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饮食干预和胃旁路术对糖尿病患者代谢功能的影响比较
Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes


Mihoko Yoshino ... 糖尿病 • 2020.08.20
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• 胃旁路术对血糖控制的改善效果可否超越通过减重实现的效果 • 胃旁路术12年后的体重和代谢结局 • 糖尿病患者减肥手术与强化药物疗法的5年结局比较研究

从外科角度对胃转流手术缓解糖尿病的临床思考

 

吴超†‡,孙晶†‡,谢丽§,郑民华*†‡

†上海交通大学医学院附属瑞金医院普外科;‡上海市微创外科临床医学中心;§上海交通大学医学院临床研究中心

*通讯作者

 

糖尿病和肥胖症不断上升的发病率已对人类健康构成重大威胁1。一项对以色列全国青少年的流行病调查报告显示,青少年重度肥胖显著提高2型糖尿病早发率2。目前认为,肥胖患者因其胰腺脂肪沉积致使组织微环境缺氧,进而通过持续性炎症反应、内质网应激和线粒体损伤等机制引起胰岛β细胞功能损伤及胰岛素抵抗,导致2型糖尿病3。虽然口服降糖药和胰岛素研发工艺的进步和成本的下降使得糖尿病成为一类可控性疾病,但终身用药的不良反应却不可忽视。

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摘要


背景

一些研究提示,Roux-en-Y胃旁路术可对2型糖尿病患者的代谢功能产生独立于减重的疗效。

 

方法

我们在22例肥胖症合并糖尿病患者中评估了通过胃旁路术(手术组)或单纯饮食干预(饮食组)达到匹配的减重幅度(约18%)之前和之后,葡萄糖稳态的代谢调节因素。主要结局是肝脏的胰岛素敏感性发生的变化,评估方法是慢速输入胰岛素(3阶段高胰岛素-正糖钳夹试验的第1和第2阶段)。次要结局是以下各项发生的变化:肌肉的胰岛素敏感性、β细胞功能及24小时血浆葡萄糖和胰岛素状况。

 

结果

减重与葡萄糖生成过程受到的平均抑制相对于基线增加相关,在钳夹试验第1阶段,饮食组和手术组分别增加了7.04 μmol/(kg去脂体重·min)(95% CI,4.74~9.33)和7.02 μmol/(kg去脂体重·min)(95% CI,3.21~10.84);在钳夹试验第2阶段,两组分别增加了5.39(95% CI,2.44~8.34)和5.37(95% CI,2.41~8.33)μmol/(kg去脂体重·min);两组之间无显著差异。减重与胰岛素刺激的葡萄糖利用增加相关,饮食组从30.5±15.9 μmol/(kg去脂体重·min)增加至61.6±13.0 μmol/(kg去脂体重·min),手术组从29.4±12.6 μmol/(kg去脂体重·min)增加至54.5±10.4 μmol/(kg去脂体重·min);两组之间无显著差异。在饮食组和手术组中,减重使β细胞功能(相对于胰岛素敏感性的胰岛素分泌)分别提高1.83个单位(95% CI,1.22~2.44)和1.11个单位(95% CI,0.08~2.15),两组之间无显著差异,并使两组的24小时血浆葡萄糖和胰岛素水平曲线下面积减小,两组之间无显著差异。两组均未发生严重并发症。

 

结论

在这项对肥胖症合并2型糖尿病患者开展的研究中,胃旁路术和饮食干预对代谢功能产生的益处相似,而且显然与减重本身相关,而无独立于减重的明显临床效应(由美国国立卫生研究院等资助,在ClinicalTrials.gov注册号为NCT02207777)。





作者信息

Mihoko Yoshino, M.D., Ph.D., Brandon D. Kayser, Ph.D., Jun Yoshino, M.D., Ph.D., Richard I. Stein, Ph.D., Dominic Reeds, M.D., J. Christopher Eagon, M.D., Shaina R. Eckhouse, M.D., Jeramie D. Watrous, Ph.D., Mohit Jain, M.D., Ph.D., Rob Knight, Ph.D., Kenneth Schechtman, Ph.D., Bruce W. Patterson, Ph.D., and Samuel Klein, M.D.
From the Center for Human Nutrition (M.Y., B.D.K., J.Y., R.I.S., D.R., K.S., B.W.P., S.K.) and the Department of Surgery (J.C.E., S.R.E.), Washington University School of Medicine, St. Louis; and the Departments of Medicine (J.D.W., M.J.), Pharmacology (J.D.W., M.J.), Pediatrics (R.K.), and Computer Science and Engineering (R.K.), University of California San Diego, San Diego. Address reprint requests to Dr. Klein at Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8031, St. Louis, MO 63110, or at sklein@wustl.edu.

 

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