代谢手术对肥胖与非肥胖2型糖尿病患者体质指数、胰岛素抵抗及血脂影响  

Effect of metabolic surgery on body mass index,insulin resistance and lipid in non-obese patients with type 2 diabetes

作　　者：孙芳[1] 闫振成[1] 陈静[1] 倪银星[1] 高羽[2] 童卫东[2] 祝之明[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所:高血压内分泌科全军高血压代谢病中心重庆市高血压研究所,400042 [2]第三军医大学大坪医院野战外科研究所胃结直肠外科,重庆400042

出　　处：《第三军医大学学报》2013年第9期820-823,共4页Journal of Third Military Medical University

基　　金：国家重点基础研究发展计划(973计划,2012CB517805);重庆市科委国际科技合作基金科技平台与基地建设项目(CSTC2011gjhz10002);第三军医大学校管临床科研课题(2009XLC30、2010XLC38)~~

摘　　要：目的比较代谢手术对肥胖与非肥胖2型糖尿病患者术后体质指数(BMI)及代谢指标的总体效果差异。方法以体质指数28为切点,分为肥胖糖尿病组(BMI≥28 kg/m2,n=10)及非肥胖糖尿病组(BMI<28 kg/m2,n=10),术前配比各项基础资料,术后3～6个月随访体质指数、葡萄糖耐量及胰岛素释放、尿酸、总胆固醇、低密度脂蛋白胆固醇水平,比较各组手术前后的差异以及两组术后效果的差异。结果相关分析发现非肥胖患者(BMI<28 kg/m2)术后BMI下降程度与术前BMI无相关(r=0.416,P=0.232),而肥胖患者(BMI≥28 kg/m2)术后BMI下降程度则与术前BMI高低明显相关(r=0.932,P<0.001)。非肥胖患者与肥胖患者手术前后胰岛素抵抗程度、总胆固醇水平均明显改善(P<0.05),而尿酸代谢、低密度脂蛋白胆固醇水平均无明显变化。两组患者术后在体质指数的下降程度差异明显,肥胖患者较非肥胖患者下降更明显,而两组患者术后在胰岛素抵抗、总胆固醇水平的改善程度上并无显著性差异。结论代谢手术能明显改善肥胖与非肥胖糖尿病患者术后体质量、胰岛素抵抗及血脂,且非肥胖2型糖尿病患者与肥胖2型糖尿病患者术后总胆固醇、低密度脂蛋白及胰岛素抵抗改善获益相当,肥胖与否不能作为是否手术的绝对指征。Objective To compare the overall effect of metabolic surgery on the body mass index （BMI） and metabolic indicators between obese and non-obese type 2 diabetes. Methods A total of 20 diabetic patients who undergoing metabolic surgery in our department from 2010 to 2012 were enrolled in this study. They were prospectively divided into obese diabetic group （BMI〉~28 kg/m2, rt = 10） and non-obese diabetic group （BMI 〈28 kg/m2, n =10） with BMI of 28 as cutoff point. Their pre-operative data were matched, and their BMI, glucose tolerance and insulin release, uric acid, total cholesterol, LDL cholesterol levels in 3 to 6 months after operation were recorded and compared to determine the different effect of the surgery. Results Correla- tion analysis showed that, the degree of decreased BMI after the operation had no relation with the pre-operative BMI in non-obese patients （r =0. 416, P =0.232）, however, obvious correlation was found in obese patients between the decreased and pre-operative BMI （ r = 0. 932, P 〈 0. 001 ）. In non-obese patients and obese patients before and after surgery, the total cholesterol levels and insulin resistance were significantly improved （P 〈 0. 05 ）, and uric acid metabolism, low-density lipoprotein cholesterol levels did not change significantly. There was a significant difference in the decreased degree of BMI between the 2 groups, with obese patients more significant. There was no significant difference in improvement of total cholesterol levels and insulin resistance in the 2 groups. Conclusion Metabolic surgery significantly improves the bodv weight, insulin resistanca and blood lipids in obesity and non-obese diabetic patients. There is no difference in the improvement regardless of BMI is less than 28 or not. So, BMI more than 28 should not be the strict indication as the therapeutic surgery for diabetes.

关 键 词：糖尿病 代谢手术 肥胖 体质指数 胰岛素抵抗 

分 类 号：R587.105[医药卫生—内分泌] R589.2[医药卫生—内科学]