CAJ | 학술논문

目的探讨Roux-en-Y胃肠转流术对胃癌合并2型糖尿病患者血糖及胰岛功能的影响.方法选择我院行Roux-en-Y胃肠转流术治疗的27例胃癌合并2型糖尿病患者,比较术前及术后3、6个月的体质量指数(BMI)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C肽(FCP)的浓度,检测并比较3个时间点口服75 g葡萄糖2h后的血糖(2 hPG)、胰岛素(2 hINS)及C肽(2hCP)水平,采用稳态模式评估法评价胰岛素抵抗指数(HOMA-IR).结果术后BMI无明显变化;术后3个月FPG、2 hPG、HbA1c、HOMA-IR[分别为:(7.58±0.84) mmol/L、(10.43±1.88) mmol/L、(7.56±1.15)％、4.55 ±0.76]均较术前显著下降[(9.93±1.57) mmol/L、(13.89 ±2.13) mmol/L、(9.88±1.66)％、5.06±1.13],手术前后比较差异均有统计学意义(P＜0.05或P＜0.01);术后6个月FPG为(6.56±0.80)mmol/L,2 hPG为(8.57±1.32) mmol/L,HbA1c为(6.37±1.24)％以及HOMA-IR为4.03 ±0.45,亦均低于术前、术后3个月(P＜0.05或P＜0.01).但术后3个月的FINS、FCP、2 hINS、2hCP[分别为:(13.67 ±1.96) mU/L、(2.62 ±0.87) μg/L、(49.91±5.14) mU/L、(6.28±1.65) μg/L]均较术前[分别为(11.08±1.69) mU/L、(1.78 ±0.61) μg/L、(36.05±4.03) mU/L、(4.28±1.48) μg/L]明显升高,差异均有统计学意义(P均＜0.01);术后6个月[FINS:(15.88±2.05) mU/L、FCP:(3.30±0.68) μg/L、2 hINS:(67.40±5.68) mU/L、2 hCP:(9.39±1.52) μg/L]均高于术前和术后3个月(P均＜0.01).结论采用Roux-en-Y胃肠转流术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 탐토Roux-en-Y위장전류술대위암합병2형당뇨병환자혈당급이도공능적영향.방법 선택아원행Roux-en-Y위장전류술치료적27례위암합병2형당뇨병환자,비교술전급술후3、6개월적체질량지수(BMI)、당화혈홍단백(HbA1c)、공복혈당(FPG)、공복이도소(FINS)、공복C태(FCP)적농도,검측병비교3개시간점구복75 g포도당2h후적혈당(2 hPG)、이도소(2 hINS)급C태(2hCP)수평,채용은태모식평고법평개이도소저항지수(HOMA-IR).결과 술후BMI무명현변화;술후3개월FPG、2 hPG、HbA1c、HOMA-IR[분별위:(7.58±0.84) mmol/L、(10.43±1.88) mmol/L、(7.56±1.15)％、4.55 ±0.76]균교술전현저하강[(9.93±1.57) mmol/L、(13.89 ±2.13) mmol/L、(9.88±1.66)％、5.06±1.13],수술전후비교차이균유통계학의의(P＜0.05혹P＜0.01);술후6개월FPG위(6.56±0.80)mmol/L,2 hPG위(8.57±1.32) mmol/L,HbA1c위(6.37±1.24)％이급HOMA-IR위4.03 ±0.45,역균저우술전、술후3개월(P＜0.05혹P＜0.01).단술후3개월적FINS、FCP、2 hINS、2hCP[분별위:(13.67 ±1.96) mU/L、(2.62 ±0.87) μg/L、(49.91±5.14) mU/L、(6.28±1.65) μg/L]균교술전[분별위(11.08±1.69) mU/L、(1.78 ±0.61) μg/L、(36.05±4.03) mU/L、(4.28±1.48) μg/L]명현승고,차이균유통계학의의(P균＜0.01);술후6개월[FINS:(15.88±2.05) mU/L、FCP:(3.30±0.68) μg/L、2 hINS:(67.40±5.68) mU/L、2 hCP:(9.39±1.52) μg/L]균고우술전화술후3개월(P균＜0.01).결론 채용Roux-en-Y위장전류술능유효강저위암합병2형당뇨병환자적혈당수평,명현개선이도β세포공능.
Objective To investigate the effect of gastrointestinal Roux-en-Y gastric bypass surgery on blood sugar and insulin function of patients with type-2 diabetes mellitus.Methods Twenty-seven cases of gastric cancer patients with type-2 diabetes and undergone Roux-en-Y bypass the gastrointestinal treatment in the centre hospital of Cangzhou were selected as our subject.Body mass index (BMI),Glycosylated hemoglobin (HBA1c),Fasting and glucose (FPG),fasting insulin (FINS),Fasting C-peptide (FCP) levels were measured.Glucose (2 hPG),insulin (2 hINS) and C-peptide (2 hCP) levels were detected after 2 h for oral use 75 g glucose.Homeostasis model was applied to assess insulin resistance index (HOMA-IR).Results No significant change was seen in terms of BMI between before and after surgery.Compared to before surgery,the levels of FPG((7.58 ±0.84) mmol/L),2 hPG((10.43 ± 1.88) mmol/L),HbA1c((7.56 ± 1.15)％) and HOMA-IR(4.55 ±0.76) were lower in patients at 3 months after surgery ((9.93 ± 1.57) mtmol/L,(13.89± 2.13) mtmol/L,(9.88 ± 1.66) ％,(4.55 ± 0.76),respectively,P ＜ 0.05 or P ＜ 0.01).FPG ((6.56± 0.80) mmol/L),2 hPG ((8.57 ± 1.32) mmol/L),HbA1 c ((6.37 ± 1.24) ％),HOMA-IR (4.03 ± 0.45)of patients after 6 months were lower than that of before surgery and 3 months after surgery (P ＜ 0.05 or P＜0.01).However,the levels of FINS ((13.67 ± 1.96) mU/L),FCP((2.62 ±0.87) μg/L),2 hINS((49.91± 5.14) mU/L) and 2 hCP ((6.28 ± 1.65) μg/L) were higher in patients with 3 months after surgery compared to that of before surgery ((11.08 ± 1.69) mU/L,(1.78 ± 0.61) μg/L,(36.05 ± 4.03) mU/L,(4.28 ± 1.48) μg/L,P ＜ 0.01).Meanwhile those indices after 6 months (FINS:(15.88 ± 2.05) mU/L,FCP:(3.30 ±0.68) μg/L,2 hINS:(67.40 ±5.68) mU/L,2 hCP:(9.39 ± 1.52) μg/L) were higher than that of before surgery and 3 months after surgery(P ＜ 0.01).Conclusion Roux-en-Y gastrointestinal bypass can effectively reduce blood sugar level and improve the situation of Pancreatic Beta-cell function of gastric cancer patients with type-2 diabetes.