Lee Young Ki, Lee Eun Kyung, Lee You Jin, Eom Bang Wool, Yoon Hong Man, Kim Young-Il, Cho Soo Jeong, Lee Jong Yeul, Kim Chan Gyoo, Kong Sun-Young, Yoo Min Kyong, Hwangbo Yul, Kim Young-Woo, Choi Il Ju, Kim Hak Jin, Kwak Mi Hyang, Ryu Keun Won
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea.
Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea.
J Clin Med. 2021 Sep 4;10(17):4008. doi: 10.3390/jcm10174008.
We evaluated the metabolic effects of gastrectomies and endoscopic submucosal dissections (ESDs) in early gastric cancer (EGC) patients with type 2 diabetes mellitus (T2DM). Forty-one EGC patients with T2DM undergoing gastrectomy or ESD were prospectively evaluated. Metabolic parameters in the patients who underwent gastrectomy with and without a duodenal bypass (groups 1 and 2, = 24 and = 5, respectively) were compared with those in patients who underwent ESD (control, = 12). After 1 year, the proportions of improved/equivocal/worsened glycemic control were 62.5%/29.2%/8.3% in group 1, 40.0%/60.0%/0.0% in group 2, and 16.7%/50.0%/33.3% in the controls, respectively ( = 0.046). The multivariable ordered logistic regression analysis results showed that both groups had better 1-year glycemic control. Groups 1 and 2 showed a significant reduction in postprandial glucose (-97.9 and -67.8 mg/dL), body mass index (-2.1 and -2.3 kg/m), and glycosylated hemoglobin (group 1 only, -0.5% point) (all < 0.05). Furthermore, improvements in group 1 were more prominent when preoperative leptin levels were high ( for interaction < 0.05). Metabolic improvements in both groups were also observed for insulin resistance, leptin, plasminogen activator inhibitor-1, and resistin. Gastrectomy improved glycemic control and various metabolic parameters in EGC patients with T2DM. Patients with high leptin levels may experience greater metabolic benefits from gastrectomy with duodenal bypass.
我们评估了胃切除术和内镜黏膜下剥离术（ESD）对2型糖尿病（T2DM）早期胃癌（EGC）患者的代谢影响。对41例接受胃切除术或ESD的T2DM EGC患者进行了前瞻性评估。将行十二指肠转流胃切除术患者（第1组和第2组，分别为24例和5例）与行ESD患者（对照组，12例）的代谢参数进行比较。1年后，第1组血糖控制改善/无变化/恶化的比例分别为62.5%/29.2%/8.3%，第2组为40.0%/60.0%/0.0%，对照组为16.7%/50.0%/33.3%（P = 0.046）。多变量有序逻辑回归分析结果显示，两组1年血糖控制均较好。第1组和第2组餐后血糖（分别降低97.9和67.8mg/dL）、体重指数（分别降低2.1和2.3kg/m²）和糖化血红蛋白（仅第1组，降低0.5个百分点）均显著降低（均P < 0.05）。此外，术前瘦素水平高时，第1组的改善更显著（交互作用P < 0.05）。两组在胰岛素抵抗、瘦素、纤溶酶原激活物抑制剂-1和抵抗素方面也观察到代谢改善。胃切除术改善了T2DM EGC患者的血糖控制和各种代谢参数。瘦素水平高的患者可能从十二指肠转流胃切除术中获得更大的代谢益处。
