腹腔镜可调控性胃束带术治疗肥胖伴T2DM的相关机制

目的探讨腹腔镜可调控性胃束带（LAGB）治疗2型糖尿病（T2DM）的相关机制。方法肥胖伴T2DM患者20例、单纯性肥胖患者20例行LAGB手术。检测术前、术后第1、3、6、12个月空腹血清Leptin水平，空腹血清胰岛素（FINS）、C肽、糖化血红蛋白（HbAlc）水平，空腹血糖（FBG）水平及体质量并计算体质量指数（BMI）。结果40例受试者LAGB术后6个月和12个月BMI由术前平均（38±5）kg／m2分别降至（30±4）kg／m2和（28±7）kg／m2（P〈0．05）。术前糖尿病组FBG、FINS、胰岛素抵抗指数HOMA—IR=FINS（mU／L）×FBG（mmol／L）／22．5]、HbAlc和C肽水平明显高于对照组（P〈0．01），术后6个月、12个月FBG由术前（8．5±3．0）mmol／L分别降至（6．5±1．0）mmol／L和（5．9±0．5）mmol／L，FINS和HbAlc术后3个月后降至正常范围。两组患者术后12个月内血清Leptin指标逐渐下降，糖尿病组血清Leptin与FBG、FINS、HbAlc、C肽及HOMA—IR呈正相关。结论LAGB能有效治疗肥胖症及T2DM，通过降低血清Leptin水平，减轻瘦素抵抗，进而减轻胰岛素抵抗，达到降低血糖的目的。

Laparoscopic adjustable gastric banding in treatment of obesity accompanying type 2 diabetes

Objective To study the related mechanism of laparoscopic adjustable gastric banding（LAGB） in treatment of type 2 diabetes mellitus（T2DM）. Methods Twenty patients with obesity accompanying T2DM and 20 patients with simple obesity underwent LAGB, respectively. Levels of fasting serum leptin, fasting serum insulin, C-peptide, glycated hemoglobin（HbAlc）, FBG, as well as body weight and calculating body mass index（BMI） were measured before and 1, 3, 6, 12 months after LAGB. Results The BMI was decreased from 38 ±5kg/m2 before operation to 30 ± 4kg/m2 and 28 ± 7kg/m2 respectively, 6 and 12 month after operation in the 40 patients（P〈0.05）. The serum levels of FBG, fasting serum insulin, insulin resistance index HOMA-IR= FINS（mU/L） x FBG（mmol/L）/22.5], HbAlc, and C-peptide preoperative levels were significantly higher in patients with T2DM than control group before operation（P〈0.01）. The FBG levels（8.5 ±3.0mmol/L） were significantly lower 6 and 12 month（6.5 ± 1.0mmol/L and 5.9 ± 0.5mmol/L） after operation than before operation. The levels of fasting serum insulin and HbAlc returned to normal range 3 month after operation（P〈0.01）. The serum level of leptin in two groups was gradually declined 12 month after operation. No significant correlation was found between the serum levels of leptin, FBG, fasting serum insulin, HbAlc, C-peptide, HOMA-IR. Conclusion LAGB can effectively treat obesity accompanying T2DM by reducing serum leptin levels, insulin resistance, and blood sugar level.