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目的:评价胃转流术(RYGP)治疗非肥胖2型糖尿病(T2DM)的1年血糖代谢变化,并探讨术前T2DM病史对术后1年效果的影响。方法:收集我科2009年6月～2010年4月期间60例行RYGP的非肥胖T2DM患者术前及术后1年内的一般资料,临床及实验室检查数据等。根据T2DM病史分为两组:Ⅰ组:≤5年;Ⅱ组:5-10年,两组体质指数(BMI)均<30 kg/m2。术后6M、12M主要随访:空腹血糖(FPG)、餐后2h血糖(2hPG)、体重、BMI、糖化血红蛋白(HbA1c)、空腹血清胰岛素(Fins)、空腹C肽(C-P)、胰岛素抵抗指数和用药情况,采用SPSS17.0软件进行手术前后对照与组间对照分析。结果:与术前相比,Ⅰ组术后6M、12M时FPG,2hPG,体重,BMI,C-P,HbA1c,Fins均明显改善(P<0.05),HOMA-IR在术后6M无显著差异(P>0.05),术后12M有显著差异(P<0.05);Ⅱ组术后6M、12M时与术前相比,FPG,2hPG,体重,BMI,C-P,HbA1c,HOMA-IR均明显改善(P<0.05),Fins在术后6M、12M与术前相比无显著差异(P>0.05)。Ⅰ组和Ⅱ组于术后6M、12M在FPG、2hPG、体重、BMI、C肽、Fins、HbA1c、HOMA-IR、用药以及手术缓解率方面均无显著差异(P>0.05)。结论:非肥胖T2DM患者胃转流术后1年血糖代谢明显改善,术后完全缓解率逐步增高,术前T2DM病史(≤5年与5-10年)对术后1年效果的影响无显著差异。
Objective: To evaluate the one-year blood glucose metabolism of non-obese type 2 diabetes mellitus (T2DM) treated with gastric bypass (RYGP) and to investigate the effect of preoperative T2DM history on postoperative 1 year outcome. Methods: The general data, clinical and laboratory data of 60 non-obese T2DM patients with RYGP from June 2009 to April 2010 in our department were collected before operation and within 1 year after operation. According to the history of T2DM, the patients were divided into two groups: group Ⅰ: ≤5 years; groupⅡ: 5-10 years, with body mass index (BMI) <30 kg / m2. Fasting blood glucose (FPG), postprandial 2h blood glucose (2hPG), body weight, BMI, HbA1c, fasting serum insulin, fasting C-peptide, insulin resistance index Drug use, using SPSS17.0 software before and after the control and inter-group control analysis. Results: The levels of FPG, 2hPG, body weight, BMI, CP, HbA1c and Fins in group Ⅰ were significantly improved at 6M and 12M after operation (P <0.05), while there was no significant difference in HOMA-IR at 6M (P> 0.05), and there was a significant difference at 12M after operation (P <0.05). Compared with preoperative, the FPG, 2hPG, body weight, BMI, CP, HbA1c and HOMA- <0.05). There was no significant difference in Fins between 6M and 12M postoperatively (P> 0.05). There was no significant difference in the remission rates of FPG, 2hPG, body weight, BMI, C peptide, Fins, HbA1c, HOMA-IR, medication and operation in group Ⅰ and group Ⅱ at 6M and 12M after operation. CONCLUSION: The blood glucose metabolism of non-obese patients with T2DM was significantly improved at 1 year after gastric bypass, and the complete remission rate was gradually increased after operation. The preoperative T2DM history (≤5 years and 5-10 years) had no significant effect on postoperative 1 year difference.