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目的 观察胃转流术对2型糖尿病患者糖代谢相关指标的影响,并评价胰岛β细胞功能及胰岛素抵抗的改善情况.方法 前瞻性研究8例2型糖尿病患者合并胃癌等胃肠道疾病行胃转流术治疗,术前和术后1周、2周、1个月、3个月的空腹血糖(FPG)及糖负荷后2 h血糖(2hPG)、空腹血浆胰岛素(Fins)、糖负荷后2 h血浆胰岛素(2hIns)、空腹血浆C肽(空腹C肽)、糖负荷后2 h血浆C肽(2hC肽)、体质指数(BMI)的变化,术前、术后3个月糖化血红蛋白(HbA1c)的变化及术后3个月糖尿病的转归情况.结果 胃转流术后1周所有患者的FPG及2hPG均较术前明显下降(P＜0.05),术后1个月Fins、2hIns、空腹C肽、2hC肽均较术前明显升高(P＜0.05);术后3个月HbA1c水平较术前明显下降(P＜0.05);患者术后各时间段BMI较术前均无明显变化(P＞0.05).术后3个月8例患者均达到糖尿病治疗有效标准,其中6例患者达到临床缓解标准.结论 胃转流术能明显降低2型糖尿病患者的血糖水平,其对血糖的控制不依赖于体重的降低;胃转流术控制血糖可能与胰岛β细胞功能改善、内源性胰岛素分泌增加有关.Abstract： Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index (BMI) were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin (HbA1c) levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased (P ＜ 0.05) and fasting and postprandial insulin C-peptide levels increased (P ＜ 0.05) after the surgery. HbA1c levels also decreased (P ＜ 0.05) after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery(P＞ 0.05). All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin. 相似文献
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<正>肝恶性肿瘤是全球发病率最高的实体恶性肿瘤之一[1]。在我国,随着肝癌发病诱因的控制,如乙肝疫苗的广泛接种、肝炎的抗病毒治疗、肥胖及糖尿病的及时干预等,肝癌的发病率及死亡率已有逐步下降,但仍占全球肝癌的45.3%、47.1%[2]。肝癌起病隐匿、早期发现率低,多数患者确诊时已处于中晚期,而肝脏结构复杂、手术难度大,我国患者又多合并病毒性肝炎等,上述情况共同导致了肝癌治疗的复杂,个体化差异明显。而对于可以接受手术切除的患者,良好的围术期管理是保证患者预后的重要 相似文献