影响胃转流术治疗2型糖尿病疗效的相关因素分析
Factors influencing the effect of gastric bypass surgery on type 2 diabetes mellitus
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摘要:
目的 探讨影响胃转流术治疗2型糖尿病疗效的相关因素。
方法 回顾性分析2009年3月至2010年3月成都军区总医院行胃转流术治疗且获得1年随访的99例2型糖尿病患者的临床资料。连续观察患者术前和术后1年口服葡萄糖耐量试验(OGTT)、C肽释放试验和胰岛素释放试验结果，并检测糖化血红蛋白，计算胰岛素抵抗指数及身高体质量指数(BMI)等指标。胃转流术后不再需要任何降糖措施，可长期保持随机血糖<11.1 mmol/L、空腹血糖<7.0 mmol/L、OGTT 2 h血糖<11.1 mmol/L、糖化血红蛋白<6.5%者判定为完全缓解(完全缓解组)；术后所需药物量明显减少或饮食调整即可控制血糖至正常者判定为好转(好转组)；不符合上述完全缓解和好转标准者均视为无效(无效组)。术后各时相点检测指标与术前比较采用重复测量设计方差分析，组间各指标比较采用单因素方差分析，多重比较采用LSD t 检验。
结果 80%(79/99)的患者症状完全缓解，9%(9/99)的患者症状好转，11%(11/99)的患者无效。完全缓解组术前体质量，BMI，空腹及餐后30 min、1、2、3 h C肽，餐后30 min和1 h血糖，餐后30 min和1 h胰岛素分别为(75±14)kg、(27±4)kg/m2、(2.1±0.8)nmol/L、(2.8±1.2)nmol/L、(3.8±1.7)nmol/L、(4.5±2.2)nmol/L、(3.5±1.2)nmol/L、(16±3)mmol/L、(19±4)mmol/L、(29±21)U/L、(37±27)U/L，好转组分别为(62±10)kg、(24±4)kg/m2、(1.3±0.5)nmol/L、(1.8±1.0)nmol/L、(1.9±0.8)nmol/L、(2.8±1.7)nmol/L、(2.7±1.5)nmol/L、(17±5)mmol/L、(20±6)mmol/L、(18±13)U/L、(17±12)U/L，无效组分别为(71±12)kg、(24±3)kg/m2、(1.6±0.6)nmol/L、(2.2±0.9)nmol/L、(2.8±1.3)nmol/L、(2.8±1.0)nmol/L、(2.5±1.4)nmol/L、(17±5)mmol/L、(20±4)mmol/L、(17±10)U/L、(24±16)U/L，完全缓解组与好转组和无效组比较，差异有统计学意义(F=3.989,5.328,5.860,4.315,7.504,5.208,4.512,3.341,8.154,3.456,3.514,P<0.05)。
结论 除体质量和BMI以外，反映胰岛β细胞功能的空腹和餐后30 min、1、2、3 h C肽，餐后30 min和1 h的血糖和胰岛素等指标均与胃转流术的临床疗效密切相关。Abstract:Objective To investigate the factors influencing the effect of gastric bypass surgery on type 2 diabetes mellitus.
Methods The clinical data of 99 patients with type 2 diabetes mellitus who received gastric bypass surgery at the General Hospital of Chengdu Military Command from March 2009 to March 2010 were retrospectively analyzed. All the patients were followed up for 1 year. The results of oral glucose tolerance test (OGTT) and Cpeptid release test were obtained, the levels of insulin and glycosylated hemoglobin (HbA1c) were dynamically monitored, and the insulin resistance indexes (HOMA IR) and body mass indexes (BMI) were calculated. Complete clinical remission was defined as not requiring any hypoglycemic measures and capable of maintaining long term random blood glucose levels<11.1 mmol/L, fasting blood glucose levels<7.0 mmol/L, 2 hour-blood glucose levels<11.1 mmol/L and HbA1c<6.5%; improved condition was defined as having a significant reduction in necessary drug administration or dietary modifcation to control normal blood glucose levels after surgery; any patient who did not meet these criteria was considered unaffected. All data were analyzed using the repeated measures design, one way analysis of variance or LSD t test.
Results Of the 99 patients, 79 patients (80%) met the criteria of complete remission, the conditions of 9 patients (9%) were improved, and the surgery was ineffective in 11 patients (11%). The preoperative body weight, BMI, fasting, 30 minutes and 1 , 2 , 3 hour postprandial C peptide, 30 minutes and 1 hour postprandial glucose, 30 minutes and 1 hour postprandial insulin were (75±14)kg, (27±4)kg/m2, (2.1±0.8)nmol/L, (2.8± 1.2)nmol/L,(3.8±1.7)nmol/L, (4.5±2.2)nmol/L, (3.5±1.2)nmol/L, (16±3)mmol/L, (19±4)mmol/L, (29±21)U/L, (37±27)U/L for patients with complete remission, (62±10)kg, (24±4)kg/m2, (1.3±0.5)nmol/L, (1.8±1.0)nmol/L, (1.9±0.8)nmol/L, (2.8±1.7)nmol/L, (2.7±1.5)nmol/L, (17±5)mmol/L, (20±6)mmol/L, (18±13)U/L and (17±12)U/L for patients with improved condition, and (71±12)kg, (24±3)kg/m2, (1.6±0.6)nmol/L,(2.2±0.9)nmol/L, (2.8±1.3)nmol/L, (2.8±1.0)nmol/L, (2.5±1.4)nmol/L, (17±5)mmol/L, (20±4)mmol/L, (17±10)U/L and (24±16)U/L for patients who were unaffected, with significant differences between the 3 groups ( F=3.989, 5.328, 5.860, 4.315, 7.504, 5.208, 4.512, 3.341, 8.154, 3.456, 3.514, P <0.05).
Conclusion The body weight, BMI, fasting, 30 minutes and 1, 2, 3 hour postprandial C-peptide, 30 minutes and 1-hour postprandial glucose, 30 minutes and 1-hour postprandial insulin are factors influencing the effect of gastric bypass surgery on type-2 diabetes mellitus.
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