CAJ | 학술논문

目的：观察胃转流术治疗2型糖尿病术后1年内各代谢指标变化，并探索胃转流术评价指标及适用人群的选择。方法：收集我院112例行胃转流术的2型糖尿病患者手术前后的临床及实验室检查资料。根据BMI大小分为两组：正常体质量组（≤25 kg/m2），超重肥胖组（＞25 kg/m2）。术后1、3、6、12个月随访各项生理及生化指标。行手术前后对照、组间对照和主成分分析。结果：与术前相比，两组在HbA1c、HOMA-IR等均有明显改善。主成分分析发现BMI、HbA1c在术后6个月前对结果贡献较大，而HOMA-β、HOMA-IR在术后6个月后对结果贡献较大，分别反映出术后恢复的综合指标及均匀程度。结论：2型糖尿病患者术后1年各代谢指标明显改善，术后完全缓解率逐步升高；超重肥胖组较正常体质量组血糖、血脂、HOMA-β改善明显，超重肥胖者是手术治疗更适合人群；BMI、HbA1c、HOMA-β、HOMA-IR对于手术效果评价及术前适应证的把握有较大指导意义。
목적：관찰위전류술치료2형당뇨병술후1년내각대사지표변화，병탐색위전류술평개지표급괄용인군적선택。방법：수집아원112례행위전류술적2형당뇨병환자수술전후적림상급실험실검사자료。근거BMI대소분위량조：정상체질량조（≤25 kg/m2），초중비반조（＞25 kg/m2）。술후1、3、6、12개월수방각항생리급생화지표。행수술전후대조、조간대조화주성분분석。결과：여술전상비，량조재HbA1c、HOMA-IR등균유명현개선。주성분분석발현BMI、HbA1c재술후6개월전대결과공헌교대，이HOMA-β、HOMA-IR재술후6개월후대결과공헌교대，분별반영출술후회복적종합지표급균균정도。결론：2형당뇨병환자술후1년각대사지표명현개선，술후완전완해솔축보승고；초중비반조교정상체질량조혈당、혈지、HOMA-β개선명현，초중비반자시수술치료경괄합인군；BMI、HbA1c、HOMA-β、HOMA-IR대우수술효과평개급술전괄응증적파악유교대지도의의。
Objective To observe multiple metabolic changes within one year after Roux-en-Y gastric bypass (RYGB) surgery in obese patients with type 2 diabetes mellitus, and to evaluate the index of the gastric bypass surgery and the determination of applicable population. Methods The clinical and laboratory data before and after surgery in 112 patients diagnosed as type 2 diabetes mellitus by RYGB were included in this study. According to BMI, these patients were divided into two groups: normal group (≤ 25kg/m2), and the overweight group (> 25 kg/m2). The physiologic and biochemical indexes of the patients were followed up at 1, 3, 6, 12 months, respectively. The statistical analysis was performed by SPSS17.0 software. Results Compared with the preoperative period, the levels of HbA1c and HOMA-IR in the postoperative period were significantly increased in the two groups. Principal component analysis showed that the postoperatively contributions of BMI and HbA1c in 6 months was bigger than that of the other indexes, while HOMA-β, HOMA-IR had larger contributions after 6-month postoperative period. Conclusion Various metabolic indexes in patients with type 2 diabetes improve significantly within one year after surgery, and the complete remission rate is gradually increased. The indexes including weight, blood glucose, serum lipids, HOMA-βand HOMA-IR in overweight and obese group have more significant improvements than those in normal group. Obese patients are more appropriate for the surgical treatment. The indexes, such as BMI, HbA1c,HOMA-βand HOMA-IR, should help to evaluate the operating effectiveness and preoperative indications.