预测代谢手术术后降糖效果的四个评分系统的比较  

Comparison of four scoring systems for predicting the effect of hypoglycemia after metabolic surgery

作　　者：闫文貌[1] 徐田磊 李有国[1] 许峻[1] 钟志强[1] 白日星[1] Yan Wenmao;Xu Tianlei;Li Youguo;Xu Jun;Zhong Zhiqiang;Bai Rixing(Department of General Surgery,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100070,China;Beijing Tsinghua Changgeng Hospital Gastrointestinal Surgery,Beijing 102218,China)

机构地区：[1]首都医科大学附属北京天坛医院普通外科,北京100070 [2]北京清华长庚医院胃肠外科,102218

出　　处：《中华腔镜外科杂志（电子版）》2020年第3期182-187,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：首都市民健康培育项目(Z161100000116068)。

摘　　要：目的比较预测代谢手术术后2型糖尿病(type 2 diabetes mellitus,T2DM)完全缓解的四个评分系统,以期筛选出更适合中国大陆人群的术前精准评估胃旁路术(gastric bypass,GBP)治疗T2DM效果的预测模型。方法回顾性分析2012年4月至2015年12月于首都医科大学附属北京天坛医院普外科接受腹腔镜GBP治疗的T2DM患者的相关临床资料,比较术前、术后相关指标的变化,采用ROC曲线比较ABCD、DiaRem、IMS及天坛预测评分系统对入组患者GBP术后T2DM完全缓解率的预测效力。结果最终入组患者101例,女58例、男43例,年龄(45.3±11.1)岁,体质量指数(body mass index,BMI)(30.3±5.5)kg/m^2,T2DM病程(7.1±4.8)年,HbA1c(8.5±1.7)%。术后1年T2DM完全缓解率70.3%(71/101)。BMI、体质量、TCHO、TG、LDL、FBG、HbA1c、空腹C肽、空腹胰岛素、HOMA-IR、血清铁蛋白均较术前明显减低,差异存在统计学意义(P<0.05)。ROC曲线分析各评分系统对入组患者GBP术后T2DM缓解率的预测效力,IMS、天坛、DiaRem及ABCD预测评分系统的AUC值分别为0.833、0.825、0.764和0.724。结论IMS和天坛预测评分系统能较好的术前预测GBP术后T2DM完全缓解率。Objective To screen out the more suitable prediction model of preoperative accurate assessment of gastric bypass(GBP)for the treatment of type 2 diabetes mellitus(T2DM)in China's Mainland by comparing several scoring systems of predicting T2DM after metabolic surgery.Methods The data of patients with T2DM who received GBP was retrospectively collected,and all the patients were seen from Apr.2012 to Dec.2015 in Beijing Tian Tan Hospital,compared changes of related clinical indicators before and one year after surgery.We compared the predictive accuracy by ROC curve for T2DM complete remission after GBP between ABCD,DiaRem,IMS,and Tian Tan predictive scoring systems.Results A total of 101 patients(58 women)were enrolled in our study.Complete remission rate of T2DM after GBP was 70.3%(71/101).Mean age of the T2DM patients was(45.3±11.1)years,mean BMI was(30.3±5.5)kg/m^2,mean HbA1c and disease duration were(8.5±1.7)%and(7.1±4.8)years,respectively.BMI,TCHO,TG,LDL,FPG,HbA1c,fasting C-peptide,fasting insulin,HOMA-IR and serum ferritin were significantly lower than those before operation(<0.05).The AUC values of IMS,Tian Tan,DiaRem,and ABCD scoring systems were 0.833,0.825,0.764,and 0.724 respectively.Conclusions The IMS and Tian Tan scoring systems were accurate estimate of T2DM complete remission of patients after GBP,allowing metabolic surgeon to optimized treatment plan based on individualized risk prediction.

关 键 词：代谢手术 减重 胃旁路术 2型糖尿病 预测 模型 

分 类 号：R58[医药卫生—内分泌]