胃转流手术治疗2型糖尿病的可行性

目的对病态肥胖症手术对2型糖尿病的影响及其作用机制做一综述, 同时探讨病态肥胖症手术是否也可用于治疗不伴有肥胖症的2型糖尿病病人. 背景资料全世界有超过1.5亿人罹患2型糖尿病,虽然对高血糖的严格控制使得2型糖尿病并发症的发生率大大减少,但目前的治疗方法还不能达到根治.某些用于治疗病态肥胖症的手术不仅导致显著而持久的体重下降,而且使2型糖尿病得以缓解. 方法复习文献,回顾分析肥胖症手术对继发的糖代谢和内分泌变化的影响. 结果胃转流和胆胰转流术后数天内,80%～100%严重肥胖的糖尿病病人血糖、血胰岛素和糖化血红蛋白达正常水平,胃肠道激素分泌形式发生显著变化.病例报道也证实因其它因素施行胆胰转流的非病态肥胖患者避免罹患2型糖尿病.结论胃转流和胆胰转流术似乎对控制2型糖尿病有原发的、独立的影响,而不是继发于对肥胖症的治疗.虽然还需要对不伴肥胖患者进行对照研究,但胃转流手术的确有可能改变当前对2型糖尿病病理生理的理解,甚至改变该病的治疗方法.     

胃旁路术治疗2型糖尿病的研究进展

随着国内外相关减重手术治疗2型糖尿病（T2DM）病例报道的增多,并显现出了良好的短期及长期的临床效果,该方法更加引人关注。然而手术治疗2型糖尿病的机制如何尚无明确结论,认为可能的治疗机制是十二指肠和近端空肠被旷置,从而引发胃肠道激素分泌的变化,使T2DM得到控制。本文分别对手术的类别、治疗效果及治疗机制进行综述。     

胃肠外科手术治疗肥胖症及2型糖尿病

肥胖症是现今社会所面临的最严重的公共健康问题之一,手术治疗是使肥胖症患者获得长期而稳定的减重效果的唯一方法。自从1954年报道第1例减肥手术以来,外科手术治疗肥胖症在全球范围内获得了很大的发展,逐渐成为治疗病态性肥胖的＂金标准＂。随着研究的不断深入,越来越多的证据表明,胃肠外科手术不仅能减重,同时可以改善甚至治愈肥胖症相关的多种代谢性疾病,尤其是2型糖尿病。目前国内外的胃肠外科医师们正致力于将手术推广到2型糖尿病的治疗中去。外科手术治疗肥胖症及2型糖尿病将有巨大的发展空间。     

减重手术治疗2型糖尿病机制研究进展

2型糖尿病患者接受减重手术后糖尿病症状显著缓解并能长期维持,主要是因为术后胃肠道激素的改变,此外体质量下降、饮食减少以及其他的因素也起着一定作用。随着其治疗机制研究的不断深入,减重手术有望成为治疗2型糖尿病的一种主要手段。     

糖尿病APP用于门诊2型糖尿病患者健康管理效果探讨

目的探讨糖尿病APP管理模式对2型糖尿病患者血糖控制以及自我管理的效果。方法将189例门诊初始使用胰岛素治疗的2型糖尿病患者随机分为对照组94例与观察组95例,在教会患者胰岛素注射方法的基础上,对照组给予常规健康教育指导,观察组应用糖尿病APP管理,连续3个月后评价效果。结果观察组空腹血糖、餐后2h血糖及糖化血红蛋白改善程度显著优于对照组(均P0.01),自我管理行为能力得分显著高于对照组(P0.05,P0.01)。结论对门诊2型糖尿病患者采用糖尿病APP进行健康管理可提高患者自我管理能力,从而较好地控制血糖水平。     

手术与多学科综合治疗肥胖症及2型糖尿病

单纯性肥胖症及2型糖尿病的治疗应是多学科的综合治疗,包括饮食结构调整、增加身体活动量、行为纠正和药物治疗。一些病态肥胖患者还需要进行微创减肥手术治疗。尽管近年来微创减肥手术对于治疗单纯性肥胖症及2型糖尿病的疗效明显,但存在的问题是：缺乏相关科室的协作与多学科综合治疗以及患者随访率低,这是手术风险增加、疗效差和并发症增多的主要原因。因此,单纯性肥胖症和2型糖尿病及其合并症应该予以微创胃肠外科与相关多学科的综合治疗并进行长期随诊。     

Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus

BACKGROUND: It is estimated that up to 80% of persons with diabetes mellitus type 2 are overweight and in these patients it is recognized that effective weight control can lead to improvement or even resolution of their diabetes (Colagiuri et al.). All currently carried out operations for morbid obesity have been shown to improve diabetes, but there appears to be a variable response to surgery depending on several surgical and patient factors. METHODS: In this prospective review, we analysed the change in the diabetic status in 72 patients undergoing three different bariatric procedures in a single institution over 30 months. A review of the published work comparing the efficacy of the various procedures in achieving improvement or resolution of diabetes was also carried out and correlated to our findings. RESULTS: At an average follow up of 13 months, 50% of patients who had placement of laparoscopic adjustable gastric band had an improvement or resolution of their diabetes, compared with 95% of patients who had had laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass. Two of 12 (17%) laparoscopic adjustable gastric band patients had normal blood glucose levels off all diabetic medications compared with 7 of 21 (33%) laparoscopic sleeve gastrectomy and 27 of 39 (69%) Roux-en-Y gastric bypass patients. There was no significant association between the amount of weight lost and the return to euglycaemia. CONCLUSION: Direct comparison has shown a significant difference in the effects of different forms of bariatric surgery on type 2 diabetes, this is in keeping with evidence that surgery can lead to improvement in diabetes additional to that obtained by weight loss alone.     

腹腔镜下胃旁路术治疗2型糖尿病

目的：探讨腹腔镜下胃旁路手术治疗2型糖尿病的有效性及可行性。方法参照2011年中国《手术治疗糖尿病专家共识》,选择2型糖尿病患者实施胃旁路手术,并回顾性分析其中随访满12个月的52例患者的糖代谢指标、胰岛细胞功能指标。结果本组2型糖尿病患者术后治疗有效45例（86.5%）,完全缓解38例（73.1%）,部分缓解7例（13.5%）,无效7例（13.5%）。术后空腹血糖、餐后2 h 血糖、糖化血红蛋白较术前明显下降（P〈0.05）;胰岛素与术前比较有统计学差异,但是 C 肽无统计学意义。虽然术后有一定的手术相关并发症,但总体可控。结论腹腔镜下胃旁路手术是2型糖尿病患者一种有效可行的治疗方法,但需严格把握手术指征;术后胰岛素敏感性的提高发挥重要的治疗作用。     

胃旁路术对非肥胖型2型糖尿病疗效的前瞻性对照研究

目的 探讨胃旁路术对非肥胖型2型糖尿病(T2DM)的疗效.方法 前瞻性研究2008年11月至2009年8月第二军医大学附属长海医院收治的加例胃部疾病合并非肥胖型T2DM患者的临床资料,按实用性随机对照原则将患者分为4组,每组10例,分别接受毕Ⅰ式远端胃切除+胃十二指肠吻合术(BⅠ组)、近端胃大部切除+食管残胃吻合术(PG组)、全胃切除+Y型吻合术(RY组)、毕Ⅱ式胃空肠吻合术(BⅡ组),后2种术式为胃旁路术.比较4组患者住院时间、胃部疾病治疗情况、手术前后体质指数、腰围、空腹血糖、糖化血红蛋白、空腹血清胰岛素和空腹C肽水平等指标.数据采用方差分析、LSD-t检验、配对t检验、x2检验进行分析.结果 4种术式对胃部疾病的疗效基本相同.RY组患者术前、术后6个月空腹血糖分别为(8.0 ±2.9)、(5.9±0.7)mmol/L,两者比较,差异有统计学意义(t=2.342,P<0.05).RY组患者术前糖化血红蛋白、空腹C肽分别为7.7%±1.1%、(1.30±0.54)μg/L,术后2、6个月分别为6.9%±0.6%、(1.95±0.86)μg/L和6.1%±0.4%、(2.18±0.63)μg/L,与术前比较,差异有统计学意义(t=4.920、6.063,3.012、4.651,P<0.05).RY组患者术前空腹血清胰岛素为(11±4)mU/L,术后1、2、6个月分别为(18±5)、(19±3)、(21±3)mU/L,与术前比较,差异有统计学意义(t=3.158,4.502,7.517,P<0.05).BⅡ组患者术前空腹血糖、糖化血红蛋白、空腹血清胰岛素和空腹血清C肽分别为(8.3±1.3)mmol/L、7.7%±0.9%、(13±4)mU/L、(1.34±0.48)μg/L,术后1、2、6个月分别为(6.7 ±1.2)mmol/L、6.8%±0.8%、(18±4)mU/L、(1.68±0.46)μg/L和(6.4±1.3)mmol/L、6.3%±0.6%、(18±4)mU/L、(1.96 ±0.67)μg/L及(5.6±0.7)mmol/L、6.0%±0.3%、(19±4)mU/L、(2.27±0.59)μg/L,与术前比较,差异有统计学意义(t=2.468、2.598、6.028,3.055、4.586、4.572,3.618、5.860、8.577,2.300、3.511、3.943,P<0.05).术后2、6个月4组患者空腹血糖、糖化血红蛋白、空腹C肽比较,差异有统计学意义(F=4.699、14.378,7.411、29.192,3.335、9.334,P<0.05).术后各时相点4组患者空腹血清胰岛素比较,差异有统计学意义(F=2.896,7.012,11.998,P<0.05).结论 胃旁路术对非肥胖型T2DM具有较好疗效.

Abstract：

Objective To investigate the efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus. Methods From November 2008 to August 2009, 40 patients with gastric diseases and nonobese type 2 diabetes mellitus were admitted to the Changhai Hospital, and their clinical data were prospectively studied. All patients were randomly divided into 4 groups; 10 patients received Billroth I distal gastrectomy +gastroduodenal anastomosis (BⅠ group) , 10 received proximal gastrectomy + remanant gastric esophageal anastomosis ( PG group), 10 received total gastrectomy + esophagoduodenal Y-anastomosis ( RY group) and 10received subtotal gastrectomy Billroth Ⅱ gastro-jejunostomy (BⅡ group). The length of hospital stay, pre- and postoperative body mass indexes (BMIs) , waist circumferences, levels of fasting blood glucose (FBG) , glycated hemoglobin ( GHbA1) , fasting serum insulin (FSI) and fasting C-peptide (FCP) of patients in the 4 groups were compared. All data were analyzed using analysis of variance, LSD-t test, paired t test or chi-square test. Results The clinical effects of the 4 different operative procedures on the gastric diseases were similar. The levels of FBG were (8.0 ±2.9)mmol/L before operation and (5.9 ±0.7)mmol/L after operation in the RY group, with a significant difference (t = 2. 342, P < 0. 05). The preoperative level of GHbA1 in the RY group was 7.7% ± 1.1%, which was significantly higher than 6. 9% ± 0. 6% at 2 months after the operation and 6. 1 % ± 0. 4% at 6 months after the operation (t = 4. 920, 3.012, P < 0.05). The preoperative level of FCP in the RY group was (1.30 ±0.54) μg/L, which was significantly lower than (1.95 ± 0.86) μg/L at 2 months after the operation and (2.18 ± 0.63)μg/L at 6 months after the operation (t =6. 063, 4. 651, P < 0.05). The levels of FSI in the RY group at postoperative month 1, 2 and 6 were (18 ±5) , (19 ±3) , (21 ±3) mU/L, which were significantly higher than the level of FSI [(11 ±4) mU/L]before operation (t =3. 158, 4. 502, 7. 517, P <0. 05). Preoperative levels of FBG, GHbA1, FSI and FCP in the B Ⅱ group were (8. 3 ± 1. 3) mmol/L, 7. 7% ±0. 9% , (13±4)mU/L and (1.34±0.48) μg/L, which were ignificantly different from (6.7 ± 1.2)mmol/L, 6.8%± 0.8%, (18±4)mU/L and ( 1.68 ±0.46) μg/L at postoperative month 1, (6.4 ± 1.3)mmol/L, 6.3% ±0.6% ,(18±4)mU/L and (1. 96 ± 0. 67) μg/L at postoperative month 2, and (5. 6 ±0. 7) mmol/L, 6.0%±0.3%, (19 ± 4) mU/L and (2.27 ± 0. 59) |μg/L at postoperative month 6 (t = 2. 468, 2. 598, 6. 028; 3. 055, 4. 586,4.572; 3.618, 5.860, 8.577; 2.300, 3.511, 3.943, P<0.05). The levels of FBG,GHbA1 and FCP in the 4 groups at 2 months after surgery were significantly different from those at 6 months after surgery (F = 4. 699,14. 378; 7.411, 29. 192; 3. 335, 9. 334, P < 0.05). The levels of FSI in the 4 groups at different time points were significantly different (F =2. 896, 7. 012, 11. 998, P < 0.05). Conclusion The efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus is satisfactory.     

腹腔镜胃肠手术治疗2型糖尿病的血清蛋白质组学初步研究

目的 探讨腹腔镜胃肠手术前后2型糖尿病患者血清蛋白质表达的差异.方法 收集2008年6月至2010年9月第二军医大学附属长海医院行腹腔镜胃肠手术治疗的12例2型糖尿病患者的血清标本,双向凝胶电泳分离2型糖尿病患者术前、术后1周及术后1个月的血清总蛋白,对手术前后差异表达明显的蛋白点行质谱鉴定及生物信息学分析.结果 建立了稳定、重复性好的血清凝胶蛋白图谱.筛选出2型糖尿病患者胃肠手术前后血清中差异表达明显的20个蛋白点,并成功鉴定出8个蛋白点,其中术后表达增高的有5个,分别是Rho GDP-dissociation inhibitor 1、Prohibitin、Alpha-1-antitrypsin precursor、Serotransferrin precursor和Fibrinogen gamma chain precursor;术后表达降低的有3个,分别是MAP3K12-binding inhibitory protein 1、Coronin-1A和Isovaleryl-CoA dehydrogenase.结论 2型糖尿病患者行腹腔镜胃肠手术后的血清蛋白质与术前比较,存在着明显的差异.共成功鉴定出8个蛋白点.

Abstract：

Objective To investigate the impact of laparoscopic gastrointestinal surgery on serum protein expression in patients with type 2 diabetes mellitus(T2DM).Methods Twelve patients with T2DM received gastrointestinal surgery at Changhai Hospital of the Second Medical University from June 2008 to September 2010.Their serum samples were collected at different time points(before surgery,1 week and 1 month after surgery).Total proteins were seperated by two-dimensional(2D)gel electrophoresis.The differentially expressed proteins were analyzed by mass spectrometry and bioinformatics.Results Protein extracts of the serum samples were separated on 2D gels successfully.Twenty differentially expressed proteins in the serum after surgery were screened out.Eight proteins were successfully identified,in which the expression of 5 proteins(Rho GDP-dissociation inhibitor 1,Prohibitin,Alpha-1-anfitrypsin precursor,Serotransferrin precursor and Fibrinogen gamma chain precursor)was increased after operation,and the expression of 3 proteins(MAP3K12-binding inhibitory protein 1,Coronin-1A and Isovalery1-COA dehydrogenase) was decreased.Conclusions The expression of 20 proteins have been changed significantly in serum samples after laparoscopic gastrointestinal surgery in patients with T2DM,and 8 proteins were successfully identified.     

胃转流术治疗非肥胖型2型糖尿病的近期疗效

目的 探讨胃转流术治疗非肥胖型2型糖尿病的近期疗效及可能的机制.方法 回顾性分析2009年3月至8月成都军区总医院收治的58例行胃转流术治疗非肥胖型2型糖尿病患者的临床资料.检测患者术后1年内空腹血糖、餐后2 h血糖、糖化血红蛋白,并计算胰岛素抵抗指数及体质指数等指标.不同时相点各指标比较采用不等距重复测量的方差分析,两两比较采用LSD法.结果 48例(83%)患者停用全部降糖药物达到完全缓解标准,7例(12%)患者降糖药物用量较手术前至少减少50%,3例(5%)患者无效.与术前比较,患者术后空腹血糖、餐后2 h血糖、糖化血红蛋白及胰岛素抵抗指数呈显著下降趋势(F=67.867,50.885,78.278,572.757,P<0.05),而体质指数变化不大(F=3.503,P>0.05).结论 对于体质指数<25 ks/m2的2型糖尿病患者,胃转流术具有较好的疗效.术后患者胰岛素抵抗显著改善可能是胃转流术发挥疗效的重要原因.

Abstract：

Objective To investigate the short term effect of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus and possible mechanisms. Methods The clinical data of 58 patients with nonobese type 2 diabetes mellitus who received gastric bypass surgery from March to August, 2009 were retrospectively analyzed. The levels of fasting plasms glucose (FPG), 2-hour postprandial plasma glucose (2h PG) and glycosylated hemoglobin (HbA1c) were dynamically monitored, and the insulin resistance index (HOMA-IR) and body mass index ( BMI) were calculated. All data were analyzed using variance of analysis and LSD test. Results Of the 58 patients, 48 (83% ) met the requirement of complete response criteria and stopped administration of hypoglycemic agents; 7( 12% ) had to use hypoglycemic agents, but the dose of the agents was lowered by 50% compared to that before surgery. The surgery was ineffective in 3 patients (5% ). The levels of FPG, 2h PG, HbAlc and HOMA-IR of the 58 patients showed a significant decreasing trend after surgery when compared to those before surgery (F = 67. 867, 50. 885, 78. 278, 572. 757, P <0.05), while there was no significant change of the BMI after surgery ( F = 3. 503, P > 0. 05 ). Conclusions Gastric bypass surgery has a good effect on nonobese patients with type 2 diabetes mellitus whose BMI was less than 25 kg/m2. The improvement of insulin resistance after the surgery might be the main reason.     

Bariatric surgery as a treatment option in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a leading cause of blindness, non-traumatic amputation and end-stage renal disease as well as a major cardiovascular risk factor. Tight glycemic control reduces the incidence of microvascular complications of T2DM whereas its effects on macrovascular complication are more controversial. However, glycemic targets are achieved by a minority of diabetic patients despite the availability of several antidiabetic agents. In the present commentary, we discuss the findings of two recent randomized studies that compared bariatric surgery with medical treatment in patients with uncontrolled T2DM. Both studies showed that bariatric surgery results in remission of T2DM in the majority of patients. However, both studies were limited to relatively young patients without comorbidities, had relatively short follow-up and did not assess the effects of surgery on T2DM complications. Moreover, the perioperative complications of bariatric surgery and its limited availability in some areas are additional barriers to the wider implementation of this therapeutic approach. On the other hand, the elucidation of the mechanisms underpinning the resolution of T2DM following bariatric surgery might resultin the development of novel, more effective pharmacotherapies for this common disease.     

代谢手术治疗肥胖症和2型糖尿病的相关问题

代谢手术治疗肥胖症和2型糖尿病在国际上越来越受到重视。在我国经过10余年的发展，目前已经广泛开展。随着这一新的外科领域的发展，许多相关问题不断产生。临床医师既要吸取国外的相关经验，又要根据我国患者和学科发展的实际情况逐步形成自己的实践经验。因此，笔者对代谢手术治疗肥胖症和2型糖尿病的相关问题进行探讨，以期促进代谢手术在我国的健康发展。     

Bone fragility in type 2 diabetes mellitus

The number of patients with osteoporosis or type 2 diabetes mellitus (T2DM) is increasing in aging and westernized societies. Both disorders predispose elderly people to disabling conditions by causing fractures and vascular complications, respectively. Recent animal studies have shown that administration of osteocalcin, which is specifically secreted from osteoblasts, can increase insulin secretion and ameliorate hyperglycemia, obesity, and high triglyceride levels in mice fed a high-fat diet. Moreover, several studies have shown that antagonism of Wnt signaling by oxidative stress contributes to the development of osteoporosis, as well as insulin resistance and hyperlipidemia. Thus, bone metabolism and glucose/fat metabolism seem to be etiologically related to each other. Meta-analyses of multiple clinical studies in humans have shown that hip fracture risk of T2DM patients is increased by 1.4-1.7-fold, although bone mineral density (BMD) is not diminished. Vertebral fracture risk of T2DM patients is also increased, and BMD is not sensitive enough to assess the risk. These findings suggest that bone fragility in T2DM, which is not reflected by BMD, depends on bone quality deterioration rather than bone mass reduction. Thus, surrogate markers are needed to replace the insensitivity of BMD in assessing fracture risks of T2DM patients. Pentosidine, the endogenous secretory receptor for advanced glycation endproducts, and insulin-like growth factor-I seem to be such candidates, although further studies are required to clarify whether or not these markers could predict the occurrence of new fractures of T2DM patients in a prospective fashion.     

Periodontal disease in type 2 diabetes mellitus

Objective: To determine the periodontal status in well controlled and poorly controlled type 2 diabetic patients compared with normal healthy individuals. Study Design: Cross-sectional comparative study. Place and Duration of Study: Diabetes Management Centre, Services Hospital, Lahore, from November 2009 to January 2010. Methodology: Forty well controlled and forty poorly controlled type 2 diabetic subjects having good oral hygiene (scored according to simplified oral hygiene index) were compared with a control group of forty normal healthy individuals. Probing depth (PD), gingival recession (GR), and attachment loss (AL) were recorded to obtain the periodontal status of each tooth, using a Michigan probe "0" with Williams marking. Glycemic control was evaluated by glycated Hb value. Using ANOVA and independent sample t-test, mean probing depth and attachment loss in each tooth type (incisors, canines, premolars and molars) were compared. Results: Mean age of diabetic subjects was 58.86 ± 6.21 years and that of control group was 56.92 ± 6.91 years; 60% were females. Probing depth was greater in patients with poorly controlled diabetes compared to well controlled diabetic patients and non-diabetic controls (4.21 mm vs. 3.72 mm and 2.93 mm respectively, p < 0.001). Attachment loss also increased in poorly controlled diabetes (p < 0.001) compared to the control group and well controlled diabetes, however, the difference was not statistically significant when comparing well controlled to the control group (p > 0.05). Number of sites and mean percentage of sites with attachment loss of 3 4 and 3 6 mm was also significantly higher in poorly controlled diabetes compared to the control group (p < 0.05 and p < 0.001 respectively). Conclusion: Periodontal status as estimated by probing depth and degree of attachment loss deteriorates significantly with poor glycemic control in diabetes.     

减重代谢手术治疗重度肥胖合并2型糖尿病术后1年疗效分析

目的:比较分析腹腔镜胃袖状切除术与腹腔镜胃转流术治疗重度肥胖合并2型糖尿病患者的短期效果。方法:回顾分析48例合并2型糖尿病重度肥胖症患者的临床资料。按手术方式分为胃袖状切除组(n=30)与胃转流组(n=18),术后随访1年,分析比较两组患者体重改善情况及相关糖脂代谢指标的变化。结果:48例均顺利完成手术。术后两组患者体质指数均明显低于术前(P<0.01),两组间差异无统计学意义(P>0.05)。术后6个月、12个月,两组患者空腹血糖、糖化血红蛋白、空腹C肽、胰岛素抵抗指数、胆固醇、甘油三酯均较术前明显改善(P<0.01)。胃袖状切除组与胃转流组糖尿病完全缓解率分别为73%与78%,两组有效率均为100%,两组缓解率相比差异无统计学意义(P>0.05)。结论:腹腔镜胃转流手术与腹腔镜胃袖状切除术均可有效治疗重度肥胖合并糖尿病,近期效果显著,且两种治疗方法临床效果相近。     

Management of type 2 diabetes mellitus in youth

The rising rates of obesity in youth have concurrently led to an increase in the rates of type 2 diabetes mellitus(T2DM) in this age group.However,there are limited data on the efficacy of different antidiabetic agents in youth.In this context,the Treatment Options for Type 2 Diabetes in Adolescents and Youth trial recently reported that the majority of obese children and adolescents 10-17-years old with newly diagnosed T2DM(T2DM duration less than 2 years) could not achieve HbA1c levels < 8% for more than 1 year with metformin monotherapy,metformin plus rosiglitazone combination,or metformin and lifestyle changes.These findings suggest that,in the majority of youth with T2DM,tight long-term glycemic control with oral agents is an elusive goal and that most patients will require treatment with insulin within a few years of diagnosis to achieve HbA1c targets and reduce the risk of macroand microvascular complications.Therefore,reducing the incidence of T2DM by preventing pediatric obesity through the implementation of lifestyle changes in the community should be the primary objective of healthcare systems.     

影响胃转流术治疗2型糖尿病效果的因素研究

目的:总结胃转流术治疗2型糖尿病疗效的影响因素,并探讨其手术适应证。方法:回顾分析为32例2型糖尿病患者行胃转流术的临床资料,对比手术前、后相关指标的变化情况。结果:胃转流术后12个月9例完全缓解,23例未缓解,术后无严重并发症发生。完全缓解组患者年龄、病史、术前空腹血糖、餐后2小时血糖、糖化血红蛋白(hemoglobin A1c,HbA1c)均小于未缓解组,差异有统计学意义(P<0.05);两组患者性别组成、BMI差异无统计学意义(P>0.05)。开腹组与腹腔镜组患者年龄、病史、术前空腹血糖、餐后2 h血糖、HbA1c、术后12个月降糖效果差异均无统计学意义(P>0.05)。结论:2型糖尿病患者术前年龄、病史、血糖控制情况及术中剩余胃囊的大小明显影响胃转流术后降糖效果。