袖状胃切除术对肥胖合并2型糖尿病病人糖代谢和胃肠激素的影响

目的 探讨腹腔镜袖状胃切除术(LSG)对肥胖合并2型糖尿病病人糖代谢和胃肠激素的影响.方法 前瞻性收集2012年1月-2015年1月肥胖合并2型糖尿病病人80例,将病人按完全随机数字表原则随机分为LSG组和对照组,每组40例.主要观察指标为体质量指数(BMI)、血清糖化血红蛋白(HbA1C)、胰岛素、胰高血糖素样多肽-1(GLP-1)、肠抑胃肽(GIP)和胃泌素.结果 两组病人入院时BMI、HbA1C、胰岛素水平、GLP-1和胃泌素水平差异无统计学意义(P>0.05).但与对照组相比,治疗12个月后LSG组病人BMI显著降低(25.48±2.49) kg·m-2 vs (29.49±2.48) kg·m-2,P<0.001)];HbA1C水平显著降低(7.26±0.73)% vs (7.99±0.89)%,P<0.001)];胰岛素水平显著降低(1.32±0.31) μg·L-1 vs (3.13±0.98) μg·L-1,P<0.001)];GLP-1水平显著升高(39.85±13.56) μg·L-1 vs (12.58±5.32) μg·L-1,P<0.001];胃泌素水平显著降低(17.46±7.46) μg·L-1 vs (34.73±11.49) μg·L-1,P<0.001].两组病人术前术后GIP水平均差异无统计学意义(P>0.05).结论 LSG对肥胖合并2型糖尿病病人糖代谢水平和胃肠激素影响显著.

Effect of laparoscopic sleeve gastrectomy on glucose metabolism and gastrointestinal hormones in obese patients with type 2 diabetes mellitus

Objective To investigate the effects of laparoscopic sleeve gastrectomy (LSG) on glucose metabolism and gastrointestinal hormones in obesity patients with type 2 diabetes.Methods From Jan 2012 to Jan 2015,80 obesity patients with type 2 diabetes admitted to our hospital were prospectively enrolled in this study.All patients were randomly signed into the LSG group and control group.The primary outcomes were body mass index (BMI),glycosylated hemoglobin (HbA1c),insulin,glucagon like peptide-1 (GLP-1),gastric inhibitory polypeptide (GIP) and gastrin.Results There was no significantly difference between the two groups in BMI,HbA1C,insulin levels,GLP-1 and gastrin levels at admission (P>0.05).When compared with the control group,patients in the LSG group got a significantly lower level of BMI(25.48±2.49) kg·m-2 vs (29.49±2.48) kg·m-2,t=5.459,P<0.001];a significantly lower level of HbA1C(7.26±0.73)% vs (7.99±0.89)%,t=5.768,P<0.001];a significantly lower level of insulin (1.32±0.31) μg·L-1vs (3.13±0.98) μg·L-1,t=9.485,P<0.001];a significantly higher level of GLP-1 level (39.85±13.56) μg·L-1vs (12.58±5.32) μg·L-1,t=18.214,P<0.001];and a significantly lower level of gastrin (17.46±7.46) μg·L-1 vs (34.73±11.49) μg·L-1,t=20.845,P<0.001].There was no significantly difference in GIP level between the two groups before and after operation (P>0.05).Conclusion LSG has a significantly effect on the level of glucose metabolism and gastrointestinal hormones in obesity patients with type 2 diabetes mellitus.