目的 探讨肥胖合并2型糖尿病患者腹腔镜胃旁路手术(LRYGB)后相关指标的变化。方法 回顾性分析2011-03至2012-02在原武警总医院普外科接受LRYGB的52例肥胖合并2型糖尿病患者的临床资料,分别在术前、术后3、6、12个月,采用人体成分分析仪检测全身脂肪总量和非脂肪总量变化,通过日本东芝公司80排螺旋CT+美国明维思公司校准体模和定量CT(QCT)分析软件,记录腹部总体脂肪体积(TAFV)、腹部内脏脂肪总体积(TVFV)和腹部皮下脂肪总体积(TSFV)的变化;同时测定相应时间点血清瘦素、脂联素(APN)及糖脂代谢指标,部分指标随访5年。结果 (1)术后12个月糖尿病达标率为86.5%,肥胖症治愈率为67.3%,术后各时间点空腹胰岛素(Fins)和HOMA-IR数值呈逐渐下降趋势,仅在术后12个月和术后5年明显下降,差异有统计学意义(P＜0.05)。与术前相比,在术后12个月三酰甘油(TG)、胆固醇(CH)下降明显,差异均有统计学意义(P＜0.05),术后5年TG略有升高,但与术前差异仍有统计学意义(P＜0.05)。(2)与术前相比,术后6、12个月和2年瘦素下降明显,差异均有统计学意义(P＜0.05);术后APN在术后3个月略有下降,然后呈逐渐升高趋势,在术后12个月和2年APN数值显著升高,差异均有统计学意义(P＜0.05)。(3)术后各时间点体重和BMI均呈下降趋势,术后5年下降明显,与术前比较,差异有统计学意义(P＜0.05)。术后非脂肪总量有下降趋势,但仅在术后5年时变化明显。与术前相比,术后6个月TVFV显著下降,术后12个月TSFV显著下降,术后5年TSFV和TVFV均显著下降,差异有统计学意义(P＜0.05)。结论 LRYGB术后腹部内脏脂肪较皮下脂肪减少更为显著,伴血清瘦素降低和APN增高。
Abstract
Objective To assess the changes of related indexes after laparoscopic Roux-en-Y gastric bypass (LYRGB)in obese patients with T2DM.Methods Fifty-two obese patients with type 2 diabetes who received LRYGB in the Department of General Surgery in 3rd Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were recruited in this retrospective study. Total abdominal fat volume(TAFV),total subcutaneous fat volume(TSFV),total visceral fat volume(TVFV) and total fat mass, total free fat mass were examined by Quantitative CT and Tanita body composition analyzer respectively, while fasting plasma glucose (FPG), fasting insulin (Fins), HbA1c, triglycerides (TC), cholesterol (CH),leptin and adiponectin(APN) were also detected simultaneously within follow-up.Results The remission rate of T2DM and obesity were 86.5% and 67.3% respectively, FPG and HbA1c values decreased after surgery and dropped significantly at the time points of 1 year and 5 years; TC and CH values decreased sharply in 1 year follow-up while TG slightly increased at the time point of 5 years. Leptin decreased sharply after surgery and significantly decreased at the time points of 6 months, 12 months and 2 years, while APN decreased gradually at the time point of 3 months, then increased significantly at the time point of 1 year and 2 years. Body weight, BMI and total fat mass decreased gradually after operation while total free fat mass decreased significantly only in 5 years after operation. However, TAFV, TSFV and TVFV dropped after surgery. Moreover, TVFV decreased earlier than TSFV and both dropped obviously at the postoperative time point of 5 years.Conclusions Abdominal visceral fat decreases more significantly than subcutaneous fat after LRYGB, followed by the decrease of leptin and the increase of APN.
关键词
肥胖症 /
胃转流术 /
腹部脂肪 /
定量CT /
瘦素 /
脂联素
Key words
obesity /
gastric bypass /
abdominal fat /
quantitative CT /
leptin /
adiponectin
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基金
首都医学发展科研基金(2009-20580);武警部队高层次人才专项基金(2013-GCCRC-04)
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