CAJ | 학술논문

目的探讨不同胃肠道重建方式对2型糖尿病患者术后胰岛功能的影响.方法对23例胃癌合并2型糖尿病患者的临床资料进行回顾性分析,并按消化道重建方式的不同分为Billroth Ⅰ式组(13例)和胃肠旁路组(10例,其中毕Ⅱ式吻合4例,Roux-en-Y吻合6例).行口服糖耐量试验(OCTT),采用电化学发光法检测血清胰岛素水平,采用葡萄糖氧化酶法测定血糖,采用稳态模式评估法评价胰岛素抵抗指数和胰岛素分泌指数.结果胃肠旁路术组和Billorth Ⅰ式组术后糖尿病好转率分别为90%(9/10)和23%(3/13),差异有统计学意义(P<0.01).与术前相比,胃肠旁路组术后糖化血红蛋白A1c和糖化血红蛋白HbA1显著降低(P<0.01),而Billroth Ⅰ式组则无明显改善(P>0.05).OGTT结果显示,胃肠旁路组空腹血糖及及糖负荷后各个时间点的血糖水平均显著低于Billroth Ⅰ式组;在糖负荷后30 min和60 min,胃肠旁路术组胰岛素水平和胰岛素释放指数明显高于Billroth Ⅰ式组(均P<0.05).胃肠旁路组的胰岛素分泌指数和早期胰岛素分泌反应同样明显高于Billroth Ⅰ式组.结论采用胃肠旁路术进行胃切除术后消化道重建,可有效控制2型糖尿病并明显改善术后胰岛功能.
목적 탐토불동위장도중건방식대2형당뇨병환자술후이도공능적영향.방법 대23례위암합병2형당뇨병환자적림상자료진행회고성분석,병안소화도중건방식적불동분위Billroth Ⅰ식조(13례)화위장방로조(10례,기중필Ⅱ식문합4례,Roux-en-Y문합6례).행구복당내량시험(OCTT),채용전화학발광법검측혈청이도소수평,채용포도당양화매법측정혈당,채용은태모식평고법평개이도소저항지수화이도소분비지수.결과 위장방로술조화Billorth Ⅰ식조술후당뇨병호전솔분별위90%(9/10)화23%(3/13),차이유통계학의의(P<0.01).여술전상비,위장방로조술후당화혈홍단백A1c화당화혈홍단백HbA1현저강저(P<0.01),이Billroth Ⅰ식조칙무명현개선(P>0.05).OGTT결과현시,위장방로조공복혈당급급당부하후각개시간점적혈당수평균현저저우Billroth Ⅰ식조;재당부하후30 min화60 min,위장방로술조이도소수평화이도소석방지수명현고우Billroth Ⅰ식조(균P<0.05).위장방로조적이도소분비지수화조기이도소분비반응동양명현고우Billroth Ⅰ식조.결론 채용위장방로술진행위절제술후소화도중건,가유효공제2형당뇨병병명현개선술후이도공능.
Objective To evaluate the impact of different techniques for gastrointestinal tract reconstruction on postoperative pancreatic β-cell function in patients with type 2 diabetes mellitus (T2DM). Methods Twenty-three patients with gastric cancer and T2DM were studied. Techniques for reconstruction included Billroth I (n=13) and bypass procedures(Billroth II n=4 and Roux-en-Y anastomosis n=6). Pancreatic P-cell function was evaluated by oral glucose tolerance test (OGTT).Serum insulin was measured by electrochemiluminescence immunoassay and blood glucose by glucose oxidase method. HOMA-IR and HOMA-B were assessed. Results T2DM remission rate was 90%(9/10) in the bypass group, and 23%(3/13) in Billroth I group (P<0.01). Glycosylated hemoglobin A1c and glycated hemoglobin HbA1 were improved significantly in patients after bypass procedures (P<0.05), but the difference in Billroth I group was not statistically significant (P>0.05). OGTT showed that fasting and post-glucose load plasma glucose at each time point were significantly lower in the bypass group compared to the Billroth I group. At 30 minutes and 60 minutes after glucose load, insulin levels and insulin release index were significantly higher in the bypass group compared to Billroth I group,as were levels of HOMA-β and △I30/△G30 in the bypass group (P<0.05). Conclusion Gastrointestinal bypass following gastrectomy may induce resolution of T2DM and improve β-cells function.