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减重手术与强化药物治疗合并糖尿病的肥胖患者的比较
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes


Philip R. Schauer ... 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

观察性研究已表明,减重手术能改善2型糖尿病患者的病情。

 

方法

在这个随机、单中心、非盲法试验中,我们对150名肥胖合并有血糖控制不佳的2型糖尿病患者分别应用单强化药物治疗和药物治疗联合Roux-en-Y胃旁路术或袖状胃切除术治疗,用以评估其相应的疗效。患者的平均年龄为49岁±8岁,其中66%为女性,平均糖化血红蛋白水平为9.2%±1.5%。终点指标是治疗12个月后糖化血红蛋白水平≤6.0%的患者比例水平。

 

结果

在150名患者中93%完成了12个月的随访。达到终点指标的患者比例:药物治疗组为12%(5/41),胃旁路术组为42%(21/50,P=0.002),袖状胃切除术组为37%(18/49,P=0.008)。三组血糖控制均有所改善,药物治疗组的平均糖化血红蛋白水平为7.5%±1.8%,胃旁路术组为6.4%±0.9%(P<0.001),袖状胃切除术为组为6.6%±1.0%(P=0.003)。胃旁路术组和袖状胃切除术组的体重(分别为-29.4 kg±9.0 kg和-25.1 kg±8.5 kg)比药物治疗组(-5.4 kg±8.0 kg)明显下降(比较检验的P值均<0.001)。手术组患者术后降糖药、降脂药及降压药使用均显著减少,但在单纯药物治疗组则有所增加。同时减重手术后胰岛素抵抗指数(HOMA-IR)明显改善,其中4位患者接受了再次手术。随访中未出现死亡或危及生命的并发症。

 

结论

2型糖尿病且控制不佳的肥胖患者中,12个月的药物治疗联合减重手术比单药物治疗患者的血糖水平得到更好的控制,同时今后需要更大规模随机对照研究来进一步证实此结论(本研究由Ethicon Endo-Surgery和其他组织资助;ClinicalTrials.gov注册号为NCT00432809)。





作者信息

Philip R. Schauer, M.D., Sangeeta R. Kashyap, M.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., John P. Kirwan, Ph.D., Claire E. Pothier, M.P.H., Susan Thomas, R.N., Beth Abood, R.N., Steven E. Nissen, M.D., and Deepak L. Bhatt, M.D., M.P.H.
From the Bariatric and Metabolic Institute (P.R.S., S.A.B., S.T., B.A.), the Endocrinology Institute (S.R.K.), the Cleveland Clinic Coordinating Center for Clinical Research (K.W., C.E.P.), the Heart and Vascular Institute (S.E.N.), and the Lerner Research Institute (J.P.K.), Cleveland Clinic, Cleveland; and the Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School — all in Boston (D.L.B.). Address reprint requests to Dr. Schauer at the Bariatric and Metabolic Institute, Cleveland Clinic M61, 9500 Euclid Ave., Cleveland, OH 44195, or at schauep@ccf.org.

 

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