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目的探讨2型糖尿病(T2DM)患者行胃转流术后血清游离脂肪酸(FFA)的变化及意义。方法检测20例T2DM患者于手术前及手术后3个月和6个月时的血浆FFA,胰岛素抵抗指数(HOMA-IR)空腹血糖(FPG),餐后2小时血糖(PPG),糖化血红蛋白(HbA1C),体质量指数(BMI)等指标,并以20例健康人群做对照。结果 T2DM组15例完全缓解,3例部分缓解,2例无效。T2DM组术前FFA,HOMA-IR,FPG,PPG,HbA1C均显著高于健康对照组。T2DM组术后3~6个月FFA,HOMA-IR呈进行性下降,均显著低于术前(均P<0.01)。FPG,PPG,HbA1C,BMI亦明显低于术前(均P<0.01)。T2DM组FFA与HOMA-IR在术前,术后3,6个月的相关系数分别为0.58(P<0.01),0.46(P<0.05),0.48(P<0.05)。结论胃转流术能降低T2DM患者血清FFA,并由此减轻患者胰岛素抵抗,这可能是胃转流术治疗T2DM的作用机制之一。
Objective To investigate the changes of serum free fatty acid (FFA) in patients with type 2 diabetes mellitus (T2DM) after gastric bypass. Methods The plasma levels of FFA, insulin resistance index (HOMA-IR) fasting plasma glucose (FPG), postprandial 2-hour postprandial blood glucose (PPG), and glycosylated hemoglobin (HbA1c) were measured in 20 patients with T2DM before surgery and at 3 and 6 months after surgery. HbA1C), body mass index (BMI) and other indicators, and 20 healthy people as a control. Results In T2DM group, 15 cases were completely relieved, 3 cases partially relieved, and 2 cases were ineffective. Preoperative FFA, HOMA-IR, FPG, PPG and HbA1C in T2DM group were significantly higher than those in healthy control group. The levels of FFA and HOMA-IR in T2DM group decreased significantly from 3 to 6 months after operation, which were significantly lower than those before operation (all P <0.01). FPG, PPG, HbA1C and BMI were significantly lower than preoperative (all P <0.01). The correlation coefficients of FFA and HOMA-IR between preoperative and postoperative 3 and 6 months in T2DM group were 0.58 (P <0.01), 0.46 (P <0.05) and 0.48 (P <0.05) respectively. Conclusion Gastric bypass can reduce serum FFA in patients with T2DM and thus reduce insulin resistance, which may be one of the mechanisms of gastric bypass in the treatment of T2DM.