·糖尿病外科治疗研究·

　　高宏凯 贾元利 吴致委 高艳红 关争梅 高相楠 梁昂

　　作者单位：100039北京，武警总医院普外科

　　【摘要】 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。

　　【关键词】 胃转流手术;糖尿病，2型; 肥胖;非肥胖;糖代谢

　　doi:10.3969/j.issn.1006-6187.2012.04.003

Follow-up observation of therapeutic effects of gastric bypass on type 2 diabetes patients with overweight, obesity and non-obesity in China     GAO Hong-kai,JIA Yuan-li,WU Zhi-wei,et al. Department of general surgery，Beijing Armed Police Corps Hospital， Beijing 100039， China

　　【Abstract】 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 (BMI<25 kg/m2).Patients received oral glucose tolerance test, insulin and C-peptide release test. Both BMI and HbA1c 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%) BMI<24 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, △I30/△G30 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.

　　【Key words】Gastric bypass; Diabetes mellitus，type 2; Obesity; Non-obesity; Glucose tolerance

[中国糖尿病杂志，2012，20（4）：248-253]