袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖性2型糖尿病患者脂质代谢的影响

目的评价袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖性2型糖尿病患者脂质代谢的影响。方法回顾性分析2009年3月至2010年8月间在四川省攀枝花市中心医院接受袖状胃切除间置回肠的十二指肠空肠旁路手术的29例非肥胖型2型糖尿病患者的临床资料。术后12个月检测总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、胰岛素抵抗指数及糖化血红蛋白（HbAlc）的变化。结果术后12个月时，28例（96．5％）患者血糖得到控制，无需服降糖药，HbAlc从术前的（8．4±1．3）％降至术后的（6．2±0．8）％，另1例血糖亦获改善。25例（86．2％）患者脂质代谢紊乱得到纠正，其中19例术前高胆固醇血症患者中16例（84．2％）术后恢复正常，17例高三酰甘油血症患者中14例（82.3％）恢复正常，12例高密度脂蛋白异常患者中8例（66．6％）恢复正常，16例低密度脂蛋白异常的患者中5例（31．2％）恢复正常；总胆固醇／高密度脂蛋白从术前的5．6±1．2降至术后的2．8±1．0，三酰甘油／高密度脂蛋白从术前的3．2±1.3降至术后的1．5±0．8（均P〈0．01）。结论袖状胃切除间置回肠的十二指肠空肠旁路手术能有效地改善非肥胖型2型糖尿病患者的脂质代谢紊乱。

Impact of sleeve gastrectomy with ileal interposition duodenojejunal bypass operation on lipid metabolism in non-obese type 2 diabetes mellitus patients

Objiective To evaluate the effect of sleeve gastrectomy with ileal interposition duodenojejunal bypass operation on lipid metabolism in non-obese type 2 diabetes mellitus patients. Methods Twenty-nine non-obese patients with type 2 diabetes mellitus underwent sleeve gastrectomy with ileal interposition duodenojejunal bypass operation. All the patients were subjected to the measurement of total cholesterol （TC）, triglycerides （TG）, high density lipoprotein （HDL）, low density lipoprotein （LDL）, homeostatic model assessment for insulin resistance （Homa-IR）, glycosylated hemoglobin （HbAlc） at postoperative 12th month. Results Twelve months after ileal interposition duodenojejunal bypass operation, the blood glucose was controlled without taking hypoglycemic drugs in 28 patients （96.5%） and HbAlc decreased from （8.4±1.3）% to （6.5±1.6）% （P〈0.01）. Dyslipidemia were corrected in 25 cases （86.2%）. TC became normal in 84.2%（15/19）, and TG became normal in 82.3%（14/17）. HDL became normal in 66.6% （8/12）. LDL became normal in 31.2%（5/16）. TC/HDL ratio decreased from 5.6±1.2 to 2.8±1.0（P〈0.01）. TG/HDL ratio decreased from 3.2±1.3 to 1.5±0.8 （all P〈0.01）. Conclusion Sleeve gastrectomy with ileal interposition duodenojejunal bypass is an effective operation for the correction of dyslipidemia in non-obese patientswith type 2 diabetes meIlitus.