, n = 11 ）, laparoscopic sleeve gastrectomy （ LSG, n = 9） and laparoscopic adjustable gastric banding （ LAGB, n = 10）. The curative effects, changes of metabolism and gastrointestinal hormones were analyzed respectively. Results Within 6 months after surgery, the clinical complete remission of T2DM was 11, 8, 6, 3 cases in LRYGB, LMGB, LSG, LAGB group respectively; the clinical partial remission was 3, 3, 2, 4 cases respectively. The inefficacy was 1, 3 patients in LSG and LAGB group respectively. The effects of surgery within 6 months postoperative among 4 groups were different （ X2 = 8. 162, P 〈 0. 05 ）. The levels of body mass index （ F = 275.29 ） and homeostasis model assessment of insulin resistance （F = 40. 09） of 4 groups were declined in 6 monthspostoperatively （P 〈 0. 01 ）. The extents of decrease were no significance among 4 groups. Compared to preoperative level, GLP-1 in LRYGB （ （ 116 ± 33 ） vs. （ 66 ± 20） ng/L and LMGB group （ （ 103 ± 22 ） vs. （65 ± 16） ng/L） was higher in the first month after surgery （F = 21.76 and 139. 21, P 〈 0. 05）. The changes in LSG and LAGB group were no significance （ P 〉 0.05 ）. The level of Ghrelin in LRYGB, LMGB, LSG group at the first week after surgery were （208±79）, （275 ± 102） and （258±91 ） ng/L respectively, and they were lower than preoperative （there were （398 ±114）, （439 ＋96） and （446±105） ng/L, F=55.08, 49. 96 and 46.47, all P 〈0. 01 ）. But the level of Ghrelin in LRYGB and LMGB groups rebounded in the first postoperat

关 键 词：糖尿病 2型 腹腔镜检查 胰高血糖素样肽1 GHRELIN 

分 类 号：R656.6[医药卫生—外科学]