Department of General Surgery, Tianjin Nankai Hosptial, Tianjin, China.
Department of Endocrinology, General Hospital of Tianjin Medical University, Tianjin, China.
Artif Cells Nanomed Biotechnol. 2020 Dec;48(1):903-911. doi: 10.1080/21691401.2020.1770263.
To compare the clinical efficacy of gastric bypass in obese patients with T2DM with different BMI. Serum leptin, adiponectin, triglyceride (TG), cholesterol (CHOL) were measured as the indicators to show clinical efficacy after laparoscopic gastric bypass surgery (LRYGB). For patients with high BMI and patients with low BMI, the therapeutic effect of LRYGB surgical diabetes is more significant. The postoperative remission rate of diabetes in the high BMI group was not correlated with the preoperative lipid metabolism index but was positively correlated with the postoperative lipid metabolism index CHOL, TG, leptin, adiponectin. The postoperative remission rate of diabetes in the low BMI group was positively correlated with the preoperative abnormal lipid metabolism of the patients, and positively correlated with the postoperative remission of leptin and adiponectin, but was not correlated with the postoperative remission of total CHOL and TG. The increase of serum adiponectin level and the decrease of leptin resistance after LRYGB surgery restored the metabolic balance of leptin and adiponectin, improved insulin resistance (IR), and thus improved blood glucose level. Therefore, LRYGB has a definite therapeutic effect on obese patients with T2DM, and elevated adiponectin and improved leptin resistance are some of the mechanisms of surgical treatment of diabetes.
比较不同 BMI 的肥胖 2 型糖尿病（T2DM）患者行胃旁路术的临床疗效。以血清瘦素、脂联素、三酰甘油（TG）、胆固醇（CHOL）为指标，显示腹腔镜胃旁路手术（LRYGB）后的临床疗效。对于高 BMI 患者和低 BMI 患者，LRYGB 手术对糖尿病的治疗效果更为显著。高 BMI 组患者的糖尿病术后缓解率与术前脂代谢指标无相关性，而与术后脂代谢指标 CHOL、TG、瘦素、脂联素呈正相关。低 BMI 组患者的糖尿病术后缓解率与术前脂代谢异常呈正相关，与术后瘦素、脂联素的缓解呈正相关，与术后总 CHOL、TG 的缓解无相关性。LRYGB 术后血清脂联素水平升高、瘦素抵抗减轻，恢复了瘦素和脂联素的代谢平衡，改善了胰岛素抵抗（IR），从而改善了血糖水平。因此，LRYGB 对肥胖 T2DM 患者有明确的治疗作用，升高脂联素、改善瘦素抵抗是手术治疗糖尿病的部分机制。
