Malapan Kirubakaran, Goel Rajat, Tai Chi-Ming, Kao Yu-Hsi, Chang Po-Chih, Huang Chih-Kun
Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan.
Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan; Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Surg Obes Relat Dis. 2014 Sep-Oct;10(5):834-40. doi: 10.1016/j.soard.2014.01.018. Epub 2014 Jan 28.
The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up.
Between June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI)<27 kg/m(2)) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c)<6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed.
All clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL)-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) = 1.13, 95% CI = 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers.
LRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating β-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better β-cell function and evidence from long-term follow-up may justify this therapeutic approach.
腹腔镜Roux-en-Y胃旁路术（LRYGB）对病态肥胖的2型糖尿病（T2 DM）患者的有益作用已得到证实；然而，几乎没有证据支持其对非肥胖T2 DM亚洲患者的有效性。本研究的目的是评估LRYGB对非肥胖T2 DM患者的影响，并阐明随访一年后糖尿病缓解的预测因素。
2009年6月至2011年5月，纳入29例接受LRYGB的非肥胖（体重指数（BMI）<27 kg/m²）亚洲T2 DM患者。所有患者均进行前瞻性随访一年。术前及LRYGB术后一年收集基线人口统计学特征、糖尿病状态以及临床和生化数据。糖尿病缓解定义为糖化血红蛋白（HbA1 c）<6.5%且未使用口服降糖药（OHA）/胰岛素的患者。将糖尿病缓解组的结果与未缓解组进行比较并分析。
除尿酸外，所有临床和生化参数均有显著改善。11例患者（37.9%）实现糖尿病缓解，其中5例（45.5%）为男性。血糖、HbA1 c、C肽、稳态模型评估（HOMA-%B）和低密度脂蛋白（LDL）胆固醇是糖尿病缓解患者的显著变量；然而，多因素logistic回归显示，只有术前HOMA-%B（比值比（OR）=1.13，95%置信区间（CI）=1.03 - 1.24）是糖尿病缓解的预测因素。虽未观察到死亡病例，但并发症发生率为20.7%，其中17.3%与边缘性溃疡有关。
LRYGB使非肥胖亚洲患者的临床和生化指标得到显著改善，HOMA-%B作为β细胞功能指标是T2 DM缓解的主要预测因素。选择β细胞功能较好的合适患者并进行长期随访的证据可能证明这种治疗方法的合理性。
