2型糖尿病患者胃转流手术后胰岛B细胞功能改变的临床研究

目的：探讨2型糖尿病患者胃转流手术后胰岛B细胞功能的变化情况。方法：回顾性分析赤峰学院附属医院2010年1月～2012年1月接受胃转流手术的28例2型糖尿病患者的临床随访资料，比较患者在术前、术后1个月和术后3个月时的口服葡萄糖耐量试验、胰岛素释放试验结果，评价胰岛B细胞功能的变化情况。结果：28名患者至术后3个月时治愈17例（治愈率60.7%），好转8例（好转率28.6%），总体有效率89.3%。结论：2型糖尿病患者胃转流手术后胰岛B细胞的分泌功能有明显改善，与术后血糖下降有重要关系。胰岛B细胞功能改善可能是胃转流手术治疗2型糖尿病的主要机制之一。

Effect of islet B-cell function after gastric bypass surgery in type 2 diabetes mellitus

Objective：This study was in order to study the effect of islet B-cell function after GBP（gastric bypass surgery） in patients with type 2 diabetes mellitus and the relationship with the decrease of blood glucose level. Method：28 cases of type 2 diabetes mellitus have been followed up for 3 months after gastric bypass surgery. OGTT and insulin releasing test were took up respectively before the GBP、after the GBP 1 month later and 3 months later. Islet B-cell function index： HOMA-B= 20 ＆#215;FINS/（FPG-3.5）was calculated by the homeostasis model assessment, draw the curve of OGTT and insulin releasing test. Contrast the level of the indexes before GBP and those of 1 month and 3months after GBP. The value of blood glucose, insulin level and HOMA-B index are expressed in mean ± standard division. Linear correlation was applied to determine the strength of relationship between two variables. Result：The Islet B-cell function index was （60.7±5.6） preoperatively. And rised to （79.6±8.5） after 1 month postoperatively, which indicated significant rise （P〈0.05）.The difference become more obvious after 3 months postoperatively （83.9 ±9.8）.Compare the insulin releasing curve before GBP with those after GBP 1 month and 3 months later , the basic insulin level and peak insulin level have rised significantly and the peak time also shortened significantly compare those before GBP. It presents negative correlation between HOMA-B and fasting plasma glucose（r=-0.56,P=0.042）.Conclusion：Patients of type 2 diabetes mellitus could gain an excellent improvement of islet B-cell function and this result have important relationship with the decrease of blood glucose level.