Di Jianzhong, Zhang Hongwei, Yu Haoyong, Zhang Pin, Wang Zhigang, Jia Weiping
Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Surg Obes Relat Dis. 2016 Aug;12(7):1357-1363. doi: 10.1016/j.soard.2016.02.007. Epub 2016 Feb 12.
Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes (T2D) and morbid obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with a body mass index (BMI)<30 kg/m.
The objective of this study was to evaluate the 3-year effect of RYGB among patients with T2D with a BMI<30 kg/m and elucidate the predictors of T2D remission.
Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Sixty-six Chinese patients with T2D and a BMI 25-30 kg/m were retrospectively examined for metabolic outcomes 3 years after RYGB. Remission was defined as glycated hemoglobin (HbA1C)<6.5% and no medications. Binary logistic regression analysis was used to identify preoperative parameters independently predictive of diabetes remission at 1 and 3 years postoperatively [variables: sex, age, BMI, T2D duration, plasma glucose 2 hours after meal, HbA1C, fasting C-peptide, visceral fat area, free triiodothyronine, and thyroid-stimulating hormone. There was no significant difference in fasting insulin or glucose between the remission and no remission groups.
Patients were a mean 50.4±11.4 years of age at baseline, and 57.6% were female. Mean T2D duration was 8.9±5.2 years, baseline HbA1C level was 8.3±1.9%, and baseline BMI was 28.2±1.2 kg/m (range: 25.5-30.0). BMI was 22.5±1.8 kg/m (range: 19.1-28.0) at 1 year and 23.0±1.76 kg/m (range: 19.7-28.0) at 3 years. Remission was achieved in 49 patients (74.2%) at 1 year and 38 patients (57.6%) at 3 years. There was a significant reduction in medication for diabetes, hypertension, and hyperlipidemia (P<.01). Compared with patients in the no remission group, patients in the remission group had higher fasting C-peptide levels (P<.01) and free triiodothyronine levels (P = .01) at 1 year. Multiple logistic regression analysis confirmed that fasting C-peptide (odds ratio = 3.795, P = .007) and free triiodothyronine (odds ratio = 4.661, P = .019) levels were predictors of T2D remission at 1 year. No significant difference was found between the 2 groups at 3 years.
RYGB resulted in significant clinical and biochemical improvements in Chinese patients with BMI 25-30 kg/m and T2D. Appropriate patient selection (better β-cell function) may produce better outcomes.
Roux-en-Y胃旁路术（RYGB）是治疗2型糖尿病（T2D）合并病态肥胖患者的有效方法。然而，对于体重指数（BMI）<30kg/m²的中国患者，术后T2D缓解情况尚未得到充分研究。
本研究旨在评估RYGB对BMI<30kg/m²的T2D患者的3年疗效，并阐明T2D缓解的预测因素。
中国上海交通大学附属第六人民医院普通外科。
回顾性分析66例BMI为25-30kg/m²的中国T2D患者RYGB术后3年的代谢结局。缓解定义为糖化血红蛋白（HbA1C）<6.5%且无需药物治疗。采用二元逻辑回归分析确定术前参数对术后1年和3年糖尿病缓解的独立预测作用[变量：性别、年龄、BMI、T2D病程、餐后2小时血糖、HbA1C、空腹C肽、内脏脂肪面积、游离三碘甲状腺原氨酸、促甲状腺激素。缓解组和未缓解组的空腹胰岛素或血糖无显著差异。
患者基线时平均年龄为50.4±11.4岁，57.6%为女性。T2D平均病程为8.9±5.2年，基线HbA1C水平为8.3±1.9%，基线BMI为28.2±1.2kg/m²（范围：25.5-30.0）。1年时49例（74.2%）患者实现缓解，3年时38例（57.6%）患者实现缓解。糖尿病、高血压和高脂血症用药显著减少（P<.01）。与未缓解组患者相比，缓解组患者1年时空腹C肽水平更高（P<.01），游离三碘甲状腺原氨酸水平更高（P =.01）。多因素逻辑回归分析证实，空腹C肽（比值比=3.795，P =.007）和游离三碘甲状腺原氨酸（比值比=4.661，P =.019）水平是1年时T2D缓解的预测因素。3年时两组间无显著差异。
RYGB使BMI为25-30kg/m²的中国T2D患者在临床和生化方面有显著改善。选择合适的患者（更好的β细胞功能）可能会产生更好的结果。
