• 1.福建醫(yī)科大學(xué)福總臨床醫(yī)學(xué)院（南京軍區(qū)福州總醫(yī)院）普通外科(福州 350025);;
  • 2.福建醫(yī)科大學(xué)?？偱R床醫(yī)學(xué)院（南京軍區(qū)福州總醫(yī)院）內(nèi)分泌科(福州 350025);

目的  觀察胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效及其對(duì)胰高血糖素樣肽-1（GLP-1）的影響。方法  檢測(cè)分析32例胃潰瘍合并非肥胖型2型糖尿病患者行胃轉(zhuǎn)流術(shù)術(shù)前和術(shù)后第1周、2周、3周、1個(gè)月、3個(gè)月及6個(gè)月的體重指數(shù)（BMI），空腹及標(biāo)準(zhǔn)饅頭餐后2 h的血糖、胰島素及GLP-1水平，糖化血紅蛋白（HbA1c，僅測(cè)術(shù)前和術(shù)后第3及6個(gè)月）水平，穩(wěn)態(tài)模型-胰島β細(xì)胞功能指數(shù)（HBCI）水平及術(shù)后6個(gè)月的糖尿病轉(zhuǎn)歸情況。結(jié)果  胃轉(zhuǎn)流術(shù)后所有患者的空腹及餐后血糖均較術(shù)前逐漸降低（P＜0.05），空腹及餐后胰島素和GLP-1均較術(shù)前逐漸升高（P＜0.05）； HBCI較術(shù)前逐漸升高，HbA1c較術(shù)前逐漸下降（P＜0.05）； 患者術(shù)后各時(shí)間段BMI較術(shù)前均無(wú)明顯變化（P＞0.05）。GLP-1與血糖呈負(fù)相關(guān)（P＜0.05）,與胰島素呈正相關(guān)（P＜0.05）。術(shù)后6個(gè)月糖尿病總控制率為78.1%（25/32）。結(jié)論  胃轉(zhuǎn)流術(shù)能明顯降低非肥胖型2型糖尿病患者的血糖，其對(duì)血糖的控制不依賴于體重的降低； 胃轉(zhuǎn)流術(shù)控制血糖可能部分是通過(guò)增加GLP-1的分泌進(jìn)而促進(jìn)胰島素分泌而起作用。

引用本文： 鄧治洲,王烈,林憶陽(yáng),王瑜. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖素樣肽-1的影響. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6): 466-469. doi: 復(fù)制

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2. Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France: the ECODIA survey [Ｊ]. Diabetes Metab, 2000; 26(5): 363-369.
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5. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity [Ｊ]. Ann Surg, 2000; 232(4): 515-529.
6. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution [Ｊ]. J Clin Endocrinol Metab, 2004; 89(6): 2608-2615.
7. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
8. Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
9. Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes-a systematic review [Ｊ]. Diabetes Metab Res Rev, 2004; 20(6): 438-445.
10. 王瑜， 王燕婷， 王烈. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的治療作用 [Ｊ]. 中國(guó)普通外科雜志， 2008； 17(10)： 1003-1006.
11. 張新國(guó)， 楊學(xué)軍， 徐紅， 等. 手術(shù)治療2型糖尿病——回顧性臨床研究及近期臨床試用報(bào)告 [Ｊ]. 中華臨床醫(yī)學(xué)實(shí)踐雜志， 2005； 4(5)： 459-461.
12. 王湘輝， 李濤， 王海忠. Roux-en-Y胃轉(zhuǎn)流術(shù)治療Ⅱ型糖尿病 [Ｊ]. 西北國(guó)防醫(yī)學(xué)雜志， 2006； 27(4)： 298-299.
13. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus [Ｊ]. Diabetes Care, 2003; 26 Suppl 1: S5-S20.
14. 黃從云， 王建南， 彭淑牖， 等. 胃腸道漿肌層吻合、黏膜外吻合、一層吻合和二層吻合的實(shí)驗(yàn)比較研究 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007； 14(4)： 432-436.
15. 張偉， 趙高平， 楊春， 等. 胃腸道腫瘤合并糖尿病患者術(shù)后早期腸內(nèi)營(yíng)養(yǎng)支持及血糖控制 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2008； 15(6)： 444-447.
16. Mottin CC, Vontobel Padoin A, Schroer CE, et al. Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass [Ｊ]. Obes Surg, 2008; 18(2): 179-181.
17. Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective [Ｊ]. Obes Surg, 2005; 15(6): 751-757.
18. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [Ｊ]. Ann Surg, 2002; 235(5): 640-645.
19. Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type Ⅱ diabetes: a randomised trial [Ｊ]. Int J Obes Relat Metab Disord, 2003; 27(7): 797-802.
20. White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass [Ｊ]. Obes Surg, 2005; 15(2): 155-163.
21. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease [Ｊ]. Ann Surg, 2004; 239(1): 1-11.
22. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [Ｊ]. Obes Surg, 2004; 14(6): 840-848.
23. Zander M, Madsbad S, Madsen JL, et al. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study [Ｊ]. Lancet, 2002; 359(9309): 824-830.
24. Egan JM, Meneilly GS, Elahi D. Effects of 1-mo bolus subcutaneous administration of exendin-4 in type 2 diabetes [Ｊ]. Am J Physiol Endocrinol Metab, 2003; 284(6): E1072-E1079.
25. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes [Ｊ]. J Clin Endocrinol Metab, 2008; 93(7): 2479-2485.
26. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes [Ｊ]. Diabetes Care, 2007; 30(7): 1709-1716.
  1. 1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 [Ｊ]. Diabetes Care， 2004; 27(5): 1047-1053.
  2. 2. Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France: the ECODIA survey [Ｊ]. Diabetes Metab, 2000; 26(5): 363-369.
  3. 3. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus [Ｊ]. Ann Surg, 2002; 236(5): 554-559.
  4. 4. Greenway SE, Greenway FL 3rd, Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus [Ｊ]. Arch Surg, 2002; 137(10): 1109-1117.
  5. 5. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity [Ｊ]. Ann Surg, 2000; 232(4): 515-529.
  6. 6. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution [Ｊ]. J Clin Endocrinol Metab, 2004; 89(6): 2608-2615.
  7. 7. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
  8. 8. Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
  9. 9. Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes-a systematic review [Ｊ]. Diabetes Metab Res Rev, 2004; 20(6): 438-445.
  10. 10. 王瑜， 王燕婷， 王烈. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的治療作用 [Ｊ]. 中國(guó)普通外科雜志， 2008； 17(10)： 1003-1006.
  11. 11. 張新國(guó)， 楊學(xué)軍， 徐紅， 等. 手術(shù)治療2型糖尿病——回顧性臨床研究及近期臨床試用報(bào)告 [Ｊ]. 中華臨床醫(yī)學(xué)實(shí)踐雜志， 2005； 4(5)： 459-461.
  12. 12. 王湘輝， 李濤， 王海忠. Roux-en-Y胃轉(zhuǎn)流術(shù)治療Ⅱ型糖尿病 [Ｊ]. 西北國(guó)防醫(yī)學(xué)雜志， 2006； 27(4)： 298-299.
  13. 13. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus [Ｊ]. Diabetes Care, 2003; 26 Suppl 1: S5-S20.
  14. 14. 黃從云， 王建南， 彭淑牖， 等. 胃腸道漿肌層吻合、黏膜外吻合、一層吻合和二層吻合的實(shí)驗(yàn)比較研究 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007； 14(4)： 432-436.
  15. 15. 張偉， 趙高平， 楊春， 等. 胃腸道腫瘤合并糖尿病患者術(shù)后早期腸內(nèi)營(yíng)養(yǎng)支持及血糖控制 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2008； 15(6)： 444-447.
  16. 16. Mottin CC, Vontobel Padoin A, Schroer CE, et al. Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass [Ｊ]. Obes Surg, 2008; 18(2): 179-181.
  17. 17. Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective [Ｊ]. Obes Surg, 2005; 15(6): 751-757.
  18. 18. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [Ｊ]. Ann Surg, 2002; 235(5): 640-645.
  19. 19. Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type Ⅱ diabetes: a randomised trial [Ｊ]. Int J Obes Relat Metab Disord, 2003; 27(7): 797-802.
  20. 20. White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass [Ｊ]. Obes Surg, 2005; 15(2): 155-163.
  21. 21. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease [Ｊ]. Ann Surg, 2004; 239(1): 1-11.
  22. 22. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [Ｊ]. Obes Surg, 2004; 14(6): 840-848.
  23. 23. Zander M, Madsbad S, Madsen JL, et al. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study [Ｊ]. Lancet, 2002; 359(9309): 824-830.
  24. 24. Egan JM, Meneilly GS, Elahi D. Effects of 1-mo bolus subcutaneous administration of exendin-4 in type 2 diabetes [Ｊ]. Am J Physiol Endocrinol Metab, 2003; 284(6): E1072-E1079.
  25. 25. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes [Ｊ]. J Clin Endocrinol Metab, 2008; 93(7): 2479-2485.
  26. 26. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes [Ｊ]. Diabetes Care, 2007; 30(7): 1709-1716.