2型糖尿病胃转流术后胰高血糖素样肽-1的变化及其意义  

Changes of glucagon-like peptide-1 in type 2 diabetic patients after gastric bypass surgery and its significance

作　　者：崔建峰[1] 陈涛[1] 石力[1] 闫洪涛[1] 黄竹[1] 汤礼军[1] 

机构地区：[1]成都军区总医院,成都610083

出　　处：《山东医药》2013年第29期10-12,共3页Shandong Medical Journal

基　　金：全军临床高新技术重大项目(2010gxjs040)

摘　　要：目的探讨2型糖尿病患者行胃转流术后血清胰高血糖素样肽-1(GLP-1)的变化及意义。方法对37例2型糖尿病患者行胃转流术,手术前后检测空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1C)、空腹胰高血糖素样肽-1(FGLP-1)、餐后2 h胰高血糖素样肽-1(2 h GLP-1),并计算胰岛素敏感指数((ISI)=1/FPG×FIns。结果 37例患者均获随访1年以上,29例达到完全缓解,5例部分缓解,3例无效,总有效率为91.9%。与术前比较,术后FPG、2 h PG、及HbA1C呈显著下降,FGLP-1、2 h GLP-1及ISI则较术前明显升高(P均<0.05);FGLP-1、2 h GLP-1与ISI呈正相关(r分别为0.64、0.58,P<0.01或<0.05)。结论胃转流术治疗2型糖尿病有明显效果,其作用机制之一是术后患者肠源性GLP-1的分泌增加进而改善胰岛素敏感性。Objective To investigate the changes of glucagon-like peptide-1 （ GLP-1 ） in type 2 diabetic patients after gastric bypass surgery. Methods Data were collected from 37 patients with type 2 diabetes who were performed gastric bypass surgery. Collected parameters included fasting plasma glucose （FPG）, 2-hour postprandial blood glucose （2 h PG）, glycosylated hemoglobin （HbAmc）, fasting plasma glucagon-like peptide-1 （FGLP-1） and 2-hour postprandial glucagonlike peptide-1 （2 h GLP-1 ）. The insulin sensitivity index （ISI = 1/fasting plasma glucose x fasting serum insulin） was calculated. Results Of the 37 patients, 29 cases achieved complete remission, 5 cases obtained partial remission, and 3 cases had no remission. In addition, values for FPG, 2 h PG and HbA1c were significantly decreased after surgery. Values for FGLP-1, 2 h GLP-1 and ISI were significantly increased after surgery （all P 〈 0.05）. Values for FGLP-1 and 2 h GLP-1 were positively correlated with IS1 （r=0.64, 0.58; P〈0.01 or P〈0.05, respectively ）. Conclusions Gastric bypass surgery has a significant clinical effect on patients with type 2 diabetes mellitus. One of the potential mechanisms is that the increased endogenous intestinal GLP-1 secretion leads to improvement of insulin sensitivity.

关 键 词：糖尿病 2型 胃转流术 胰高血糖素样肽-1 

分 类 号：R587.1[医药卫生—内分泌] R656.6[医药卫生—内科学]