胃旁路术后的长期糖尿病反应。
Long-term diabetic response to gastric bypass.
机构信息
Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
Department of Public Health, Biostatistics Unit, Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
出版信息
J Surg Res. 2014 Aug;190(2):498-503. doi: 10.1016/j.jss.2014.01.047. Epub 2014 Jan 29.
BACKGROUND
As obesity and type II diabetes continue to rise, bariatric surgery offers a solution, but few long-term studies are available. The purpose of this study was to evaluate the long-term outcomes of diabetic patients after gastric bypass.
MATERIALS AND METHODS
This was a retrospective cohort study of all diabetic patients undergoing gastric bypass at our institution, from 1998 to 2012. Patients were compared by postoperative diabetic response to treatment (i.e., response = off oral medication/insulin versus refractory = on oral medication/insulin) and followed at 1-, 3-, 5-, and 10-y intervals. Continuous data were analyzed using Student t-test or Wilcoxon rank-sum test. Multivariable, Cox proportional hazard regression model was performed to compute diabetic cure ratios and 95% confidence intervals.
RESULTS
A total of 2454 bariatric surgeries were performed at our institution during the time period. A total of 707 diabetic patients were selected by Current Procedural Terminology codes for gastric bypass. Mean follow-up was 2.1 y. Incidence of diabetic response was 56% (1 y), 58% (3 y), 60% (5 y), and 44% (10 y). Postoperatively, responsive patients experienced greater percentage of total body weight loss (1 y [P < 0.0001], 3 y [P = 0.0087], and 5 y [P = 0.013]), and less hemoglobin A1c levels (1 y [P = 0.035] and 3 y [P = 0.040]) at follow-up than refractory patients. Multivariable analysis revealed a significant, independent inverse trend in incidence of diabetic cure as both age and body mass index decreased (Ptrend = 0.0019 and <0.0001, respectively). In addition, degenerative joint disease was independently associated with responsive diabetes (cure ratio = 1.6 [95% confidence interval = 1.1-2.2]).
CONCLUSIONS
At follow-up, both groups in our study experienced substantial weight loss; however, a greater loss was observed among the response group. Further research is needed to evaluate methods for optimizing patient care preoperatively and improving patient follow-up.
背景
随着肥胖症和 II 型糖尿病的不断增加，减重手术提供了一种解决方案，但目前可用的长期研究很少。本研究的目的是评估胃旁路术后糖尿病患者的长期结果。
材料和方法
这是一项对我院 1998 年至 2012 年所有接受胃旁路手术的糖尿病患者进行的回顾性队列研究。根据术后糖尿病治疗反应（即反应=停用口服药物/胰岛素与难治性=口服药物/胰岛素）将患者进行比较，并在 1、3、5 和 10 年时进行随访。使用学生 t 检验或 Wilcoxon 秩和检验分析连续数据。使用多变量 Cox 比例风险回归模型计算糖尿病治愈率和 95%置信区间。
结果
在研究期间，我院共进行了 2454 例减重手术。根据胃旁路术的当前程序术语代码，共选择了 707 例糖尿病患者。平均随访时间为 2.1 年。糖尿病反应发生率为 56%（1 年）、58%（3 年）、60%（5 年）和 44%（10 年）。术后，反应性患者的体重总减轻百分比更高（1 年[P<0.0001]、3 年[P=0.0087]和 5 年[P=0.013]），且血红蛋白 A1c 水平更低（1 年[P=0.035]和 3 年[P=0.040]）。多变量分析显示，随着年龄和体重指数的降低，糖尿病治愈率呈显著、独立的反向趋势（Ptrend=0.0019 和<0.0001）。此外，退行性关节病与反应性糖尿病独立相关（治愈率=1.6[95%置信区间=1.1-2.2]）。
结论
在随访时，我们研究中的两组患者都经历了显著的体重减轻；然而，反应组的体重减轻更大。需要进一步研究以评估术前优化患者护理和改善患者随访的方法。
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