CAJ | 학술논문

目的：评估Roux-en-Y胃转流术（RYGB）对超重2型糖尿病患者的疗效及对心血管风险的影响。方法2011年3月至2012年3月期间，共有57例超重的2型糖尿病患者于武警重庆总队医院行RYGB术，检测患者术前及术后6个月的空腹血糖（FPG）、餐后2小时血糖（2hPG）、糖化血红蛋白（HbA1c）、体重指数（BMI）、血压、血脂，并根据是否合并高血压分为高血压组（n=30）和血压正常组（n=27）。使用中国缺血性心血管疾病（ICVD）危险评估模型和Framingham危险评估模型对术前、术后心血管风险进行评估。结果术后6个月，患者FPG、2hPG、HbA1c、BMI、收缩压、舒张压与手术前比较，均明显降低（P均＜0.01）。三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）较术前下降（P均＜0.05)。高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A1（ApoA1）/载脂蛋白B（ApoB）术前、术后比较无明显变化（P＞0.05）。术前合并原发性高血压的患者30例，术后收缩压、舒张压均明显降低（P均＜0.01）；术前为高血压3级的患者，术后较高血压1级、2级患者术后血压下降幅度增加（P均＜0.05）。术后6个月评估患者未来10年心血管风险较术前明显下降。研究期间无死亡病例及严重不良反应发生。结论对于超重的2型糖尿病患者，RYGB可以改善血糖、血压、血脂，并降低未来10年心血管风险。
목적：평고Roux-en-Y위전류술（RYGB）대초중2형당뇨병환자적료효급대심혈관풍험적영향。방법2011년3월지2012년3월기간，공유57례초중적2형당뇨병환자우무경중경총대의원행RYGB술，검측환자술전급술후6개월적공복혈당（FPG）、찬후2소시혈당（2hPG）、당화혈홍단백（HbA1c）、체중지수（BMI）、혈압、혈지，병근거시부합병고혈압분위고혈압조（n=30）화혈압정상조（n=27）。사용중국결혈성심혈관질병（ICVD）위험평고모형화Framingham위험평고모형대술전、술후심혈관풍험진행평고。결과술후6개월，환자FPG、2hPG、HbA1c、BMI、수축압、서장압여수술전비교，균명현강저（P균＜0.01）。삼선감유（TG）、총담고순（TC）、저밀도지단백담고순（LDL-C）교술전하강（P균＜0.05)。고밀도지단백담고순（HDL-C）화재지단백A1（ApoA1）/재지단백B（ApoB）술전、술후비교무명현변화（P＞0.05）。술전합병원발성고혈압적환자30례，술후수축압、서장압균명현강저（P균＜0.01）；술전위고혈압3급적환자，술후교고혈압1급、2급환자술후혈압하강폭도증가（P균＜0.05）。술후6개월평고환자미래10년심혈관풍험교술전명현하강。연구기간무사망병례급엄중불량반응발생。결론대우초중적2형당뇨병환자，RYGB가이개선혈당、혈압、혈지，병강저미래10년심혈관풍험。
Objective To review the curative effect of Roux-en-Y gastric bypass (RYGB) surgery in overweight patients with type 2 diabetes and its influence on cardiovascular risk. Methods There were totally 57 patients having RYGB surgery in the Hospital of Chinese PLA Chongqing General Unit from Mar. 2011 to Mar. 2012. The changes of fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), HbA1c, BMI, blood pressure (BP) and blood fat were detected before the surgery and 6 m after the surgery. All patients were divided into hypertension group (n=30) and normal group (n=27). The cardiovascular risks were reviewed by using Chinese risk assessment model of ischemia cardiovascular diseases (ICVD) and Framingham risk assessment model before and after the surgery. Results After the surgery for 6 m, FPG, 2hPG, HbA1c, BMI, systolic BP and diastolic BP all decreased significantly than those before the surgery (all P<0.01). The levels of TG, TC and LDL-C decreased after the surgery (all P<0.05), and levels of HDL-C and ApoA1/ApoB had no significant changes (P>0.05). In 30 patients with complicating primary hypertension, systolic BP and diastolic BP decreased significantly after the surgery (all P<0.01). In the patients with grade 3 hypertension, the descend range of BP increased compared with those with grade 1 or grade 2 hypertension (all P<0.05). The assessment 6 m after the surgery showed that the cardiovascular risk decreased significantly in the next decade. There were no deaths or severe adverse reactions observed. Conclusion RYGB surgery can ameliorate blood glucose, BP and blood fat, and reduce the cardiovascular risk in the next decade in overweight patients with type 2 diabetes.