CAJ | 학술논문

目的：探讨胃旁路术（ gastric bypass，GBP）治疗不同体重指数（ body mass index，BMI）的2型糖尿病（type 2 diabetes mellitus，T2DM）的临床效果。方法将宝鸡人民医院2012年9月至2013年7月间行手术治疗的T2DM分为2组：肥胖组BMI≥28 kg／m2）16例，超重组（ BMI＜28 kg／m2）21例，均行GBP。观察术后3、6个月患者空腹血糖（ FPG）、胰岛素抵抗指数（ HOMA-IR）、胰岛素刺激释放（ INS）、C肽释放、BMI、糖化血红蛋白（HbA1c）变化。结果术后3个月INS、C肽较术前均好转（P＜0.05），术后6个月基本接近正常值；术后3个月HbA1c与术前比较明显下降（P＜0.05），术后6个月基本接近正常值；HO-MA-IR与术前比较差异有统计学意义，同时肥胖组差异有统计学意义（ P＜0.05）；术后3个月肥胖组体重较术前明显下降，术后6个月肥胖组体重下降达稳态，BMI＜25 kg／m2达到15例（93.7％），差异有统计学意义（P＜0.05），超重组体重有所下降，但差异无统计学意义（P＞0.05）。肥胖组术后3、6个月血糖均不同程度下降，术后6个月肥胖组有效率92％，超重组有效率78％，2组总有效率90％。结论 GBP对不同BMI的T2DM均有明显治疗价值，但肥胖组显效优于超重组；GBP治疗T2DM疗效有效，值得临床推广。
목적：탐토위방로술（ gastric bypass，GBP）치료불동체중지수（ body mass index，BMI）적2형당뇨병（type 2 diabetes mellitus，T2DM）적림상효과。방법장보계인민의원2012년9월지2013년7월간행수술치료적T2DM분위2조：비반조BMI≥28 kg／m2）16례，초중조（ BMI＜28 kg／m2）21례，균행GBP。관찰술후3、6개월환자공복혈당（ FPG）、이도소저항지수（ HOMA-IR）、이도소자격석방（ INS）、C태석방、BMI、당화혈홍단백（HbA1c）변화。결과술후3개월INS、C태교술전균호전（P＜0.05），술후6개월기본접근정상치；술후3개월HbA1c여술전비교명현하강（P＜0.05），술후6개월기본접근정상치；HO-MA-IR여술전비교차이유통계학의의，동시비반조차이유통계학의의（ P＜0.05）；술후3개월비반조체중교술전명현하강，술후6개월비반조체중하강체은태，BMI＜25 kg／m2체도15례（93.7％），차이유통계학의의（P＜0.05），초중조체중유소하강，단차이무통계학의의（P＞0.05）。비반조술후3、6개월혈당균불동정도하강，술후6개월비반조유효솔92％，초중조유효솔78％，2조총유효솔90％。결론 GBP대불동BMI적T2DM균유명현치료개치，단비반조현효우우초중조；GBP치료T2DM료효유효，치득림상추엄。
Objective To investigate the clinical effects of gastric bypass( GBP) on type 2 diabetes mel-litus(type 2 diabetes mellitus, T2DM)patients with different body mass index(BMI).Methods T2DM patients undergoing GBP from Sep.2012 to Jul.2013 were divided into 2 groups:obese group( BMI≥28 kg/m2 , 16 ca-ses)and overweight group(BMI<28 kg/m2,21 cases).Changes of fasting plasma glucose(FPG), insulin resist-ance index(HOMA-IR)and insulin stimulation release(INS), C peptide release, BMI, glycosylated hemoglobin ( HbA1c) at 3 and 6 months after surgery were observed.Results INS and C peptide improved 3 months after surgery(P<0.05),and they were close to normal at 6 months after surgery.HbA1c significantly decreased 3 months after surgery compared with that before surgery( P<0.05) and it was close to normal at 6 months after sur-gery.Patients in obese group had significantly declined weight 3 months after surgery compared with that before surgery, and reached the steady state 6 months after surgery.15 cases(93.7%) in the obese group had BMI<25 kg/m2 , and the difference had statistical significance ( P<0.05 ) .Patients in the overweight group had their weight declined but no statistical difference was found(P>0.05).Blood sugar in the obese group decreased with different degrees at 3 and 6 months after surgery.The effective rate was 92%for the obese group and 78%for the overweight group.The overall effective rate was 90%.Conclusion GBP has significant therapeutic value for T2DM patients with different BMI, especially for patients in obese group, which is worth of clinical promotion.