9540中国2型糖尿病病人胃转流术后1年糖代谢变化规律的研究.doc

中国2型糖尿病病人胃转流术后1年糖代谢变化规律的研究 Effect of gastric bypass on the glucose tolerance in T2DM patients in China during 1 year follow-up. 高宏凯 高艳红 郭晓博 李晗 张全义 张新国 通讯作者：高宏凯 武警总医院普外科 100039 E-mail：wjgaohk@163.com 摘要 目的 胃转流手术(GBP)对糖尿病有确切的治疗作用，然而目前关于此方面的报道仅限于国外肥胖症病人术后的临床回顾性研究，且国内糖尿病病人伴发肥胖症的比例明显低于国外发达国家。基于以上情况，我们探索中国2型糖尿病病人GBP术后的糖代谢变化规律。 方法 2006年1月-2007年6月期间，我院普外科纳入145例2型糖尿病病人，按照糖化血红蛋白将病人分为3组，Ⅰ组：HbA1C 7-7.9%；Ⅱ组：HbA1C 8-9%；Ⅲ组：HbA1C 9%。129例病人实施GBP手术，排除16例病人。术前和术后1、3、6、12月检查OGTT、胰岛素释放试验、C-肽释放试验、糖化血红蛋白和体重指数，计算早期胰岛素分泌指数，术后随访期限1年。 结果 ①与术前BMI相比，术后各组BMI呈下降趋势，在Ⅲ组差异有显著性(P0.001)；②与术前空腹血糖相比，术后空腹血糖水平逐渐下降至术后12月有显著性(P0.001)；③与术前空腹胰岛素水平相比，术后各组空腹胰岛素无明显差异；④与术前空腹C-肽水平相比，Ⅰ组术后空腹C-肽水平明显升高(P=0.006)；⑤与术前HbA1c相比，术后HbA1c逐渐下降，术后12月差异有显著性（P0.001）；⑥与术前ΔI30相比，Ⅰ组术后12月ΔI30明显改善，差异有显著性(P0.001)。 结论 胃转流术后2型糖尿病病人糖代谢明显改善，并且与术后胰岛功能改善相关。 关键词 胃转流手术；糖尿病；2型；糖代谢；胰岛功能 Abstract Objective To explore the effect of gastric bypass (LRYGB) on type 2 diabetes mellitus patients in China. Methods From January 2006 to June 2007, 145 type 2 diabetes mellitus (T2DM)patients were recruited for our study and were divided into 3 groups by the level of HbA1C(group 1,HbA1C 7-7.9%;group 2, HbA1C 8-9%;group 3, HbA1C 9%).129 patients were underwent gastric bypass surgery (GBP) and 16 patients were exclude. Oral glucose tolerance test, insulin release test, C peptide release test, HbA1C,body mess index(BMI) , ΔI30/ΔG30and ΔI30were evaluated before surgery and 1,3,6,12 months after surgery during the 1year follow-up. Results After GBP, ①comparing with BMI before surgery,BMI droped slightly and significantly in group Ⅲ; ②comparing with FBG level before surgery, fasting blood glucose (FBG) level dropped significantly in 12 months after the surgery; ③comparing with fasting insulin level before the surgery, fasting insulin did not change significantly; ④comparing with fasting C peptide level before surgery, fasting C peptide increased significantly in groupⅠ after surgery; ⑤comparing with HbA1C level before surgery, HbA1C level reduced slightly 12