腹腔镜Roux-en-Y胃旁路术对2型糖尿病患者术后胰岛素抵抗影响的观察  

Influence of laparoscopic Roux-en-Y gastric bypass on postoperative insulin resistance of the patients with type 2 diabetes mellitus

作　　者：童山[1] 殷骏[1] 朱政[1] 吴润达[1] 毛忠琦[1] TONG Shan, YIN Jun, ZHU Zheng, et al.(Department of General Surgery, The First Affiliated of Soochow University, Suzhou 215006, China)

机构地区：[1]苏州大学附属第一医院普外科,215006

出　　处：《中国糖尿病杂志》2018年第8期624-627,共4页Chinese Journal of Diabetes

基　　金：苏州市临床重点病种诊疗技术专项项目(LCZX201303);江苏省临床医学科技专项项目-新型临床诊疗技术攻关资助项目(BL2014048)

摘　　要：目的观察腹腔镜Roux-en-Y胃旁路术(LRYGB)后对T2DM患者IR的改善效果。方法回顾性分析2013年12月至2015年12月于苏州大学附属第一医院采用LRYGB治疗50例T2DM患者的临床资料,比较手术前后3、6、12个月的体重、BMI、WC、WHR、TC、TG、LDL-C、HDL-C、FPG、FC-P、FIns、HbA1c、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、胰升血糖素样肽1(GLP-1)及葡萄糖依赖性促胰岛素多肽(GIP)水平。结果与术前比较,术后3个月体重[(86.8±23.4)vs(73.9±19.1)kg]、BMI[(32.8±7.6)vs(27.9±6.0)kg/m2]、WC[(104.7±14.7)vs(92.3±13.8)cm]、WHR[(1.0±0.1)vs(0.9±0.1)]、TC[(4.9±1.2)vs(4.3±0.9)mmol/L]、TG[(2.4±1.9)vs(1.5±0.9)mmol/L]、LDL-C[(3.0±1.0)vs(2.6±0.7)mmol/L]、FPG[(8.6±1.5)vs(6.7±1.3)mmol/L]、FC-P[(3.0±1.7)vs(2.2±1.1)ng/ml]、FIns[(12.6±4.7)vs(8.1±4.0)mIU/L]、HbA1c[(8.9±2.2)%vs(6.5±0.8)%]、HOMA-IR[(4.8±1.9)vs(2.4±1.0)]、GIP[4.16(1.54,12.46)vs2.58(1.78,4.27)pg/ml]降低(P<0.05),术后12个月HDL-C[(1.2±0.2)vs(1.4±0.3)mmol/L]升高(P<0.05)。术后6个月HOMA-β[62.0(30.9,108.0)vs 50.6(36.1,65.0)]、GLP-1[3.10(2.25,4.05)vs 2.25(1.25,3.40)pg/ml]高于术前(P<0.05)。结论 LRYGB可降低T2DM患者体重、血糖、血脂,降低IR。Objective To study the remission of insulin resistance（HOMA-IR）in type 2 diabetes mellitus（T2DM）after laparoscopic Roux-en-Y gastric bypass surgery（LRYGB）. Methods Clinical data of 50 patients with T2DM underwent LRYGB in the First Affiliated Hospital of Soochow University from December 2013 to December 2015 were retrospectively studied.The indexes about body weight,BMI,waist circumference（WC）,waist-to-hip ratio（WHR）,total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,fasting plasma glucose（FPG）,fasting C peptide（FC-P）,fasting insulin（FIns）,glycosylated hemoglobin A1 c（HbA1c）,HOMA-IR,HOMA-β,glucagon-like peptide 1（GLP-1）and glucose-dependent insulinotropic polypeptide（GIP）were collected and compared before and 3,6,and 12 months after surgery. Results 50 patients had high blood glucose with IR before operation.Compared with the preoperative state,the body weight[（86.8±23.4）vs（73.9±19.1）kg],BMI[（32.8±7.6）vs（27.9±6.0）kg/m2],WC [（104.7±14.7）vs（92.3±13.8）cm],WHR[（1.0±0.1）vs（0.9±0.1）,TC[（4.9±1.2）vs（4.3±0.9）mmol/L],TG[（2.4±1.9）vs（1.5±0.9）mmol/L],LDL-C [（3.0±1.0）vs（2.6±0.7）mmol/L],FPG [（8.6±1.5）vs（6.7±1.3）mmol/L],FC-P [（3.0±1.7）vs（2.2±1.1）ng/ml],FIns[（12.6±4.7）vs（8.1±4.0）mIU/L],HbA1c[（8.9±2.2）% vs（6.5±0.8）%],HOMA-IR [（4.8±1.9）vs（2.4±1.0）],GIP [4.16（1.54,12.46）vs 2.58（1.78,4.27）pg/ml]decreased at 3 months after operation（P〈0.05）.HDL-C level increased significantly at 12 months after surgery[（1.2±0.2）vs（1.4±0.3）mmol/L]（P〈0.05）.At 6 months after operation,the levels of HOMA-β[62.0（30.9,108.0）vs 50.6（36.1,65.0）]and GLP-1[3.10（2.25,4.05）vs 2.25（1.25,3.40）pg/ml]were higher than preoperative state（P〈0.05）. Conclusion LRYGB can reduce body weight,blood glucose,blood lipids and IR in patients with T2DM.

关 键 词：腹腔镜Roux-en-Y胃旁路术 糖尿病 2型 胰岛素抵抗 

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