肥胖 2 型糖尿病患者行袖状胃切除术和 Roux-en-Y 胃旁路术后的血糖控制。

Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus.

机构信息

Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Department of Endocrinology, Diabetology, and Metabolism, University of Antwerp, Antwerp, Belgium.

出版信息

Obes Surg. 2018 Jun;28(6):1461-1472. doi: 10.1007/s11695-017-3061-3.

BACKGROUND

Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG.

METHODS

Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery.

RESULTS

Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline-8.1 ± 0.6 vs. 8.2 ± 0.4 mmol/l, 2 days-7.8 ± 0.5 vs. 7.4 ± 0.3 mmol/l, 3 weeks-6.6 ± 0.4 vs. 6.6 ± 0.3 mmol/l, respectively, P < 0.01 vs. baseline for both groups; 12 months-6.6 ± 0.4 vs. 5.9 ± 0.4, respectively, P < 0.05 for LRYGB and P < 0.001 for LSG vs. baseline, P = ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean ± SEM; LSG + 58 ± 14%, P < 0.01; LRYGB - 8 ± 17%, P = ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525 ± 1258 vs. 4779 ± 712 pmol × min, respectively, P < 0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (- 10.1 ± 0.9 vs. - 7.9 ± 0.5 kg/m, respectively, P < 0.05).

CONCLUSION

LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.

背景

Roux-en-Y 胃旁路术（LRYGB）对肥胖 2 型糖尿病患者的血糖具有与体重无关的作用，而袖状胃切除术（LSG）的作用则不太明确。本研究旨在比较 LRYGB 和 LSG 的早期与晚期与体重无关的血糖作用。

方法

研究纳入了 18 例 LRYGB 和 15 例 LSG 患者。在手术前和手术后 2 天、3 周和 12 个月进行改良 30g 口服葡萄糖耐量试验时，监测血糖、胰岛素、GLP-1 和 GIP 水平。患者在手术前后 2 周内自行监测血糖水平。

结果

两组术后空腹血糖均相似下降（LRYGB 组与 LSG 组：基线-8.1±0.6mmol/L 与 8.2±0.4mmol/L，2 天-7.8±0.5mmol/L 与 7.4±0.3mmol/L，3 周-6.6±0.4mmol/L 与 6.6±0.3mmol/L，两组均 P<0.01 与基线相比；12 个月-6.6±0.4mmol/L 与 5.9±0.4mmol/L，LRYGB 组 P<0.05，LSG 组 P<0.001 与基线相比，两组间任何时间点 P=ns）。与 LRYGB 相比，LSG 在术后 2 天显示出更高的胰岛素峰值水平（均值±SEM；LSG+58±14%，P<0.01；LRYGB-8±17%，P=ns）。GLP-1 水平在 2 天内相似增加，但在 3 周时 LRYGB 更高（AUC；7525±1258 与 4779±712pmol×min，分别为 P<0.05）。GIP 水平无差异。LRYGB 术后体重指数（BMI）下降幅度大于 LSG（-10.1±0.9kg/m2 与-7.9±0.5kg/m2，P<0.05）。