腹腔镜胃旁路术后血清瘦素、脂联素变化与胰岛素抵抗的关系  

Relationships between expressions of serum adiponectin,leptin,and insulin resistance in type 2 diabetes patients with obesity following laparoscopic gastric bypass

作　　者：郭晓博 韩辉[2] 苗山[2] 张冶[2] 刘昕伟 高宏凯[2] GUO Xiaobo;HAN Hui;MIAO Shan;ZHANG Ye;LIU Xinwei;GAO Hongkai(Department of General Surgery, Fengtai Hospital, 100071 Beijing, China;Department of General Surgery, General Hospital of Chinese People＇s Armed Police Force, 100039 Beijing, China)

机构地区：[1]北京市丰台医院普外科,100071 [2]武警总医院普外科,北京100039

出　　处：《武警医学》2018年第6期615-618,共4页Medical Journal of the Chinese People's Armed Police Force

基　　金：首都医学发展科研基金(2009-2058)

摘　　要：目的观察腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y,LRYGB)前后肥胖症伴2型糖尿病(type 2 diabetes,T2DM)患者的血清瘦素和脂联素表达变化,并探讨该变化与胰岛素抵抗的关系。方法回顾性分析2011-03至2012-02武警总医院普通外科行腹腔镜胃旁路手术的52例肥胖症伴T2DM患者的临床资料,BMI为28~35 kg/m2,术后随访期12个月。术前和术后1、3、6、12个月分别检测血清瘦素、脂联素、糖化血红蛋白(glycated hemoglobin,Hb A1c)、三酰甘油(triglyceride,TG)和胆固醇(cholesterol,CH)、BMI,并行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)和胰岛素释放试验。结果 (1)12个月随访期间,T2DM显效率为86.5%(45/52),肥胖症治愈率为67.3%(35/52),无失访病例;(2)与术前空腹脂联素水平[(4.36±2.63μg/ml)]相比,术后空腹脂联素水平呈下降趋势至术后3个月[(2.93±1.37)μg/ml],而升高至术后12个月[(7.36±3.70)μg/ml,P=0.028];(3)与术前空腹瘦素值(20.79±8.75)ng/ml相比,术后空腹瘦素值明显下降直至术后12个月[(5.06±2.46)ng/ml,P=0.005];(4)术后12个月空腹血糖水平较术前明显下降(P=0.003);术后12个月空腹胰岛素水平较术前明显下降(P=0.03);术后12个月Hb A1c水平较术前明显下降(P=0.002);术后12个月HOMA-IR水平明显较术前明显下降(P=0.003);(5)术后12个月TG水平较术前明显下降(P=0.03),术后12个月CH较术前明显下降(P=0.04)。结论 LRYGB后脂联素表达上调和瘦素抵抗改善是胰岛素抵抗改善的机制之一。Objective To investigate the relationships between expressions of serumadiponectin,leptin,and insulin resistance in T2DM patients with obesity following laparoscopic Roux-en-Y gastric bypass（ LRYGB）. Methods The clinical data on 52 cases of T2DM patients（ BMI 28-35 kg/m2） treated with LRYGB between March 2011 and February 2012 was retrospectively analyzed. Levels of adiponectin,letptin,OGTT,HbA1c,triglycerides and cholesterol were detected before surgery and at 1,3,6,12 months postoperatively during one year follow-up. Oral glucose tolerance test and insulin release test were also conducted. Results（ 1） During the follow-up,the cure rate of T2 DM and obesity was 86. 5%（ 45/52） and 67. 3%（ 35/52） respectively.（ 2） Compared with the preoperative mean level（ 4. 36 ± 2. 16） μg/ml,adiponectin decreased to（ 2. 93 ± 1. 37） μg/ml within 3 months of follow-up,but increased gradually to[（ 7. 36 ± 3. 70） μg/ml,P = 0. 028]till postoperative 12 months.（ 3） Leptin decreased gradually from base line（ 20. 79 ±8. 75 ng/ml） until 12 months after surgery [（ 5. 06 ± 2. 46） ng/ml,P = 0. 005].（ 4） Fasting blood glucose decreased gradually from base line（ 10. 00 ± 3. 5） mmol/L until 12 months after surgery [（ 6. 48 ± 0. 5） mmol/L,P = 0. 003]. Compared with the preoperative fasting insulin level（ 24. 8 ± 9. 8） pmol/L,the level decreased to [（ 6. 9 ± 2. 0） pmol/L,P = 0. 03] after 12 months. Compared with the preoperative Hb A1 c level（ 8. 0% ± 1. 5%）,the level decreased to（ 6. 5% ± 0. 9%,P = 0. 002） after 12 months. Compared with the preoperative HOMA-IR level（ 10. 25 ± 5. 01）,there was a significant decrease after 12 months（ 2. 64 ± 0. 98,P = 0. 003）（ 5） Preoperative TG was（ 3. 50 ± 1. 46） mmol/L and decreased to [（ 1. 14 ± 0. 38） mmol/L,P = 0. 03]in 12 months. Preoperative CH was（ 5. 14 ± 1. 18） mmol/L and decreased to [（ 4. 01 ± 0. 49） mmol/L,P = 0. 04] after 12 months. Conclusions The improvement of the pattern

关 键 词：2型糖尿病 胃旁路术 脂联素 瘦素 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]