中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
15期
2808-2811
,共4页
糖尿病,2型%胰高血糖素样肽1%葡萄糖依赖性胰岛素释放肽
糖尿病,2型%胰高血糖素樣肽1%葡萄糖依賴性胰島素釋放肽
당뇨병,2형%이고혈당소양태1%포도당의뢰성이도소석방태
Diabetes melitus,type 2%Glucagon-like peptide 1%Gastric inhibitory polypeptide
目的：研究Roux-en-Y胃大部切除术后糖尿病的缓解并探讨具体的机制。方法15例非肥胖2型糖尿病患者合并上消化道溃疡或胃癌，接受Roux-en-Y胃大部切除术，在基线、术后1周和4周行75 g口服葡萄糖耐量试验（OGTT），检测血糖、胰高血糖素样肽-1（GLP-1）、血葡萄糖依赖性胰岛素释放肽（GIP）、血清胰岛素、C肽，测体重，计算HOMA-IR。结果术后1周、4周未发现明显体重下降，术1周GLP-1曲线下面积（AUC）较术前显著增加[（867.5±142.6）pmol/L vs.（485.1±117.1）pmol/L，P＜0.01]，术后4周GLP-1 AUC亦较术前显著增加[（922.8±131.3） pmol/Lvs.（485.1±117.1）pmol/L，P＜0.01]，术后1周GIP AUC较术前明显降低[（2939±791.3） pmol/Lvs.（5305±1047）pmol/L，P＜0.01]，术后4周GIP AUC亦较术前显著增加[（2143±811.1） pmol/Lvs.（5305±1047）pmol/L，P＜0.01]，术后胰岛素抵抗明显改善。结论Roux-en-Y胃大部切除术后胰岛素抵抗的改善、GLP-1分泌的改善、胰岛素和GIP分泌的正常化参与了非肥胖2型糖尿病的缓解。
目的：研究Roux-en-Y胃大部切除術後糖尿病的緩解併探討具體的機製。方法15例非肥胖2型糖尿病患者閤併上消化道潰瘍或胃癌，接受Roux-en-Y胃大部切除術，在基線、術後1週和4週行75 g口服葡萄糖耐量試驗（OGTT），檢測血糖、胰高血糖素樣肽-1（GLP-1）、血葡萄糖依賴性胰島素釋放肽（GIP）、血清胰島素、C肽，測體重，計算HOMA-IR。結果術後1週、4週未髮現明顯體重下降，術1週GLP-1麯線下麵積（AUC）較術前顯著增加[（867.5±142.6）pmol/L vs.（485.1±117.1）pmol/L，P＜0.01]，術後4週GLP-1 AUC亦較術前顯著增加[（922.8±131.3） pmol/Lvs.（485.1±117.1）pmol/L，P＜0.01]，術後1週GIP AUC較術前明顯降低[（2939±791.3） pmol/Lvs.（5305±1047）pmol/L，P＜0.01]，術後4週GIP AUC亦較術前顯著增加[（2143±811.1） pmol/Lvs.（5305±1047）pmol/L，P＜0.01]，術後胰島素牴抗明顯改善。結論Roux-en-Y胃大部切除術後胰島素牴抗的改善、GLP-1分泌的改善、胰島素和GIP分泌的正常化參與瞭非肥胖2型糖尿病的緩解。
목적：연구Roux-en-Y위대부절제술후당뇨병적완해병탐토구체적궤제。방법15례비비반2형당뇨병환자합병상소화도궤양혹위암，접수Roux-en-Y위대부절제술，재기선、술후1주화4주행75 g구복포도당내량시험（OGTT），검측혈당、이고혈당소양태-1（GLP-1）、혈포도당의뢰성이도소석방태（GIP）、혈청이도소、C태，측체중，계산HOMA-IR。결과술후1주、4주미발현명현체중하강，술1주GLP-1곡선하면적（AUC）교술전현저증가[（867.5±142.6）pmol/L vs.（485.1±117.1）pmol/L，P＜0.01]，술후4주GLP-1 AUC역교술전현저증가[（922.8±131.3） pmol/Lvs.（485.1±117.1）pmol/L，P＜0.01]，술후1주GIP AUC교술전명현강저[（2939±791.3） pmol/Lvs.（5305±1047）pmol/L，P＜0.01]，술후4주GIP AUC역교술전현저증가[（2143±811.1） pmol/Lvs.（5305±1047）pmol/L，P＜0.01]，술후이도소저항명현개선。결론Roux-en-Y위대부절제술후이도소저항적개선、GLP-1분비적개선、이도소화GIP분비적정상화삼여료비비반2형당뇨병적완해。
ObjectiveThis study was conducted to determine improvement in glycemic control and entero-insular axis after subtotal gastrectomy and Roux-en-Y gastrojejunostomy in diabetic patients. Methods15 non-obese type 2 diabetic patients underwent subtotal gastrectomy and ROUX-en-Y gastrojejunostomy. OGTT was performed at baseline and at 1 and 4 weeks after surgery. Plasma levels of glucose, glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP), serum levels of insulin, C-peptide were measured. Weight, HOMA-IR were measured or calculated.ResultsThere were no significant weight loss at 1 week and 4 weeks after subtotal gastrectomy and ROUX-en-Y gastrojejunostomy. But significant decrease in fasting plasma glucose levels and glucose AUC during the OGTT after surgery was observed. GLP-1 AUC increased significantly while insulin, C-peptide and GIP AUC decreased significantly after surgery. An improvement in insulin sensitivity (HOMA-IR) was found after surgery.ConclusionsImprovement in insulin sensitivity and GLP-1 secretion, normalization of insulin and GIP secretion after subtotal gastrectomy and Roux-en-Y gastrojejunostomy play an important role on glucose metabolism in non-obese type 2 diabetic patients.
