胃旁路手术可改善糖尿病神经病变，与血糖正常化无关——前瞻性队列研究（DiaSurg1 研究）结果。
Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization--results of a prospective cohort study (DiaSurg 1 study).
机构信息
*Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany †Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany ‡Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany.
出版信息
Ann Surg. 2013 Nov;258(5):760-5; discussion 765-6. doi: 10.1097/SLA.0b013e3182a618b2.
OBJECTIVE
Surprisingly, 40% to 95% of patients with type 2 diabetes mellitus (T2DM) show early remission of hyperglycemia after obesity surgery. It is unknown to what extent other diabetes-associated comorbidities such as distal peripheral neuropathy (DPN) might be influenced by obesity surgery. This pilot study aimed at providing further evidence for the impact of Roux-en-Y gastric bypass (RYGB) on both glycemic control and DPN in non-severely obese patients with insulin-dependent T2DM.
METHODS
In the present prospective cohort study, 20 patients with long-standing, insulin-dependent T2DM and a body mass index (BMI) between 25 and 35 kg/m underwent laparoscopic RYGB. Body mass index, glycosylated hemoglobin (HbA1c), and DPN [quantified by the Neuropathy Symptom Score (NSS) and the Neuropathy Deficit Score (NDS)] were investigated.
RESULTS
Six months after surgery, the preoperative BMI of 32.8 ± 2.1 kg/m (mean ± standard deviation) dropped to 25.6 ± 2.5 kg/m (P < 0.001). Preoperative HbA1c levels decreased from 8.5 ± 1.2% to 7.1 ± 1.2% (P < 0.001), with 15% of patients having a normalized HbA1c level lower than 6.2%. Of 12 patients with documented DPN, the median NSS was 8 (range, 0-10) preoperatively and 0 (range, 0-9) postoperatively (P = 0.004), with 8 patients scoring an NSS of 0. The median NDS was 6 (range, 2-8) preoperatively and 4 (range, 0-8) postoperatively (P = 0.027), with 1 patient scoring an NDS of 0. All patients had an improvement or normalization in either 1 or both scores.
CONCLUSIONS
As expected, BMI and HbA1c levels improved significantly after RYGB. More interestingly, neuropathy scores, such as NSS and NDS, improved significantly early after surgery. Symptomatic neuropathy was completely reversible in 67% of the patients. These findings add further evidence to the fact that RYGB might be a valuable treatment option not only for improving glycemic control but also for reducing diabetes-associated comorbidities, such as DPN. This points to a complex metabolic effect of RYGB that exceeds glucose normalization. However, the results still need to be confirmed in controlled trials.
目的
令人惊讶的是，40%至 95%的 2 型糖尿病（T2DM）患者在肥胖手术后会早期缓解高血糖。目前尚不清楚肥胖手术对其他糖尿病相关合并症（如远端周围神经病变[DPN]）的影响程度。本研究旨在为 Roux-en-Y 胃旁路术（RYGB）对非重度肥胖胰岛素依赖型 2 型糖尿病患者的血糖控制和 DPN 的影响提供进一步的证据。
方法
在本前瞻性队列研究中，20 例长期、胰岛素依赖的 T2DM 患者，BMI 在 25 至 35 kg/m2 之间，接受腹腔镜 RYGB 手术。测量体重指数（BMI）、糖化血红蛋白（HbA1c）和 DPN[通过神经症状评分（NSS）和神经缺陷评分（NDS）量化]。
结果
术后 6 个月，术前 BMI 从 32.8 ± 2.1 kg/m2（平均值 ± 标准差）降至 25.6 ± 2.5 kg/m2（P < 0.001）。术前 HbA1c 水平从 8.5 ± 1.2%降至 7.1 ± 1.2%（P < 0.001），15%的患者 HbA1c 水平正常，低于 6.2%。在 12 例有记录的 DPN 患者中，术前 NSS 中位数为 8（范围为 0-10），术后为 0（范围为 0-9）（P = 0.004），8 例患者的 NSS 为 0。术前 NDS 中位数为 6（范围为 2-8），术后为 4（范围为 0-8）（P = 0.027），1 例患者的 NDS 为 0。所有患者的评分在 1 项或 2 项评分中均有改善或正常化。
结论
正如预期的那样，RYGB 后 BMI 和 HbA1c 水平显著改善。更有趣的是，神经病变评分，如 NSS 和 NDS，术后早期显著改善。67%的患者症状性神经病变完全可逆。这些发现进一步证明，RYGB 不仅是改善血糖控制的有效治疗选择，而且还可降低糖尿病相关合并症（如 DPN）。这表明 RYGB 具有复杂的代谢效应，超出了血糖正常化的范围。然而，这些结果仍需要在对照试验中得到证实。
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