CAJ | 학술논문

目的：探讨胃癌根治术不同胃肠道重建方式对合并2型糖尿病患者血糖变化及胰岛β细胞功能的影响。方法选择行根治性手术治疗的48例胃癌合并2型糖尿病患者，根据胃肠道重建方式分为2组，A组35例行BillrothⅠ式吻合术，B组13例行Roux-en-Y胃肠转流术，比较2组患者术前及术后3，6个月的体质量指数（ BMI）、糖化血红蛋白（HbA1c）、空腹血糖（FBG）、空腹胰岛素（FINS）、空腹C肽（FC-P）的水平，检测并比较口服75 g葡萄糖2 h后的血糖（2hPG）、胰岛素（2hINS）及C肽（2hC-P）水平，采用稳态模式评估法评价胰岛素抵抗指数（HOMA-IR）。结果 A组术后BMI、HOMA-IR、FBG、2hPG、FINS、2hINS、FC-P和2hC-P水平与术前比较无明显变化；术后3个月A组HbA1c水平较术前显著下降（P＜0．05）。 B组术后BMI虽无明显变化，但FBG、2hPG、HbA1c水平及HOMA-IR较术前显著下降（P均＜0．05），FINS及2hINS、FC-P及2hC-P较术前明显升高（P均＜0．01）。结论采用Roux-en-Y吻合重建能有效降低胃癌合并2型糖尿病患者的血糖水平，明显改善胰岛β细胞功能。
목적：탐토위암근치술불동위장도중건방식대합병2형당뇨병환자혈당변화급이도β세포공능적영향。방법선택행근치성수술치료적48례위암합병2형당뇨병환자，근거위장도중건방식분위2조，A조35례행BillrothⅠ식문합술，B조13례행Roux-en-Y위장전류술，비교2조환자술전급술후3，6개월적체질량지수（ BMI）、당화혈홍단백（HbA1c）、공복혈당（FBG）、공복이도소（FINS）、공복C태（FC-P）적수평，검측병비교구복75 g포도당2 h후적혈당（2hPG）、이도소（2hINS）급C태（2hC-P）수평，채용은태모식평고법평개이도소저항지수（HOMA-IR）。결과 A조술후BMI、HOMA-IR、FBG、2hPG、FINS、2hINS、FC-P화2hC-P수평여술전비교무명현변화；술후3개월A조HbA1c수평교술전현저하강（P＜0．05）。 B조술후BMI수무명현변화，단FBG、2hPG、HbA1c수평급HOMA-IR교술전현저하강（P균＜0．05），FINS급2hINS、FC-P급2hC-P교술전명현승고（P균＜0．01）。결론채용Roux-en-Y문합중건능유효강저위암합병2형당뇨병환자적혈당수평，명현개선이도β세포공능。
Objective It is to approach the influence of different techniques for gastrointestinal tract reconstruction on blood glucose and pancreatic β-cell function in gastric cancer patients with type 2 diabetes.Methods 48 gastric cancer pa-tients with type 2 diabetes were selected and divided into two groups according to different alimentary tract reconstruction , Group A with 35 cases were treated by Billroth I anastomosis and Group B with 13 cases were treated by Roux-en-Y anasto-mosis.Both groups were subjected to the measuring of preoperative and postoperative third , sixth months The values of body mass index (BMI), glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), fasting insulin (FINS) and C-pep-tide (FC-P) were compared;the levels of 2 hour blood glucose (2hPG), insulin (2hINS) and C-peptide (2hC-P) in o-ral glucose tolerance ( OGTT) were observed and compared .The homeostasis model ( HOMA) was adopted to estimate the in-dex of insulin resistance (IR).Results There were no significant difference in levels of BMI , FBG, FINS, FC-P, 2hPG, 2hINS, 2hC-P and HOMA-IR between before and after operation in Group A (all P>0.05);while the value of HBA1c at postoperative third month was markedly decreased compared to preoperative (P<0.05).The BMI in Group B has no change compared before operation , but there were significant differences in the levels of FBG , 2hPG, HbA1c and HOMA-IR after operation three and six months in Group B , postoperative third , sixth months and there were very significant differences in the values of FINS, FC-P, 2hINS and 2hC-P between before and after operation (P<0.05).Conclusion Roux-en-Y gas-tric bypass can effectively decrease blood glucose level and improve pancreatic β-cell function in gastric cancer patients with type 2 diabetes .