中国超重肥胖与非肥胖2型糖尿病患者胃转流术后疗效与治疗作用的随访观察

摘要

Objective To observe the effects of gastric bypass (GBP) on type 2 diabetes mellitus (T2DM) patients with overweight, obese and non-obese. The changes of glucose tolerance on T2DM patients with overweight/obesity and normal weight after GBP surgery were investigated during the follow-up. Methods From January 2006 to June 2007, 103 T2DM patients undergoing GBP were recruited and divided into overweight/obese group (BMI≥25 kg/m2)and normal weight group (BMK25 kg/m2). Patients received oral glucose tolerance test, insulin and C-peptide release test. Both BMI and HbAic were measured at pre-GBP and at six months, one, two, and three years after GBP. Results During the three years follow-up, among all the patients, total remission rate of T2DM was 87%, 91% in overweight/obesity group and 77% in normal weight group. BMI reduced significantly in overweight/ obese group with 62 patients(95%) BMK24 kg/m2, while no change of BMI in normal weight group. Compared to the level of insulin secretion in normal weight group at pre-GBP, AI30/AG30 increased significantly at three years post-GBP. HOMA-IR in overweight/obesity group decreased obviously at three years post-GBP compared to pre-GBP. Conclusions GBP could achieve remission of T2DM both in overweight/obese and normal weight patients. However, normal weight patients had a lower rate of glucose normalization than overweight/obese patients, indicating that the effect of GBP on diabetes was independent of weight loss in normal weight patients, while in overweight/obesity patients it was mainly associated with the amelioration of insulin resistance.%目的 观察胃转流手术(GBP)对超重、肥胖与非肥胖T2DM患者的疗效与治疗作用,为此我们随访观察超重肥胖和正常体重两组患者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103例T2DM患者,按照BMI分为2组,超重肥胖组(BMI≥25 kg/m2)和正常体重组(BMI<25 kg/m2).术后随访期为半年、1年、2年、3年,分别观察HbA1c、BMI、OGTT、胰岛素释放试验和C-P释放试验.结果 3年随访期中,T2DM总体显效率为87%,其中超重肥胖组显效率为91%,正常体重组显效率为77%;与术前BMI相比,超重肥胖组术后BMI明显下降,62例超重肥胖患者BMI<24 kg/m2,显效率为95%,正常体重组BMI无明显变化;与正常体重组患者术前胰岛素分泌值相比,术后3年胰岛素分泌值△I30/△G30明显升高,差异有统计学意义(P<0.05);与术前胰岛素抵抗指数(HOMA-IR)相比,超重肥胖组术后3年HOMA-IR明显改善,差异有统计学意义(P<0.05).结论 GBP对超重肥胖和正常体重T2DM均有明显治疗作用,但正常体重组T2DM有效率低于超重肥胖组,显示其降糖作用独立于减重作用,而超重肥胖组主要有赖于术后IR改善.