病程十年以上2型糖尿病患者代谢手术后体重减轻与糖尿病缓解的关系  

Association of weight loss with diabetes remission after metabolic surgery in patients with type 2 diabetes for 10 years and above

作　　者：张念荣[1] 王喆 孟化 Zhang Nianrong;Wang Zhe;Meng Hua(General Surgery Department&Obesity and Metabolic Disease Center,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院普外科·代谢减重中心,北京100029

出　　处：《中华临床营养杂志》2022年第2期73-78,共6页Chinese Journal of Clinical Nutrition

基　　金：中国医药卫生事业发展基金会减重糖尿病专项基金(2021-HX-34)。

摘　　要：目的探究病程≥10年2型糖尿病(type 2 diabetes mellitus,T2DM)患者代谢手术后体重减轻与糖尿病缓解的关系。方法回顾性分析2017年11月至2021年6月于中日友好医院代谢减重中心行代谢手术的肥胖伴T2DM的患者,术后随访体重、血糖改善情况。糖尿病缓解定义为未接受降糖药物治疗3个月以上,糖化血红蛋白<6.5%或空腹血糖<7.0 mmol/L。按照总体重减轻百分比(percentage of total weight loss,%TWL)是否≥20%分为两组,比较两组间年龄、性别、术前体重、体重指数(body mass index,BMI)、空腹C肽、糖化血红蛋白、使用胰岛素的患者比例,术后体重、BMI、糖尿病缓解率的差异,并进行Cox多因素回归分析。结果共纳入病程≥10年T2DM病患者65例(男性28例,女性37例),中位随访时间12个月,术后76.9%达到糖尿病缓解(50/65)。术后%TWL在<10%、10~20%、20~30%、≥30%的发生概率分别为6.2%、41.5%、38.5%、13.8%,对应的糖尿病缓解率分别为50%、63.0%、92.0%、88.9%。两组间比较结果提示,%TWL≥20%组术前体重[(95.5±18.8)kg比(85.5±11.0)kg,P=0.012]、BMI[(34.4±6.0)比(30.9±3.3),P=0.006]明显高于%TWL<20%组,%TWL≥20%组糖尿病缓解率明显高于%TWL<20%组(91.2%比61.3%,P=0.010)。Cox多因素回归分析显示,调整年龄、术前BMI、空腹C肽、糖尿病病程,%TWL≥20%与≥10年病程T2DM患者代谢手术后糖尿病缓解率增加独立相关[HR=1.99(1.03~3.83),P=0.04]。结论对于≥10年长病程T2DM患者,代谢手术后糖尿病初始缓解率仍能达到70%以上,术后%TWL≥20%与糖尿病缓解率增加独立相关。Objective To explore the association of weight loss with diabetes remission after metabolic surgery in patients with type 2 diabetes mellitus(T2DM)for 10 years and more.Methods Data of T2DM patients with obesity who underwent metabolic surgery in the General Surgery Department&Obesity and Metabolic Disease Center of China-Japan Friendship Hospital from November 2017 to June 2021 were retrospectively collected and analyzed.Remission of diabetes was defined as glycated hemoglobin(HbA1c)<6.5%or fasting blood glucose<7.0 mmol/L after discontinuing anti-diabetic medication for more than 3 months.The patients were followed up and divided into two groups according to whether the percentage total weight loss(%TWL)was≥20%or not.The age,sex,body mass index(BMI),fasting C-peptide,and HBA1c were compared between the two groups.Results Among 65(28 males and 37 females)patients with T2DM for≥10 years,50(76.9%)achieved diabetes remission after a median of 12-month follow-up.6.2%,41.5%,38.5%and 13.8%of the patients achieved%TWL<10%,10~20%,20~30%and≥30%,respectively.The diabetes remission rates were 50%,63.0%,92.0%and 88.9%,respectively.Compared with the%TWL<20%group,the preoperative weight[(95.5±18.8)kg vs(85.5±11.0)kg,P=0.012]and BMI[(34.4±6.0)vs(30.9±3.3),P=0.006]were significantly higher in the%TWL≥20%group,and diabetes remission rates was aslo significantly higher in the%TWL≥20%group(91.2%vs 61.3%,P=0.010).After adjusting for age,preoperative BMI,fasting C-peptide and duration of T2DM,Cox multivariate regression analysis showed that%TWL≥20%was independently associated with diabetic remission after metabolic surgery in patients with T2DM for≥10 years(HR=1.99,95%CI:1.03 to 3.83,P=0.04).Conclusions More than 70%of patients with T2DM for≥10 years could achieve diabetes remission after metabolic surgery.%TWL≥20%may be one independent factor of diabetes remission in patients with long-duration T2DM.

关 键 词：2型糖尿病 代谢手术 糖尿病缓解 病程 

分 类 号：R656.61[医药卫生—外科学]