摘要目的 通过病例自身对照研究,评价改良Roux-en-Y胃转流术(RYGP)治疗非肥胖型2型糖尿病( T2DM)的1年效果,并探讨合理的手术择入标准.方法 2009年5月至2010年6月72例T2DM患者接受改良RYGP,其中男性45例,女性27例；年龄22 ～ 69岁,平均年龄(47±10)岁.术前体质量指数(BMI) 18.69 ～ 31.22 kg/m2,平均(26 ±4) kg/m2.分别在术前以及术后1、3、6、12个月检测空腹血糖、餐后2h血糖(2hPG)、体质量、BMI和用药情况,在术前以及术后6、12个月检测糖化血红蛋白、空腹胰岛素( Fins)、空腹C肽和胰岛素抵抗指数.比较手术前后的各项指标.结果 改良RYGP后1、3、6、12个月与术前相比,空腹血糖、2hPG、体质量和BMI明显改善(t=7.014 ～ 10.254,P=0.000);术后6、12个月与术前相比,糖化血红蛋白、空腹C肽和胰岛素抵抗指数明显改善(t=1.782～ 7.789,P=0.000 ～0.103),Fins变化差异无统计学意义(P＞0.05).术后1、3、6、12个月的手术完全缓解率分别为22.2％、27.8％、36.1％、60.6％,1年时缓解率为94.3％.术后1年完全缓解与术前空腹C肽正常、胰岛素抗体阴性和口服降糖药有关(x2=11.730,P =0.003;x2 =7.131,P=0.028;x2=6.149,P =0.046).结论 改良RYGP治疗非肥胖的T2DM安全、有效,术后胰岛细胞功能明显改善.术前空腹C肽正常、胰岛素抗体阴性的T2DM患者术后1年手术完全缓解率较好.

abstractsObjective To evaluate the one year effect of modified Roux-en-Y gastric bypass (RYGP) in the treatment of non-obese type 2 diabetes and to investigate the reasonable indications for surgery.Methods Totally 72 patients diagnosed as type 2 diabetes underwent RYGP from May 2009 to June 2010. There were 45 male and 27 female patients,with an average age of (47 ± 10 ) years.Preoperative body mass index (BMI) of the patients was 18.69 to 31.22 kg/m2,average (26 ±4) kg/m2.The follow-up data included fasting plasma glucose (FPG),2 h plasma glucose after oral glucose challenge (2hPG),weight,BMI and medication usage in 1,3,6 and 12 months postoperative; hemoglobin Alc (HbA1c),fasting C-peptide (C-P),fasting serum insulin (Fins) and homeostasis model assessment of insulin resistance index (HOMA-IR) in 6 and 12 months postoperative,respectively.Results Compared with the preoperative,FPG,2hPG,weight and BMI in 1,3,6 and 12 months after surgery were improved (t =7.014 to 10.254,P =0.000),while HbAlc,C-P and HOMA-IR in 6 and 12 months after surgery were improved ( t =1.782 to 7.789,P =0.000 to 0.103 ) and there was no significant difference in Fins (P＞0.05). The rates of complete remission in 1,3,6 and 12 months after surgery were gradually improved to 22.2％,27.8％,36.1％ and 60.6％,respectively,and the rate of remission in 1 year was 94.3％.The complete remission of 1 year after surgery was associated with normal C-P,insulin antibody and oral antidiabetic drugs ( x2 =11.730,P =0.003 ; x2 =7.131,P =0.028 ; x2 =6.149,P =0.046).Conclusions Modified RYGP is safely and effectively in the treatment of no-obese type 2 diabetes patients.The function of islet cells is significantly improved after operation.Especially for the patients of whom C-P is normal,insulin antibody is negative before surgery,the rate of complete remission after 1 year is better.