腹腔镜袖状胃切除术联合二甲双胍治疗2型糖尿病的效果及安全性  

Efficacy and Safety of Laparoscopic Sleeve Gastrectomy Combined with Metformin in Treating Type 2 Diabetes Mellitus

作　　者：刘岩 胡扬喜[1] 董星 LIU Yan;HU Yang-xi;DONG Xing(Department of Gastrointestinal and Metabolic Surgery,Zhengzhou Central Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市中心医院胃肠代谢外科,郑州450000

出　　处：《中国合理用药探索》2025年第3期43-48,共6页Chinese Journal of Rational Drug Use

基　　金：河南省医学科技攻关计划项目(LHGJ20210242)。

摘　　要：目的:探讨腹腔镜袖状胃切除术(LSG)联合二甲双胍治疗2型糖尿病(T2DM)患者的临床疗效及安全性。方法:选取2022年2月~2023年1月期间于某院治疗的86例T2DM患者作为研究对象,采用随机数字表法分为对照组和观察组,每组43例。两组患者治疗前均调整饮食和生活习惯。对照组患者给予盐酸二甲双胍缓释片治疗,观察组患者在对照组基础上给予LSG治疗。记录观察组患者术中出血量、手术时间等手术相关指标及术后并发症发生情况;比较两组患者血糖代谢指标[糖化血红蛋白(HbA1c)、餐后2 h血糖(2hPG)、空腹血糖(FBG)]、胰岛素抵抗指数(HOMA-IR)、血脂指标[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、血清胰岛素敏感性相关指标[蛋白酪氨酸磷酸酶1B(PTP1B)、摄食抑制因子-1(NSF-1)、羧化不全骨钙素(uc OC)]、临床疗效及不良反应发生情况。结果:观察组患者术中平均出血量(15.28±5.26)ml,平均手术时间(85.29±8.87)min,术后并发症发生率为4.65%。治疗3个月后,两组患者HbA1c、2hPG、FBG、HOMA-IR、TG、TC和LDL-C水平均降低(P<0.05),且观察组低于对照组(P<0.05);HDL-C水平均升高(P<0.05),且观察组高于对照组(P<0.05);PTP1B、NSF-1水平均降低(P<0.05),且观察组低于对照组(P<0.05);uc OC水平均升高(P<0.05),且观察组高于对照组(P<0.05)。观察组患者治疗总有效率(93.02%)高于对照组(74.42%,P<0.05)。两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:LSG联合二甲双胍治疗T2DM患者临床疗效较佳,可有效改善糖脂代谢及血清PTP1B、NSF-1、uc OC水平,且不会增加不良反应的发生风险。Objective:To investigate the clinical efficacy and safety of laparoscopic sleeve gastrectomy(LSG)combined with metformin in patients with type 2 diabetes mellitus(T2DM).Methods:A total of 86 patients with T2DM treated in a hospital from February 2022 to January 2023 were selected and assigned to the control group and the observation group by random number table method,with 43 patients in each group.The diet and lifestyle habits of patients in the two groups were adjusted before treatment.The control group was treated with metformin hydrochloride extended-release tablets,and the observation group was treated with LSG in addition to the treatment given in the control group.The intraoperative indicators including intraoperative blood loss and operation time,and postoperative complications were recorded in the observation group.The plasma glucose metabolism parameters[glycosylated haemoglobin(HbA1c),2-hour postprandial blood glucose(2hPG),fasting blood glucose(FBG)],insulin resistance index(HOMA-IR),blood lipid parameters[triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],serum insulin sensitivity related parameters[protein tyrosine phosphatase 1B(PTP1B),nesfatin-1(NSF-1),undercarboxylated osteocalcin(ucOC)],clinical efficacy and adverse reactions were compared between the two groups.Results:In the observation group,the mean intraoperative blood loss was(15.28±5.26)ml and the mean operation time was(85.29±8.87)min.The incidence of postoperative complications was 4.65%.After 3 months of treatment,the levels of HbA1c,2hPG,FBG,HOMA-IR,TG,TC and LDL-C were decreased in both groups(P<0.05),with the observation group showing lower levels than the control group(P<0.05).The HDL-C level was increased in both groups(P<0.05),with the observation group showing a higher level than the control group(P<0.05).The levels of PTP1B and NSF-1 were decreased in both groups(P<0.05),with the observed group showing lower levels than the control group(P<0.05).The u

关 键 词：二甲双胍 腹腔镜袖状胃切除术 2型糖尿病 疗效 安全性 

分 类 号：R587.1[医药卫生—内分泌]