代谢手术治疗BMI为27.5～32.5 kg/m^2的2型糖尿病患者的临床疗效  

Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m^2

作　　者：嵇光年 朱利勇[1] 李鹏洲[1] 杨湘武[1] 李伟正[1] 孙许龙[1] 邱先杰 李娆 朱晒红[1] 

机构地区：[1]中南大学湘雅三医院普外三科,长沙410013

出　　处：《中国普外基础与临床杂志》2018年第3期271-275,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨代谢手术对体质量指数(BMI)为27.5~32.5 kg/m^2的2型糖尿病(T2DM)患者的治疗效果。方法回顾性分析2014年10月至2016年10月期间在中南大学湘雅三医院接受代谢手术治疗的43例T2DM患者手术前后的BMI、血糖、血脂等相关指标。结果 43例患者均成功实施代谢手术,其中35例接受了腹腔镜胃旁路术,8例接受了腹腔镜胃袖状切除术,术后均未发生相关并发症,顺利出院。除代谢手术后第1周时的糖化血红蛋白(HbA1c)外,代谢手术后不同时相的BMI、空腹血糖、HbA1c、甘油三酯及总胆固醇指标均明显低于代谢手术前(P<0.05),高密度脂蛋白水平于代谢手术后第12个月时明显高于代谢手术前(P<0.05);代谢手术后第1周和第3个月时的口服糖耐量试验(OGTT)30、60和120 min血糖水平以及术后第6个月和第12个月时的60 min和120 min血糖水平均明显低于代谢手术前(P<0.05);代谢手术后第3个月时的OGTT-IRT 60 min胰岛素水平以及术后第6和第12个月时的30 min胰岛素水平均明显高于代谢手术前(P<0.05);代谢手术后第6个月时的OGTT-CRT 30 min和60 min C肽水平以及术后第12个月时的30 min C肽水平均明显高于代谢手术前(P<0.05)。结论代谢手术治疗BMI为27.5~32.5 kg/m^2的T2DM患者是有效的,血糖、血脂水平能得到明显改善,胰岛细胞合成释放胰岛素功能有所提高。Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus （T2DM） patients with body mass index （BMI） 27.5-32.5 kg/m^2. Methods The clinical data of 43 T2DM patients with BMI 27.5-32.5 kg/m^2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbAlc, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased （P〈0.05） except for the HbAlc on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased （P〈0.05）. The OGTT 30, 60, and 120 rain blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 rain blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased （P〈0.05）. The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased （P〈0.05）. The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 rain C peptide on the postoperative 12-month were all significantly increased （P〈0.05）. Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5-32.5 kg/m^2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.

关 键 词：代谢手术 2型糖尿病 轻度肥胖 

分 类 号：R587.1[医药卫生—内分泌]