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目的观察胃转流手术(GBP)对超重、肥胖与非肥胖T2DM患者的疗效与治疗作用,为此我们随访观察超重肥胖和正常体重两组患者GBP术后的糖代谢变化规律。方法 2006年1月～2007年6月期间,我院普外科纳入103例T2DM患者,按照BMI分为2组,超重肥胖组(BMI≥25kg/m2)和正常体重组(BMI<25kg/m2)。术后随访期为半年、1年、2年、3年,分别观察HbA1c、BMI、OGTT、胰岛素释放试验和C-P释放试验。结果 3年随访期中,T2DM总体显效率为87%,其中超重肥胖组显效率为91%,正常体重组显效率为77%;与术前BMI相比,超重肥胖组术后BMI明显下降,62例超重肥胖患者BMI<24kg/m2,显效率为95%,正常体重组BMI无明显变化;与正常体重组患者术前胰岛素分泌值相比,术后3年胰岛素分泌值△I30/△G30明显升高,差异有统计学意义(P<0.05);与术前胰岛素抵抗指数(HOMA-IR)相比,超重肥胖组术后3年HOMA-IR明显改善,差异有统计学意义(P<0.05)。结论 GBP对超重肥胖和正常体重T2DM均有明显治疗作用,但正常体重组T2DM有效率低于超重肥胖组,显示其降糖作用独立于减重作用,而超重肥胖组主要有赖于术后IR改善。
Objective To observe the curative effect and therapeutic effect of gastric bypass surgery (GBP) on T2DM patients with overweight, obesity and non-obesity. To this end, we observed the changes of glucose metabolism in GBP patients after overweight and obesity and normal body weight. Methods From January 2006 to June 2007, 103 patients with T2DM were enrolled in our department and divided into 2 groups according to BMI. Overweight and obesity (BMI≥25kg / m2) and normal weight group (BMI <25kg / m2) . The follow-up period was 6 months, 1 year, 2 years and 3 years. The HbA1c, BMI, OGTT, insulin release test and C-P release test were observed. Results The overall effective rate of T2DM was 87% in 3-year follow-up period, in which the markedly effective rate was 91% in the overweight and obesity group and 77% in the normal body weight group. Compared with the preoperative BMI, the BMI in the overweight and obesity group decreased significantly In patients with overweight and obesity, the BMI <24kg / m2, markedly effective rate was 95%, no significant change in normal weight BMI; insulin secretion in patients with normal body weight compared to preoperative 3-year insulin secretion △ I30 / △ G30 significantly (P <0.05). Compared with HOMA-IR, the HOMA-IR of overweight and obesity group was significantly improved after 3 years (P <0.05), and the difference was statistically significant ). CONCLUSION: GBP has a significant therapeutic effect on both overweight and normal body weight T2DM. However, the effective rate of T2DM in normal body weight group is lower than that of overweight and obese group, indicating that its hypoglycemic effect is independent of weight loss. Overweight and obesity group mainly depends on postoperative IR improvement .