Roux-en-Y胃旁路术治疗不同体质指数2型糖尿病的疗效及其对患者糖脂代谢的影响

目的：探讨Roux-en-Y胃旁路术(RYGB)治疗不同体质指数2型糖尿病的疗效及其对患者糖脂代谢的影响。方法选取2014年1月至2015年12月在涿州市医院外科接受Roux-en-Y胃旁路术治疗的2型糖尿病患者96例，根据体质量指数(BMI)不同分为高BMI组44例(BMI≥30.0 kg/m2)和低BMI组52例(BMI<30.0 kg/m2)。分别在术前及术后1个月、3个月、6个月、12个月检测两组患者的空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹C肽(FC-P)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平、体质量、腰围、BMI和用药情况，比较手术前后的各项指标。随访患者术后12个月的疗效及相关影响因素。结果高BMI组和低BMI组患者手术前，术后1个月、3个月、6个月及12个月的体质量、BMI、腰围的变化趋势比较，差异均无统计学意义(P>0.05)；脂代谢分析显示，高BMI组和低BMI组患者手术前，术后1个月、3个月、6个月及12个月TC、TG、LDL-C、HDL-C的变化趋势比较，差异均无统计学意义(P>0.05)；糖代谢分析显示，高BMI组和低BMI组患者手术前，术后1个月、3个月、6个月及12个月HbA1c、FC-P的变化趋势比较，差异均无统计学意义(P>0.05)；高BMI组患者FPG水平术后3个月[(5.7±1.4) vs (7.0±1.8)]、6个月[(5.5±1.6) vs (6.7±2.1)]及12个月[(5.4±1.2) vs (6.7±1.6)]明显低于低BMI组，两组比较差异均有统计学意义(P<0.05)；高BMI组患者2 hPG水平术后1个月[(9.3±1.5) vs (10.8±1.7)]、3个月[(9.0±1.8) vs (10.2±1.4)]及6个月[(7.9±1.3) vs (8.7±1.1)]明显低于低BMI组，两组比较差异均有统计学意义(P<0.05)；高BMI组患者术后疗效为93.2%，与低BMI组的88.5%比较差异无统计学意义(P>0.05)。单因素分析结果显示，术后1年缓解的相关影响因素为FPG、糖尿病病程及术前用药情况(P<0.05)。结论 Roux-en-Y胃旁路术对BMI≥30.0 kg/m2或BMI<30.0 kg/m2的2型糖尿病患者均具有良好的疗效和安全性。术前空腹血糖水平低、病程短的2型糖尿病患者术后1年手术缓解率较好。

Efficacy of Roux-en-Y gastric bypass in the treatment of type 2 diabetes mellitus with different body mass index and its effect on glucose and lipid metabolism

Objective To investigate the efficacy of Roux-en-Y gastric bypass (RYGB) in the treatment of pa-tients with type 2 diabetes mellitus with different body mass index and its effect on glucose and lipid metabolism. Methods Ninety-six patients with type 2 diabetes mellitus who underwent RYGB in Department of Surgery in Hospital of Zhuozhou City were selected from January 2014 to December 2015. According to body mass index (BMI), the patients were divided into high BMI group of 44 cases (BMI≥30.0 kg/m2) and low BMI group of 52 cases (BMI<30.0 kg/m2). The 2 h postprandial blood glucose (2 hPG), hemoglobin A1c (HbA1c), fasting C peptide (FC-P), total cholesterol (TC), tri-glyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) levels, body mass, waist circumference, BMI, drug use situation were detected and compared in two groups at preoperative and post-operative 1 month, 3 months, 6 months, 12 months, respectively. The patients were followed up for 12 months after oper-ation for efficacy and related influencing factors. Results The high BMI group and low BMI group had no significant differences in the change trend of body mass, waist circumference, BMI before surgery, and at postoperative 1 month, 3 months, 6 months and 12 months (P>0.05). Lipid metabolism analysis showed that high BMI group and low BMI group had no significant difference in the change trend of TC, TG, LDL-C, HDL-C before surgery, and at postoperative 1 month, 3 months, 6 months and 12 months (P>0.05). Glucose metabolism analysis showed that high BMI group and low BMI group had no significant differences in the change trend of HbA1c, FC-P before surgery, and at postoperative 1 month, 3 months, 6 months and 12 months (P>0.05). The FPG levels of patients in high BMI group were significantly lower than those in low BMI group at postoperative 3 months, 6 months and 12 months [(5.7±1.4) vs (7.0±1.8), (5.5±1.6) vs (6.7±2.1), (5.4 ± 1.2) vs (6.7 ± 1.6), P<0.05]. The 2 hPG levels of patients in high BMI group for postoperative month, 3 months and 6 months were significantly lower than those in low BMI group [(9.3±1.5) vs (10.8±1.7), (9.0±1.8) vs (10.2±1.4), (7.9±1.3) vs (8.7±1.1), P<0.05]. The postoperative efficacy of high BMI group and low BMI group were 93.2%and 88.5%respective-ly, and there were no significant differences between the two groups (P>0.05). Single factor analysis showed that the re-lated factors of remission 1 year after surgery were fasting blood glucose levels, diabetes duration and preoperative medi-cation (P<0.05). Conclusion Roux-en-Y gastric bypass has good efficacy and safety for patients of type 2 diabetes mel-litus with BMI≥30.0 kg/m2 or BMI<30.0 kg/m2, and the 1-year remission rate of patients with lower FPG before sur-gery and shorter diseases course is better.