中国普外基础与临床杂志

中国普外基础与临床杂志

代谢手术治疗 BMI 为 27.5~32.5 kg/m2 的 2 型糖尿病患者的临床疗效

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目的 探讨代谢手术对体质量指数(BMI)为 27.5~32.5 kg/m2 的 2 型糖尿病(T2DM)患者的治疗效果。 方法 回顾性分析 2014 年 10 月至 2016 年 10 月期间在中南大学湘雅三医院接受代谢手术治疗的 43 例 T2DM 患者手术前后的 BMI、血糖、血脂等相关指标。 结果 43 例患者均成功实施代谢手术,其中 35 例接受了腹腔镜胃旁路术,8 例接受了腹腔镜胃袖状切除术,术后均未发生相关并发症,顺利出院。除代谢手术后第 1 周时的糖化血红蛋白(HbA1c)外,代谢手术后不同时相的 BMI、空腹血糖、HbA1c、甘油三酯及总胆固醇指标均明显低于代谢手术前(P<0.05),高密度脂蛋白水平于代谢手术后第 12 个月时明显高于代谢手术前(P<0.05);代谢手术后第 1 周和第 3 个月时的口服糖耐量试验(OGTT)30、60 和 120 min 血糖水平以及术后第 6 个月和第 12 个月时的 60 min 和 120 min 血糖水平均明显低于代谢手术前(P<0.05);代谢手术后第 3 个月时的 OGTT-IRT 60 min 胰岛素水平以及术后第 6 和第 12 个月时的 30 min 胰岛素水平均明显高于代谢手术前(P<0.05);代谢手术后第 6 个月时的 OGTT-CRT 30 min 和 60 min C 肽水平以及术后第 12 个月时的 30 min C 肽水平均明显高于代谢手术前(P<0.05)。 结论 代谢手术治疗 BMI 为 27.5~32.5 kg/m2 的 T2DM 患者是有效的,血糖、血脂水平能得到明显改善,胰岛细胞合成释放胰岛素功能有所提高。

Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m2. Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.

关键词: 代谢手术; 2 型糖尿病; 轻度肥胖

Key words: metabolic surgery; type 2 diabetes mellitus; mild obesity

引用本文: 嵇光年, 朱利勇, 李鹏洲, 杨湘武, 李伟正, 孙许龙, 邱先杰, 李娆, 朱晒红. 代谢手术治疗 BMI 为 27.5~32.5 kg/m2 的 2 型糖尿病患者的临床疗效 . 中国普外基础与临床杂志, 2018, 25(3): 271-275. doi: 10.7507/1007-9424.201712102 复制

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