腹腔镜迷你胃旁路术治疗2型糖尿病的效果：体重指数>35与<35kg/m²的比较
Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI>35 and <35 kg/m2.
作者信息
Lee Wei-Jei, Wang Weu, Lee Yi-Chih, Huang Ming-Te, Ser Kong-Han, Chen Jung-Chien
机构信息
Department of Surgery, Min-Sheng General Hospital, and Department of International Business, Ching Yun University, Taoyuan, Taiwan, Republic of China.
出版信息
J Gastrointest Surg. 2008 May;12(5):945-52. doi: 10.1007/s11605-007-0319-4. Epub 2007 Oct 16.
BACKGROUND
Laparoscopic gastric bypass resulted in significant weight loss and resolution of type 2 diabetes mellitus (T2DM). The current indication for bariatric surgery is mainly applied for patients with body mass index (BMI)>35 kg/m2 with comorbidity status. However, little is known concerning T2DM patients with BMI<35 kg/m2. Recent studies have suggested that T2DM patients with BMI<35 kg/m2 might benefit from gastric bypass surgery.
METHODS
From Jan 2002 to Dec 2006, 820 patients who underwent laparoscopic mini-gastric bypass were enrolled in a surgically supervised weight loss program. We identified 201 (24.5%) patients who had impaired fasting glucose or T2DM. All the clinical data were prospectively collected and stored. Patients with BMI<35 kg/m2 were compared with those of BMI>35 kg/m2. Successful treatment of T2DM was defined by HbA1C<7.0%, LDL<100 mg/dl, and triglyceride<150 mg/dl.
RESULTS
Among the 201 patients, 44 (21.9%) had BMI<35 kg/m2, and 114 (56.7%) had BMI between 35 and 45, 43 (21.4%) had BMI>45 kg/m2. Patients with BMI<35 kg/m2 are significantly older, female predominant, had lower liver enzyme and C-peptide levels than those with BMI>35 kg/m2. The mean total weight loss for the population was 32.1, 33.4, 31.9, and 32.8% (at 1, 2, 3, 5 years after surgery), and percentage to change in BMI was 31.9, 34.2, 32.2, and 29.5% at 1, 2, 3, and 5 years. One year after surgery, fasting plasma glucose returned to normal in 89.5% of BMI<35 kg/m2 T2DM and 98.5% of BMI>35 kg/m2 patients (p=0.087). The treatment goal of T2DM (HbA1C<7.0%, LDL<150 mg/dl and triglyceride<150 mg/dl) was met in 76.5% of BMI<35 kg/m2 and 92.4% of BMI>350 kg/m2 (p=0.059).
CONCLUSION
Laparoscopic gastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%. Despite a slightly lower response rate of T2DM treatment, patients with BMI <35 still had an acceptable DM resolution, and this treatment option can be offered to this group of patients.
背景
腹腔镜胃旁路手术可显著减轻体重并缓解2型糖尿病（T2DM）。目前减肥手术的适应症主要适用于体重指数（BMI）>35kg/m²且伴有合并症的患者。然而，对于BMI<35kg/m²的T2DM患者知之甚少。最近的研究表明，BMI<35kg/m²的T2DM患者可能从胃旁路手术中获益。
方法
从2002年1月至2006年12月，820例行腹腔镜迷你胃旁路手术的患者纳入一项手术监督的减肥计划。我们确定了201例（24.5%）空腹血糖受损或患有T2DM的患者。所有临床数据均前瞻性收集并存储。将BMI<35kg/m²的患者与BMI>35kg/m²的患者进行比较。T2DM的成功治疗定义为糖化血红蛋白（HbA1C）<7.0%、低密度脂蛋白（LDL）<100mg/dl和甘油三酯<150mg/dl。
结果
在这201例患者中，44例（21.9%）BMI<35kg/m²，114例（56.7%）BMI在35至45之间，43例（21.4%）BMI>45kg/m²。BMI<35kg/m²的患者比BMI>35kg/m²的患者年龄显著更大，女性居多，肝酶和C肽水平更低。总体人群术后1、2、3、5年的平均体重减轻分别为32.1%、33.4%、31.9%和32.8%，BMI变化百分比在术后1、2、3、5年分别为31.9%、34.2%、32.2%和29.5%。术后1年，BMI<35kg/m²的T2DM患者中89.5%的空腹血糖恢复正常，BMI>35kg/m²的患者中这一比例为98.5%（p=0.087）。BMI<35kg/m²的患者中76.5%达到了T2DM的治疗目标（HbA1C<7.0%、LDL<150mg/dl和甘油三酯<150mg/dl），BMI>350kg/m²的患者中这一比例为92.4%（p=0.059）。
结论
腹腔镜胃旁路手术可显著且持续减轻体重，T2DM的成功治疗率高达87.1%。尽管T2DM治疗的缓解率略低，但BMI<35的患者糖尿病缓解情况仍可接受，可将这种治疗选择提供给这组患者。
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