胃轉流術對非肥胖型2型糖尿病的療效觀察及其對胰高血糖素樣肽-1的影響_《中國普外基礎與臨床雜志》

作者：

鄧治洲 ¹ , 王烈 ¹ , 林憶陽 ² , 王瑜 ¹

1.福建醫科大學福總臨床醫學院（南京軍區福州總醫院）普通外科(福州 350025);;
2.福建醫科大學福總臨床醫學院（南京軍區福州總醫院）內分泌科(福州 350025);

關鍵詞：

胃轉流術 2型糖尿病非肥胖型胰高血糖素樣肽-1 胰島素血糖

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目的觀察胃轉流術對非肥胖型2型糖尿病的療效及其對胰高血糖素樣肽-1（GLP-1）的影響。方法檢測分析32例胃潰瘍合并非肥胖型2型糖尿病患者行胃轉流術術前和術后第1周、2周、3周、1個月、3個月及6個月的體重指數（BMI），空腹及標準饅頭餐后2 h的血糖、胰島素及GLP-1水平，糖化血紅蛋白（HbA1c，僅測術前和術后第3及6個月）水平，穩態模型-胰島β細胞功能指數（HBCI）水平及術后6個月的糖尿病轉歸情況。結果胃轉流術后所有患者的空腹及餐后血糖均較術前逐漸降低（P＜0.05），空腹及餐后胰島素和GLP-1均較術前逐漸升高（P＜0.05）； HBCI較術前逐漸升高，HbA1c較術前逐漸下降（P＜0.05）；患者術后各時間段BMI較術前均無明顯變化（P＞0.05）。GLP-1與血糖呈負相關（P＜0.05）,與胰島素呈正相關（P＜0.05）。術后6個月糖尿病總控制率為78.1%（25/32）。結論胃轉流術能明顯降低非肥胖型2型糖尿病患者的血糖，其對血糖的控制不依賴于體重的降低；胃轉流術控制血糖可能部分是通過增加GLP-1的分泌進而促進胰島素分泌而起作用。

引用本文： 鄧治洲,王烈,林憶陽,王瑜. 胃轉流術對非肥胖型2型糖尿病的療效觀察及其對胰高血糖素樣肽-1的影響. 中國普外基礎與臨床雜志, 2009, 16(6): 466-469. doi: 復制

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12.	王湘輝，李濤，王海忠. Roux-en-Y胃轉流術治療Ⅱ型糖尿病 [Ｊ]. 西北國防醫學雜志， 2006； 27(4)： 298-299.
13.	Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus [Ｊ]. Diabetes Care, 2003; 26 Suppl 1: S5-S20.
14.	黃從云，王建南，彭淑牖，等. 胃腸道漿肌層吻合、黏膜外吻合、一層吻合和二層吻合的實驗比較研究 [Ｊ]. 中國普外基礎與臨床雜志， 2007； 14(4)： 432-436.
15.	張偉，趙高平，楊春，等. 胃腸道腫瘤合并糖尿病患者術后早期腸內營養支持及血糖控制 [Ｊ]. 中國普外基礎與臨床雜志， 2008； 15(6)： 444-447.
16.	Mottin CC, Vontobel Padoin A, Schroer CE, et al. Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass [Ｊ]. Obes Surg, 2008; 18(2): 179-181.
17.	Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective [Ｊ]. Obes Surg, 2005; 15(6): 751-757.
18.	DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [Ｊ]. Ann Surg, 2002; 235(5): 640-645.
19.	Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type Ⅱ diabetes: a randomised trial [Ｊ]. Int J Obes Relat Metab Disord, 2003; 27(7): 797-802.
20.	White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass [Ｊ]. Obes Surg, 2005; 15(2): 155-163.
21.	Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease [Ｊ]. Ann Surg, 2004; 239(1): 1-11.
22.	Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [Ｊ]. Obes Surg, 2004; 14(6): 840-848.
23.	Zander M, Madsbad S, Madsen JL, et al. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study [Ｊ]. Lancet, 2002; 359(9309): 824-830.
24.	Egan JM, Meneilly GS, Elahi D. Effects of 1-mo bolus subcutaneous administration of exendin-4 in type 2 diabetes [Ｊ]. Am J Physiol Endocrinol Metab, 2003; 284(6): E1072-E1079.
25.	Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes [Ｊ]. J Clin Endocrinol Metab, 2008; 93(7): 2479-2485.
26.	Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes [Ｊ]. Diabetes Care, 2007; 30(7): 1709-1716.

1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 [Ｊ]. Diabetes Care， 2004; 27(5): 1047-1053.
2. Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France: the ECODIA survey [Ｊ]. Diabetes Metab, 2000; 26(5): 363-369.
3. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus [Ｊ]. Ann Surg, 2002; 236(5): 554-559.
4. Greenway SE, Greenway FL 3rd, Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus [Ｊ]. Arch Surg, 2002; 137(10): 1109-1117.
5. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity [Ｊ]. Ann Surg, 2000; 232(4): 515-529.
6. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution [Ｊ]. J Clin Endocrinol Metab, 2004; 89(6): 2608-2615.
7. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
8. Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
9. Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes-a systematic review [Ｊ]. Diabetes Metab Res Rev, 2004; 20(6): 438-445.
10. 王瑜，王燕婷，王烈. 胃轉流術對非肥胖型2型糖尿病的治療作用 [Ｊ]. 中國普通外科雜志， 2008； 17(10)： 1003-1006.
11. 張新國，楊學軍，徐紅，等. 手術治療2型糖尿病——回顧性臨床研究及近期臨床試用報告 [Ｊ]. 中華臨床醫學實踐雜志， 2005； 4(5)： 459-461.
12. 王湘輝，李濤，王海忠. Roux-en-Y胃轉流術治療Ⅱ型糖尿病 [Ｊ]. 西北國防醫學雜志， 2006； 27(4)： 298-299.
13. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus [Ｊ]. Diabetes Care, 2003; 26 Suppl 1: S5-S20.
14. 黃從云，王建南，彭淑牖，等. 胃腸道漿肌層吻合、黏膜外吻合、一層吻合和二層吻合的實驗比較研究 [Ｊ]. 中國普外基礎與臨床雜志， 2007； 14(4)： 432-436.
15. 張偉，趙高平，楊春，等. 胃腸道腫瘤合并糖尿病患者術后早期腸內營養支持及血糖控制 [Ｊ]. 中國普外基礎與臨床雜志， 2008； 15(6)： 444-447.
16. Mottin CC, Vontobel Padoin A, Schroer CE, et al. Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass [Ｊ]. Obes Surg, 2008; 18(2): 179-181.
17. Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective [Ｊ]. Obes Surg, 2005; 15(6): 751-757.
18. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [Ｊ]. Ann Surg, 2002; 235(5): 640-645.
19. Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type Ⅱ diabetes: a randomised trial [Ｊ]. Int J Obes Relat Metab Disord, 2003; 27(7): 797-802.
20. White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass [Ｊ]. Obes Surg, 2005; 15(2): 155-163.
21. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease [Ｊ]. Ann Surg, 2004; 239(1): 1-11.
22. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [Ｊ]. Obes Surg, 2004; 14(6): 840-848.
23. Zander M, Madsbad S, Madsen JL, et al. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study [Ｊ]. Lancet, 2002; 359(9309): 824-830.
24. Egan JM, Meneilly GS, Elahi D. Effects of 1-mo bolus subcutaneous administration of exendin-4 in type 2 diabetes [Ｊ]. Am J Physiol Endocrinol Metab, 2003; 284(6): E1072-E1079.
25. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes [Ｊ]. J Clin Endocrinol Metab, 2008; 93(7): 2479-2485.
26. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes [Ｊ]. Diabetes Care, 2007; 30(7): 1709-1716.

《中國普外基礎與臨床雜志》

胃轉流術對非肥胖型2型糖尿病的療效觀察及其對胰高血糖素樣肽-1的影響

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《中國普外基礎與臨床雜志》

胃轉流術對非肥胖型2型糖尿病的療效觀察及其對胰高血糖素樣肽-1的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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