肥胖及超重2型糖尿病患者代谢手术后5年疗效随访研究  

Follow up study of obesity and overweight in patients with type 2 diabetes mellitus after 5 years of metabolic surgery

作　　者：李东玲[1] 陈小燕[1] 黄炯强[2] 柯传烽[2] LI Dongling;CHEN Xiaoyan;HUANG Jiongqiang(Department of Endocrinology,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院内分泌科,510120 [2]广州医科大学附属第一医院胃肠外科

出　　处：《中国糖尿病杂志》2022年第2期101-105,共5页Chinese Journal of Diabetes

摘　　要：目的探讨肥胖及超重T2DM患者代谢手术后5年疗效。方法采用前瞻性病例自身前后对照法,对接受代谢手术满5年且随访资料完整的38例肥胖及超重T2DM患者进行疗效分析,观察术后代谢指标、DM缓解率和并发症变化。结果患者代谢手术后第1~5年,体重、BMI、WC、FPG、HbA1c、FIns、FC-P、胰岛素抵抗指数(HOMA-IR)、LDL-C较术前降低(P<0.05)。将14例T2DM患者分为术后5年完全缓解组(CR,缓解率为42.9%)和部分缓解及无效组(Con)。与Con组比较,CR组术前FIns(t=-2.33,P=0.038)、HOMA-IR(t=2.82,P=0.016)、FC-P(t=4.73,P=0.000)、BMI(t=3.07,P=0.01)较高,年龄低(t=-2.33,P=0.038),DM病程短(t=-4.04,P=0.002)。术后5年脂代谢异常、高血压病、阻塞性睡眠呼吸暂停综合征缓解率分别为55.2%、60.0%、64.3%。结论肥胖及超重T2DM患者实施代谢手术,可持续有效控制体重,改善各项代谢指标及减少多种并发症。T2DM长期缓解可能与术前胰岛功能、IR程度、DM病程、BMI和年龄相关。ObjectiveTo report the efficacy outcomes of metabolic surgery followed up for 5 years in patients with type 2 diabetes mellitus(T2 DM).MethodsUsing a before and afterself-controlledstudy design,we prospectively enrolled a total of 38 patients with severe obesity or/and T2 DM who underwent metabolic surgery.They were followed up for 5 years after surgery.The metabolic efficacy,DM remission rate and associated comorbidities were evaluated in all the patients.ResultsBody weight,BMI,waist circumference(WC),FPG,HbA1 c,FIns,FC-P,HOMA-IR and LDL-C decreased significantly at the 1,2,3,4 and 5 years after surgery in comparison with baseline(P<0.05).The 14 patients with T2 DM were further divided into two groups after followed up for 5 years:complete remission group(CR)and partial remission or failed group(Con).The complete remission rate was 42.9%.FIns(t=-2.33,P=0.038),HOMA-IR(t=2.82,P=0.016),FC-P(t=4.73,P=0.000),BMI(t=3.07,P=0.01)were higher,while age was younger,and DM duration was shorter in CR group than in Con group.Remission rates for dyslipidemia,hypertension and obstructive sleep apnea at 5-year follow-up were 55.2%,60.0%and 64.3%respectively.ConclusionMetabolic surgery is effective in body weight control,metabolic indicator improvement,and reduction in a variety of complication sinobese patients and patients with T2 DM and obesity/overweight.In addition,long-term remission of T2 DM is closely related to preoperative islet function,insulin resistance,BMI,age and diabetes duration.

关 键 词：代谢手术 肥胖 糖尿病 2型 

分 类 号：R587.1[医药卫生—内分泌] R656.61[医药卫生—内科学]