Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Am Coll Surg. 2021 Dec;233(6):753-762. doi: 10.1016/j.jamcollsurg.2021.08.688. Epub 2021 Sep 13.
Effects of pancreatectomy on glucose tolerance have not been clarified, and evidence regarding the difference in postoperative glucose tolerance between pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) is lacking.
This prospective, single-center observational study analyzed 40 patients undergoing PD and 29 patients undergoing DP (Clinical trial registry number UMIN000008122). Glucose tolerance, including insulin secretion (Δ C-peptide immunoreactivity, ΔCPR) and insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR) were assessed before and 1 month after pancreatectomy using the oral glucose tolerance test (OGTT) and glucagon stimulation test. We assessed long-term hemoglobin A1c (HbA1c) levels in patients, with a follow-up time of 3 years.
Percentages of patients diagnosed with abnormal OGTT decreased after PD (from 12 [30%] to 7 [17.5%] of 40 patients, p = 0.096); however, they increased after DP (from 4 [13.8%] to 8 [27.6%] of 29 patients, p = 0.103), although the changes were not statistically significant. ΔCPR decreased after both PD (from 3.2 to 1.0 ng/mL, p < 0.001) and DP (from 3.3 to 1.8 ng/mL, p < 0.001). HOMA-IR decreased after PD (from 1.10 to 0.68, p < 0.001), but did not change after DP (1.10 and 1.07, p = 0.42). Median HbA1c level was higher after DP than after PD for up to 3 years, but the differences were not statistically significant.
In comparisons of pre- and 1 month post-pancreatectomy data, glucose tolerance showed improvement after PD, whereas it worsened after DP. Insulin secretion decreased after both PD and DP. Insulin resistance improved after PD, but did not change after DP. Further studies are warranted to clarify mechanisms of improved insulin resistance after PD.
胰腺切除术对糖耐受性的影响尚不清楚，并且缺乏关于胰十二指肠切除术（PD）和胰尾部切除术（DP）术后糖耐受性差异的证据。
这是一项前瞻性、单中心观察性研究，分析了 40 例行 PD 和 29 例行 DP 的患者（临床试验注册号 UMIN000008122）。使用口服葡萄糖耐量试验（OGTT）和胰高血糖素刺激试验，在胰腺切除术前和术后 1 个月评估糖耐受性，包括胰岛素分泌（ΔC-肽免疫反应性，ΔCPR）和胰岛素抵抗（稳态模型评估的胰岛素抵抗，HOMA-IR）。我们评估了患者的长期血红蛋白 A1c（HbA1c）水平，随访时间为 3 年。
PD 后诊断为 OGTT 异常的患者比例从 40 例中的 12 例（30%）下降至 7 例（17.5%）（p=0.096）；然而，DP 后该比例从 29 例中的 4 例（13.8%）上升至 8 例（27.6%）（p=0.103），尽管变化无统计学意义。PD 后（从 3.2 降至 1.0ng/mL，p<0.001）和 DP 后（从 3.3 降至 1.8ng/mL，p<0.001），ΔCPR 均下降。PD 后 HOMA-IR 从 1.10 降至 0.68（p<0.001），而 DP 后无变化（1.10 和 1.07，p=0.42）。DP 后中位 HbA1c 水平在 3 年内均高于 PD，但差异无统计学意义。
与胰腺切除术前和术后 1 个月的数据相比，PD 后糖耐受性改善，而 DP 后恶化。PD 和 DP 后胰岛素分泌均下降。PD 后胰岛素抵抗改善，而 DP 后无变化。需要进一步研究以阐明 PD 后胰岛素抵抗改善的机制。
