Roux-en-Y胃旁路手术对2型糖尿病患者糖脂代谢、胰岛功能及内脂素水平变化影响及疗效相关因素分析  

The influence of Roux-en-Y gastric bypass surgery on the changes of glucose and lipid metabolism,pancreatic islet function and visfatin levels in patients with T2 DM and related factors

作　　者：裴芝皆 马军 谢飞 PEI Zhi-jie;MA Jun;XIE Fei(Department of General Surgery,Jingmen Second People's Hospital,448000 Jingmen,Hubei,China)

机构地区：[1]荆门市第二人民医院普外科,湖北荆门448000

出　　处：《临床消化病杂志》2023年第5期367-372,共6页Chinese Journal of Clinical Gastroenterology

基　　金：荆门市科学技术研究与开发计划(No:2020 YFYB007)。

摘　　要：[目的]探究Roux-en-Y胃旁路手术对2型糖尿病(T2 DM)患者糖脂代谢、胰岛功能及内脂素水平变化影响及疗效相关因素。[方法]回顾性分析接受腹腔镜下Roux-en-Y胃旁路手术治疗的87例T2 DM患者临床资料,收集患者术前和术后3、6、12个月糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hFG)、糖化血红蛋白(HbA1 c)、空腹C肽(FCP)]、脂代谢指标[三酰甘油(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)]、胰岛功能指标[稳态模型β细胞功能指数(HOMA-β)、稳态模型胰岛素(Ins)抵抗指数(HOMA-IR)、稳态模型Ins敏感指数(HOMA-IS)、早相Ins30分泌(ΔIns_(30)/ΔC_(30))、晚相Ins120分泌(ΔIns_(120)/ΔC_(120))]及内脂素水平变化。根据患者术后康复情况,参照疗效标准将患者分为治愈组(55例)和非治愈组(32例)。[结果]术后3、6、12个月FPG、2hFG、HbA1 c、FCP水平均较术前降低,差异有统计学意义(P<0.05)。术后3、6、12个月TC、TG水平均较术前降低,术后12个月HDL水平高于术前,术后12个月LDL水平低于术前,差异均有统计学意义(P<0.05)。术后3、6、12个月HOMA-IRa低于术前,术后6、12个月ΔIns_(30)/ΔC_(30) a高于术前,术后3个月、6个月ΔIns_(120)/ΔC_(120) a高于术前,差异有统计学意义(P<0.05)。术后3、6、12个月内脂素水平均较术前降低,差异有统计学意义(P<0.05)。术前资料显示:治愈者年龄、病程低于非治愈组,BMI、2hFG、FCP水平高于非治愈组(P<0.05)。多因素回归分析显示,年龄大、病程长、BMI水平低、FCP水平低是非治愈的独立危险因素(P<0.05)。[结论]T2 DM患者腹腔镜下Roux-en-Y胃旁路手术可显著改善糖脂代谢和胰岛功能,降低内脂素水平,且年龄大、病程长、BMI水平低、FCP水平低是非治愈的独立危险因素。[Objective]To explore the influence of Roux-en-Y gastric bypass surgery on the changes in glucose and lipid metabolism,islet function and visfatin levels in patients with type 2 diabetes(T2 DM)and related factors.[Methods]The medical records of 87 patients with T2 DM treated with laparoscopic Roux-en-Y gastric bypass surgery were retrospectively analyzed to collect pre-operative and post-operative glucose metabolic indexes at 3,6 and 12 months[fasting blood glucose(FPG),2 h postprandial blood glucose(2hFG),glycated hemoglobin(HbA1 c),fasting C-peptide(FCP)],lipid metabolism indexes[triglycerides(TG),total serum cholesterol(TC),low-density lipoprotein cholesterol(LDL),high-density lipoprotein cholesterol(HDL)],islet function indexes[steady-state model beta-cell function index(HOMA-β),steady-state model insulin(Ins)resistance index(HOMA-IR),steady-state model Ins sensitivity index(HOMA-IS),early-phase Ins30 secretion(ΔIns_(30)/ΔC_(30)),late-phase Ins120 secretion(ΔIns_(120)/ΔC_(120))]and changes in endolipin levels.According to the patient's postoperative recovery,the patients were divided into a cured group(55 cases)and a non-cured group(32 cases)according to the efficacy criteria.[Results]The levels of FPG,2hFG,HbA1 c,and FCP at 3,6,and 12 months after surgery were lower than those before surgery,and the differences were statistically significant(P<0.05).The levels of TC and TG at 3,6 and 12 months after surgery were lower than those before surgery,and the levels of HDL at 12 months after surgery were higher than those before surgery,and the levels of LDL were lower than those before surgery,and the differences were statistically significant(P<0.05).HOMA-IRa at 3,6 and 12 months postoperatively was lower than before surgery,ΔIns_(30)/ΔC_(30 a)at 6 and 12 months postoperatively was higher than before surgery,and ΔIns_(120)/ΔC_(120 a)at 3,6 months postoperatively was higher than before surgery,and the differences were statistically significant(P<0.05).Endolipin levels were lower at 3,6,and 12 months postop

关 键 词：2型糖尿病 胃旁路手术 糖脂代谢 胰岛功能 内脂素 

分 类 号：R587.1[医药卫生—内分泌]