胃转流术治疗2型糖尿病的机制

胃转流术是目前2型糖尿病外科治疗的主流术式之一,但其治疗2型糖尿病的相关机制并不完全清楚.现有的相关研究表明,胃转流术对2型糖尿病的治疗作用可能通过如下机制：摄入受限和吸收不良、胰岛素抵抗的改善和胰岛β细胞功能的恢复、胃肠道激素水平的变化等.此外,脂肪因子以及血清胆汁酸水平的变化也可能发挥了一定作用.下一步的研究需要进一步明确胃转流术对于机体神经内分泌系统的影响机制,并探讨胃转流术消化道重建方式对于相关激素的影响情况.     

Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes: short-term outcomes of a single-center randomized controlled trial

BackgroundDuodenojejunal bypass with sleeve gastrectomy (DJB-SG) is a novel bariatric surgery composed of sleeve gastrectomy (SG) and duodenojejunal anastomosis. Both loop and Roux-en-Y DJB-SGs were reported to have acceptable hypoglycemic and weight loss outcomes, but it remains unclear which reconstruction method is better regarding therapeutic efficacy and safety for type 2 diabetes (T2D).ObjectiveThis study was undertaken to prospectively compare the short-term therapeutic outcomes and surgical safety of loop versus Roux-en-Y DJB-SG.SettingUniversity hospital.MethodsA total of 96 patients with T2D with body mass index of 27.5–40 kg/m² were randomized in a 1:1 ratio to undergo loop or Roux-en-Y DJB-SG from January 2020 to December 2020. The primary end point was to determine the 1-year T2D remission rate. Additionally, medical cost, operative outcomes, weight loss, metabolic improvement, nutritional status, and gastrointestinal disorders at 1-year follow-up also were determined.ResultsThe preoperative data were comparable at baseline. The 1-year follow-up rate was 89.6% (43 of 48 patients) for loop DJB-SG and 93.8% (45 of 48 patients) for Roux-en-Y DJB-SG. The T2D remission rates were 93.02% (40 of 43) for loop DJB-SG and 88.89% (40 of 45) for Roux-en-Y DJB-SG at 1-year follow-up. Loop DJB-SG patients exhibited higher total weight loss (30.85% ± 7.24% versus 26.11% ± 7.12%), shorter operative times, and less medical cost than Roux-en-Y DJB-SG patients. However, there was no statistical difference regarding lipid profiles, major postoperative complications, nutritional status, and gastrointestinal disorders between the 2 groups.ConclusionDespite similar hypoglycemic effects, loop DJB-SG was simpler and exhibited better weight loss and less medical cost than Roux-en-Y DJB-SG. Thus, loop DJB-SG was better than Roux-en-Y DJB-SG for T2D.     

腹腔镜下Roux-en-Y胃空肠转流术治疗肥胖型2型糖尿病14例

目的探讨腹腔镜下Roux-en-Y胃空肠转流术(LRYGB)对肥胖型2型糖尿病的临床疗效。方法以14例肥胖型2型糖尿病患者作为研究对象,实施LRYGB,观察患者术前及术后体重指数(BMI)、空腹血糖(FBG)、餐后2小时血糖(2hPBG)、C肽(C-P)及糖化血红蛋白(HbA1C)的变化情况,分析手术预后的相关因素。结果 14例患者手术顺利,均无术中并发症的发生及中转开腹。术后随访3个月。1例出现腹泻,经饮食调整及口服药物改善,术后3月BMI、FBG、2hPBG、HbA1C均较术前明显降低(P<0.05);C-P在术后1个月开始下降,术后3月明显,但术后3个月与术前比较无明显差异(P=0.08)。结论腹腔镜Roux-en-Y胃空肠转流术治疗肥胖型2型糖尿病近期疗效明显,远期疗效有待进一步观察研究。     

Roux-en-Y gastric bypass increases hepatic and peripheral insulin sensitivity in rats with type 2 diabetes mellitus

BackgroundRoux-en-Y gastric bypass (RYGB) surgery for the treatment of obesity leads to long-term diabetes remission in approximately 80% of cases. The aim of this study was to investigate the effects of RYGB on hepatic and peripheral insulin sensitivity in type 2 diabetic rats and their possible mechanisms. We also tested the hypothesis that RYGB reduces lipid content and improves insulin sensitivity in hepatocytes and skeletal muscle cells.MethodsSprague–Dawley rats were divided into 4 groups: diabetic RYGB group (n = 18), diabetic RYGB sham group (n = 6), diabetic group (n = 6), and nondiabetic control group (n = 6). The hyperinsulinemic-euglycemic clamp with tracer infusion was completed at 2, 4, and 8 weeks postoperatively to assess insulin sensitivity. The lipid content in liver and muscle tissue was examined.ResultsPostoperatively, the diabetic RYGB group had significant decreases in weight, fat mass, and food intake. Two weeks after surgery, RYGB had significantly improved the hepatic insulin sensitivity index and decreased the hepatic triglyceride, total cholesterol, and fatty acyl-CoA content. The significantly increased insulin sensitivity and decreased lipid content in muscle were not detected until 4 weeks after RYGB surgery. The basal insulin and C-peptide concentrations were significantly lower than those in diabetic group by 2 weeks after RYGB.ConclusionThe increased insulin sensitivity after RYGB occurs earlier in the liver than in the muscle and both may contribute to long-term remission of type 2 diabetes. Reduced lipid content of hepatocytes and skeletal muscle cells after RYGB may contribute to the improved insulin sensitivity in these cells.     

Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes

BackgroundRoux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity, which improves cardiovascular health and reduces the risk of premature mortality. However, some reports have suggested that RYGB may predispose patients to adverse health outcomes, such as inflammatory bowel disease (IBD) and colorectal cancer.ObjectivesThe present prospective study aimed to evaluate the impact of RYGB surgery on cardiovascular risk factors and gastrointestinal inflammation in individuals with and without type 2 diabetes (T2D).SettingUniversity hospital setting in Finland.MethodsBlood and fecal samples were collected at baseline and 6 months after surgery from 30 individuals, of which 16 had T2D and 14 were nondiabetics. There were also single study visits for 6 healthy reference patients. Changes in cardiovascular risk factors, serum cholesterol, and triglycerides were investigated before and after surgery. Fecal samples were analyzed for calprotectin, anti-Saccharomyces cerevisiae immunoglobulin A antibodies (ASCA), active lipopolysaccharide (LPS) concentration, short-chain fatty acids (SCFAs), intestinal alkaline phosphatase activity, and methylglyoxal-hydro-imidazolone (MG-H1) protein adducts formation.ResultsAfter RYGB, weight decreased on average ?21.6% (?27.2 ± 7.8 kg), excess weight loss averaged 51%, and there were improvements in cardiovascular risk factors. Fecal calprotectin levels (P < .001), active LPS concentration (P < .002), ASCA (P < .02), and MG-H1 (P < .02) values increased significantly, whereas fecal SCFAs, especially acetate (P < .002) and butyrate (P < .03) levels, were significantly lowered.ConclusionThe intestinal homeostasis is altered after RYGB, with several fecal markers suggesting increased inflammation; however, clinical significance of the detected changes is currently uncertain. As chronic inflammation may predispose patients to adverse health effects, our findings may have relevance for the suggested association between RYGB and increased risks of incident IBD and colorectal cancer.     

Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: A meta-analysis,meta-regression,and systematic review

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally. However, it remains controversial which procedure provides better glycemic control. To identify predictors of glycemic control after SG versus RYGB, a systematic search of PubMed, EMBASE, and the Cochrane Library was conducted up to January 2017 for comparative studies with both SG and RYGB arms for the treatment of type 2 diabetes (T2D). A meta-analysis and systematic review was performed to evaluate glycemic control after SG versus RYGB with both short- and long-term follow-up. A meta-regression was performed to evaluate impacts of clinical indicators on glycemic control after SG versus RYGB. A total of 17 comparative studies involving 1160 patients were included. SG and RYGB achieved similar diabetic remission rates with both short- and long-term follow-up. However, SG provided lower endpoint glycosylated hemoglobin (A1C) after 1-year follow-up (mean deviation?=?.17, 95% confidence interval .03–.31, P?=?.02). When adjusted by baseline A1C, SG and RYGB provided similar percent delta A1C with 1-, 2-, 3-, and 5-year follow-up. The baseline body mass index, duration of T2D, preoperative fasting plasma glucose, and preoperative A1C had predictive value for glycemic control after SG, but only duration of T2D and preoperative A1C were correlated with that after RYGB. These findings showed that the choice of procedure between SG and RYGB predicts no better glycemic control. However, more factors should be considered when SG is recommended to a given patient with diabetes.     

Sleeve gastrectomy and Roux-en-Y gastric bypass in the treatment of type 2 diabetes. Two-year results from a Swedish multicenter randomized controlled trial

BackgroundObesity is a world-wide epidemic and it is a risk factor for type 2 diabetes (T2D). Few randomized controlled studies have compared the 2 most common surgical procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in the treatment of obese patients with T2D.ObjectivesTo compare diabetes remission rates (glycosylated hemoglobin ≤6.0%, without diabetes medications) in obese T2D patients (body mass index, 35–50) undergoing RYGB or SG.SettingThree University Hospital clinics and 1 Regional Hospital in Sweden.MethodsForty-nine patients with T2D were included. Twenty-five were randomized to RYGB and 24 to SG. There was no difference between groups regarding patient characteristics, duration of T2D, overall usage of antidiabetic medications, or glycosylated hemoglobin levels. All patients (100%) completed 1-year follow-up and 47 (95.9%) 2-year follow-up.ResultsRemission of T2D was not significantly different between the RYGB and SG, reaching 44% and 46% (n = 25 and n = 24, respectively, P = .897, power = .80) at 1 year, and 48% and 55% (n = 25 and n = 22, respectively, P = .654) at 2 years of follow-up. Similarly, mean glycosylated hemoglobin was improved in both groups at 1 and 2 years, with no significant differences between the groups (RYGB baseline versus 1 yr; mean ± standard deviation: 7.9 ± 1.5 versus 5.8 ± .6%, P < .0001; versus 2 yr: 5.9 ± .7%, P < .0001; SG baseline versus 1 yr: 8.2 ± 1.9 versus 5.9 ± .7%, P < .0001; versus 2 yr: 5.9 ± 1.1%, P < .0001). Total weight loss was not different but percentage excess weight loss was higher after RYGB compared with SG both at 1 and 2 years; mean ± standard deviation: 78 ± 22 versus 60 ± 22%, and 76 ± 24 versus 54 ± 21%, respectively (P < .01 for both). Waist circumference also decreased significantly more in the RYGB group.ConclusionsDespite superior excess weight loss after RYGB, T2D remission rates did not differ significantly between RYGB and SG after 2 years. Long-term follow-up data are needed to define the role of SG in the treatment of patients with obesity and T2D.     

腹腔镜Roux-en-Y胃旁路术的研究现状

肥胖及肥胖引起的心血管疾病、高血压、高血脂等并发症已成为当今社会很严重的公共卫生问题。1975~2016年,全球大部分地区的肥胖症患病率呈现上升趋势,其中以亚洲地区的上升趋势尤为显著。到2016年,我国已是全世界肥胖症及2型糖尿病患者最多的国家。外科减重手术是目前治疗肥胖症及相关并发症的主要手段,其中应用最为广泛的减重手术为腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)、腹腔镜袖状胃切除术。笔者对LRYGB的研究现状做一综述。     

胃转流术治疗2型糖尿病的临床疗效：附214例报告

目的 Roux-en-Y式胃转流术（RY-GBP）是2型糖尿病患者接受外科手术治疗的主要术式之一。本研究旨在进一步验证RY-GBP的手术治疗效果。方法 214例2型糖尿病（T2DM）患者均行RY-GBP术,术中根据体质指数和胰岛素抵抗情况,选择合适的残胃（Pouch）容积和空肠袢长度。患者于术前和术后3,6,12个月行OGTT试验,并测定空腹血清胰岛素（FIns）、空腹血清C肽（FC-P）、糖化血红蛋白（HbAlc）、体重指数（BMI）,密切关注患者术后的降糖药服用情况及糖尿病并发症改善情况。结果 214例患者中,51例（23.8%）术后出院时即达治愈标准,停用降糖药物,78例（36.4%）于术后0～3个月内停药,21例（9.8%）于术后3～6个月内停药,18例（8.4%）于术后6～12个月内停药。另外46例（21.5%）12个月后仍服用降糖药物,但药物剂量有不同程度地减少,尚在进一步观察中。上述病例在术后3,6,12个月的各项检测指标均有所改善,近期治愈率达78.5%（168/214）。本组无死亡病例,相关并发症包括吻合口出血2例,吻合口溃疡7例,胃瘫21例,营养不良3例,贫血8例,在给予相应治疗后均缓解。结论 RY-GBP胃转流术对肥胖型和非肥胖型2型糖尿病均有良好治疗效果,对非肥胖型2型糖尿病的治疗效果更值得进一步深入研究。     

Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for quality of life: a systematic review and meta-analysis

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the mainstays of bariatric surgery in recent years. In addition, there has been an increased interest in the quality of life (QoL) of obese patients after surgery. This study examined the QoL of patients who had undergone either LSG or LRYGB. We retrieved the literature from PubMed, Web of Science, Embase, and the Cochrane Library database before November 2019. A total of 10 articles and 2327 obese patients were included in our meta-analysis. The QoL scoring tools included in the statistical analysis are the following: the gastrointestinal quality of life index, 36-items short-form health survey, bariatric analysis and reporting outcome system, and the Moorehead-Ardelt quality of life questionnaire II. Although the QoL score of the LRYGB group was higher than that of the LSG group in the bariatric analysis and reporting outcome system subgroup, statistical analysis showed no difference in the postoperative QoL of LSG and LRYGB. In our study, no difference was found in the QoL between LSG and LRYGB. Therefore, in terms of postoperative QoL, surgical methods should be selected on the basis of the patients’ condition and level of understanding of the surgeries.     

2胆胰分流术与胃旁路术治疗2型糖尿病的机制比较

临床研究发现,减重手术可以改善甚至治愈糖尿病。采用不同术式其效果不一,其中胆胰分流术（BPD）对糖尿病治愈率最高,达98％以上：其次为Roux-en-Y胃旁路术（RGBP）,可达80％。但这两种手术对于治疗糖尿病的具体作用机制尚不明确．且争议较多。BPD与RGBP术后患者体内多种激素水平、尤其是肠道激素GLP．1和GIP的变化并不一致．很难用前肠及后肠假说完全解释。本综述根据国内外最新研究结果．比较了BPD及RGBP两种术式的解剖结构及术后GLP．1和GIP的变化,并对两种术式在治疗糖尿病上可能存在的不同机制进行了探讨。     

Decreased visceral fat area correlates with improved total testosterone levels after Roux-en-Y gastric bypass in obese Chinese males with type 2 diabetes: a 12-month follow-up

Background

Obesity and type 2 diabetes (T2D) are recognized as risk factors for hypogonadism in males. Serum sex hormone profiles have not been assessed adequately in obese Chinese males with T2D who have undergone Roux-en-Y gastric bypass (RYGB).

Unacylated ghrelin is correlated with the decline of bone mineral density after Roux-en-Y gastric bypass in obese Chinese with type 2 diabetes

BackgroundBariatric surgery is an effective and therapeutic way for different metabolic diseases. It has become a focus of attention about the effects and molecular mechanisms to bone metabolism.ObjectiveWe aim to assess the changes of bone mineral density (BMD) among Chinese obese individuals with type 2 diabetes who have undergone Roux-en-Y gastric bypass surgery (RYGB). Two ghrelin gene products, namely unacylated ghrelin (UAG) and obestatin, were evaluated the roles in this pathologic process.SettingUniversity-affiliated hospital, China.MethodsThirty patients who had received RYGB were enrolled in the study. Changes in anthropometric parameters, metabolic indexes, and serum UAG and obestatin were assessed preoperatively, 6, 12, and 24 months postoperatively. BMD at lumbar spine (LS), femoral neck (FN), and total hip (TH) were identified.ResultsRYGB resulted in statistical reductions of BMD in 3 different skeletal parts. After the first 6 months, BMD began to reduce and maintained a declining trend until 24 months postoperatively. Comparing to baseline, the maximal reduction of BMD was as high as 10.28% in total hip. The plasma concentration of UAG increased after 6 months (51.61 ± 55.21 versus 71.95 ± 64.91 pg/mL; P < .01), as well as the serum obestatin level (1.65 ± 0.88 versus 1.71 ± 0.99 ng/mL; P > .05). Although there was a slight drop of both peptides in the first year, they were still above the baseline. Notably, in the second year, UAG and obestatin rose to their peak values, respectively (91.90 ± 77.11 pg/mL and 1.74 ± 1.09 ng/mL). There was a negative correlation between UAG and BMD in all sites. Multiple linear regression analysis showed that the UAG level was the independent parameter associated with BMD at baseline (FN: β = -.407, P = .012 and TH: β = -0.396, P = .030 respectively), as well as the changes of UAG that were independently related with reduction percentage of LS BMD after 24 months (β = - .379, P = .046).ConclusionThe reduction of BMD in obese Chinese with type 2 diabetes was observed after RYGB. The pronounced increase of serum UAG acts as an independent risk factor for the decrease of BMD.     

腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病及其并发症的临床疗效观察

目的探讨腹腔镜Roux-en-Y胃旁路术(Laparoscopic Roux—en-Y gastric bypass,LRYGB)对2型糖尿病(type 2 diabetes mellitus,T2DM)及其并发症的长期临床疗效。方法回顾性分析我院收治的48例T2DM患者的临床资料。术后随访4年,分析术前及术后体重指数(BMI)、腰臀比(WHR)、糖脂代谢指标的变化。同时观察T2DM相关并发症的改善情况。结果48例手术均在腹腔镜下顺利完成,无一例中转开腹,随访期间,无死亡病例及严重手术并发症发生。48例T2DM患者的BMI及WHR在术后3个月、6个月、1年、2年、3年、4年均较术前显著下降,差异有统计学意义(P0.05)。同时,糖代谢相关指标空腹血糖(FPG)、标准馒头餐后2h血糖(2h PG)、空腹C肽(FC-P)、糖化血红蛋白(HbA1c)于术后各时间点均较术前明显下降(P0.05)。与术前比较,脂代谢相关指标TC、TG、HDL、LDL于术后各时间点均较术前明显改善(P0.05)。48例接受LRYGB的T2DM患者有效率达100%。结论腹腔镜Roux-en-Y胃旁路术是治疗2型糖尿病的一种安全有效的手术方式,完善的术前评估、围手术期规范化的管理及长期随访是保证手术疗效的关键。     

Roux—en—Y胃旁路术对2型糖尿病大鼠肾功能的影响

目的探讨Roux—en—Y胃旁路术对2型糖尿病大鼠肾功能的影响。方法采用高脂高糖饮食联合腹腔注射小剂量链脲佐菌素（streptozocin,STZ,35肛∥g）方法建立2型糖尿病大鼠模型。将造模成功的糖尿病SD大鼠分为3组：糖尿病组（8只）,假手术组（8只）,手术组（14只）;另取正常SD大鼠作为正常组（8只）。术前、术后8周检测大鼠空腹血糖,术前及术后4、8周测定血清BUN、Cr;术后8周取肾组织进行病理组织学观察,计算肾脏质量指数;免疫组织化学染色方法检测肾组织纤连蛋白、Ⅳ型胶原和TGF—B1的表达,采用Real—timePCR和Westernblot检测MMP-2、MMP-9mRNA和蛋白的表达。多组比较采用单因素方差分析,两两比较采用LSD检验。结果术后8周,糖尿病组大鼠血糖、BUN、Cr、肾脏质量指数分别为（15．9±1．6）mmol／L、（9．24-0．6）mmol／L、（44±4）~mol／L、（10．7±1．5）mg／g,手术组大鼠分别为（5．9±0．7）mmol／L、（6．64-0．4）mmol／L、（304-2）~mol／L、（8．6±0．6）mg／g,两组比较,差异有统计学意义（P〈0．05）。与正常组比较,糖尿病组、假手术组大鼠肾小球体积增大,系膜增生;手术组有明显改善。正常组大鼠肾脏皮质纤连蛋白、Ⅳ型胶原、TGF—B1免疫组织化学染色积分光密度值、MMP-2、MMP-9mRNA和蛋白的表达水平分别为664±23、864-5、524-6、1．00-4-0．04、644-4、1．004-0．20、48±5,糖尿病组大鼠分别为16654-44、7894-66、4594-35、0．52±0．13、514-6、0．364-0．05、384-4,假手术组大鼠分别为1701±55、7544-49、4254-42、0．544-0．19、484-5、0．434-0．09、394-4,手术组大鼠分别为11054-61、1954-11、1474-16、1．53±0．29、634-5、1．114-0．14、49-4-5,4组比较,差异均有统计学意义（F=1340．30,4982．50,2025．10,654．19,13．58,610．74,7．86,P〈0．05）。两两比较,差异均有统计学意义（P〈0．05）。结论Roux—eFl—Y胃旁路术可改善糖尿病大鼠肾功能,减少细胞外基质沉积,其作用机制可能与抑制TGF-β1表达和上调MMP-2、MMP-9mRNA和蛋白水平有关。     

Banded versus nonbanded Roux-en-Y gastric bypass: a systematic review and meta-analysis of randomized controlled trials

BackgroundBariatric surgery is remarkably effective in achieving weight loss and improving obesity-related co-morbidities; however, efforts still continue to improve its long-term outcomes. Particularly, banded Roux-en-Y gastric bypass (RYGB) has been scrutinized in comparison to standard (nonbanded) RYGB in terms of benefits and postoperative complications.ObjectivesThis study aims to compare the safety and efficacy of banded versus nonbanded RYGB.SettingMeta-analysis of randomized controlled trials (RCTs).MethodsA meta-analysis of high-quality studies that compared banded and nonbanded RYGB was conducted through February 2019 by systematically searching multiple electronic databases. Published RCTs comparing these 2 procedures were included to pool the data on excess weight loss, food tolerability, and postoperative complications.ResultsThree RCTs were eligible to be included in this meta-analysis, comprising a total of 494 patients (247 in each group). Two of the RCTs provided 2-year postoperative data, and 1 study reported 5-year outcome. Age ranged from 21 to 50 years, and body mass index ranged from 42 to 65 kg/m². Percentage of excess weight loss was significantly greater with banded RYGB than with nonbanded RYGB (mean difference 5.63%; 95% CI 3.26–8.00; P < .05). Postoperative food intolerance, emesis, and dysphagia were more common after banded RYGB (odds ratio 3.76; 95% CI 2.27–6.24; P < .001). Nevertheless, major postoperative complications did not significantly differ between the 2 groups.ConclusionFindings of this meta-analysis of RCTs indicate that in a medium-term follow-up, excess weight loss with banded RYGB would be 5% greater than that with the nonbanded RYGB (about 1 point difference in body mass index) at the expense of more food intolerance and postoperative vomiting; however, the frequency of postoperative complications would not be significantly different.     

Roux-en-Y胃旁路术对非肥胖2型糖尿病患者生活质量的影响

目的观察Roux-en-Y胃旁路术（RYGB）对非肥胖2型糖尿病患者生活质量的影响。方法2008年6月至2010年10月间,前瞻性入组37例非肥胖2型糖尿病患者接受RYGB治疗,分别于术前和术后12个月,通过简明健康状况量表（SF36）、糖尿病治疗满意度问卷（DTSQ）、2型糖尿病生活质量量表（DMQLS）评价患者的生活质量。结果37例患者术后血糖和血脂均显著下降（均P〈0．05）,糖尿病得到有效控制。术后12个月时,SF36生理相关综合评分（74．6±18．3）和精神相关综合评分（78．9±14．5）均高于术前（54．9±15．1和56．4±17．8,均P〈0．01）;DTSQ治疗满意度优于术前（29．2±7．1比15．4±5．6,P〈0．01）;DMQLS满意度亦优于术前（60．9±8．0比33．3±7．0,P〈0．01）。结论Roux-en-Y胃旁路术可有效地改善非肥胖2型糖尿病患者的生活质量。     

十二指肠空肠旁路术治疗2型糖尿病的作用及机制

2型糖尿病是最常见的威胁公众健康的慢性病之一.传统治疗控制血糖的方法效果较差.胃旁路术在治疗病态性肥胖的同时,可以快速、有效、长期地缓解其并发的2型糖尿病,但其机制目前仍不明确.十二指肠空肠旁路术是胃旁路术的一种改良术式,主要用来研究胃旁路术治疗2型糖尿病的机制,对非病态性肥胖的2型糖尿病患者的临床治疗也取得了一些初步的研究结果.本文对十二指肠空肠旁路术治疗2型糖尿病的效果及机制进行总结,以期对胃旁路术改善糖代谢的机制进行进一步的阐述,并对代谢手术治疗糖尿病的临床应用提供理论依据.     

Resolution of diabetes,gastrointestinal symptoms,and self-reported dietary intake after gastric bypass versus sleeve gastrectomy: a randomized study

BackgroundThere is a lack of randomized studies examining diabetes remission and dietary intake between patients undergoing Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG).ObjectiveTo examine longitudinal differences in diabetes resolution, dietary intake, and gastrointestinal (GI) symptoms in patients with obesity and type 2 diabetes (T2D) randomized to either RYGB or SG and according to remission of T2D.SettingFour hospitals in Sweden, 2 of which are university hospitals.MethodsDietary intake and GI symptoms were calculated from questionnaires and morphometric differences between surgical methods and T2D remission were compared using the Student t test, effect size (ES) for parametric parameters, and Mann-Whitney U test for nonparametric parameters.ResultsFive years after RYGB or SG there was no significant difference in the rate of remission of T2D between RYGB and SG (43% versus 20%, P = .176). RYGB (n = 19) patients had greater weight loss than SG patients (n = 14) (26.4 [9.5] versus 13.1 [9.6] kg, P < .001), despite reporting higher daily caloric intake (Δ 669 kcal, P = .059, ES .67) and food weight (Δ 1029 g/d, P = .003, ES 1.11). RYGB patients, compared with SG patients, also ate 1 more fruit per day (P = .023). Pooled data showed no differences between patients with and without T2D remission regarding weight loss, but those in remission drank more nonalcoholic drinks and milk.ConclusionsFive years postoperatively, patients randomized to RYGB reported considerably higher food intake compared with SG despite lower body weight. The reason and importance of the higher food intake after RYGB compared with SG needs to be further studied.     

腹腔镜胃袖套状切除术与Roux-en-Y胃肠短路术治疗2型糖尿病前瞻性研究Meta分析

目的 外科治疗2型糖尿病（T2DM）对于血糖控制有良好效果,腹腔镜胃袖套状切除术（LSG）与腹腔镜Roux-en-Y胃肠短路术（LRYGB）是常采用的两种术式,本次研究将系统评价该两种术式对T2DM的疗效及其临床应用价值。方法 通过Pubmed、Embase、Springerlink、万方和CNKI数据库文献搜索LSG与LRYGB两种术式治疗肥胖的随机对照试验研究,文献检索时间截止至2012年4月。采用RevMan 5.1软件对纳入文献进行Meta分析。结果 共纳入6篇前瞻性研究文献,Meta分析的结果显示两术式对术后血糖缓解率、HbA1c、血糖下降幅度、体重指数和体重下降的影响无统计学差异（P>0.10）;LSG术后额外体重丢失低于LRYGB（P=0.04）,并效应值-14.17（95%CI：-27.44,-0.90）。结论 LSG与LRYGB在对T2DM的体重和血糖的控制效果相当,提示LSG可作为外科治疗T2DM的优先考虑术式之一。