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减重手术与传统药物对2型糖尿病疗效的比较
Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes


Geltrude Mingrone ... 糖尿病 • 2012.04.26
相关阅读
• 重度肥胖症胃旁路手术随访12年结局 • 胃旁路术12年后的体重和代谢结局

摘要


背景

Roux-en-Y胃旁路术(RYGB)与胆胰转流术(BPD)可明显改善病理性肥胖患者的糖尿病,常可使病情得到缓解。因此,有必要开展前瞻性随机试验来比较这两种外科手术与传统药物对糖尿病的治疗效果。

 

方法

在本次单中心、非盲法的随机对照试验中,60名年龄30~60岁、体质指数(BMI,以体重的千克数除以身高米数的平方)≥35、糖尿病病史超过5年,且糖化血红蛋白(HbA1c)水平大于或等于7.0%的糖尿病患者被随机分配至传统药物治疗组、Roux-en-Y胃旁路术组或胆胰转流术治疗组。主要终点是治疗2年后的糖尿病缓解率(定义为空腹血糖<100 mg/dL[5.6 mmol/L],且未经药物治疗的情况下HbA1c<6.5%)。

 

结果

两年后,糖尿病缓解未在任何药物治疗组患者中出现,而Roux-en-Y胃旁路术组和胆胰转流术组的缓解率分别为75%和95%(两种手术与药物治疗相比P值均小于0.001)。年龄、性别、基线BMI、病程及体重变化均与治疗后2年糖尿病缓解及治疗1个月或3个月时血糖改善无显著相关。治疗后2年,各组HbA1c水平较基线均值(8.65%±1.45%)均下降,但两个手术组患者的改善更为显著(平均HbA1c水平:药物治疗组为7.69%±0.57%,胃旁路术组为6.35%±1.42%,胆胰转流术组为4.95%±0.49%)。

 

结论

对于伴严重肥胖的2型糖尿病患者,外科减重手术可获得比药物治疗更好的血糖控制效果。术前控制BMI和体重与术后高血糖症的改善程度无关(该研究由Catholic University of Rome资助;ClinicalTrials.gov注册号NCT00888836)。





作者信息

Geltrude Mingrone, M.D., Simona Panunzi, Ph.D., Andrea De Gaetano, M.D., Ph.D., Caterina Guidone, M.D., Amerigo Iaconelli, M.D., Laura Leccesi, M.D., Giuseppe Nanni, M.D., Alfons Pomp, M.D., Marco Castagneto, M.D., Giovanni Ghirlanda, M.D., and Francesco Rubino, M.D.
From the Departments of Internal Medicine (G.M., C.G., A.I., L.L., G.G.) and Surgery (G.N., M.C., F.R.), Università Cattolica S. Cuore; and National Research Council of Italy–Institute of Systems Analysis and Computer Science (IASI), BioMatLab (S.P., A.D.G.) — both in Rome; and the Section of Gastrointestinal Metabolic Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York (A.P., F.R.). Address reprint requests to Dr. Mingrone at the Department of Internal Medicine, Università Cattolica S. Cuore, Largo A. Gemelli 8, 00168 Rome, Italy, or at gmingrone@rm.unicatt.it.

 

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