腹腔镜胃旁路手术对胰岛素抵抗和糖化血红蛋白 A1c 的影响：一项为期 2 年的随访研究。
The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study.
机构信息
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, SE-70185, Örebro, Sweden.
出版信息
Obes Surg. 2020 Sep;30(9):3489-3495. doi: 10.1007/s11695-020-04599-w.
BACKGROUND
Bariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration.
METHODS
Cohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the Örebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes.
RESULTS
Fasting insulin levels improved for all groups (diabetics baseline 25.5 mIU/L, IQR 17.5-38.0, 2 years 7.6 mIU/L, IQR 5.4-11.1, p < 0.001; prediabetics baseline 25.0 mIU/L, IQR 17.5-35.0, 2 years 6.7mIU/L, IQR 5.3-8.8, p < 0.001; non-diabetics baseline 20.0 mIU/L, IQR 14.0-30.0, 2 years 6.4 mIU/L, IQR 5.0-8.5, p < 0.001). HbA1c improved in all groups (diabetics baseline 56 mmol/mol, IQR 49-74 [7.3%, IQP 6.6-8.9], 2 years 38 mmol/mol, IQR 36-47 [5.6%, IQR 5.4-6.4], p < 0.001; prediabetics baseline 40 mmol/mol, IQR 39-42 [5.8%, IQR5.7-6.0], 2 years 36 mmol/mol, IQR 34-38 [5.5%, IQR 5.3-5.6], p < 0.001; non-diabetics baseline 35 mmol/mol, IQR 33-37 [5.4%, IQR 5.2-5.5]; 2 years 34 mmol/mol, IQR 31-36 [5.3%, IQR 5.0-5.4], p < 0.001). HOMA-IR improved in all groups (diabetics baseline 9.3 mmol/mol, IQR 5.4-12.9, 2 years 1.9 mmol/mol, IQR 1.4-2.7, p < 0.001; prediabetics baseline 7.0 mmol/mol, IQR 4.3-9.9, 2 years 1.6 mmol/mol, IQR 1.2-2.1, p < 0.001; non-diabetics 4.9 mmol/mol, IQR 3.4-7.3, 2 years 1.4 mmol/mol, IQR 1.1-1.9, p < 0.001).
CONCLUSION
Insulin homeostasis and glucometabolic control improve in all patients after LRYGB, not only in diabetics but also in prediabetics and non-diabetic obese patients, and this improvement is sustained 2 years after surgery.
背景
减重手术可改善 2 型糖尿病患者的胰岛素敏感性和分泌，但对于处于糖尿病前期甚至血糖正常的患者，其效果值得进一步考虑。
方法
这是一项队列研究，纳入了在奥勒布罗大学医院（Örebro University Hospital）接受腹腔镜 Roux-en-Y 胃旁路手术（LRYGB）的患者（n=813），并随访了 742 名术后 2 年的患者。对明确诊断为 2 型糖尿病、糖尿病前期或非糖尿病的患者，分别在基线和术后 2 年检测空腹胰岛素、血糖、糖化血红蛋白（HbA1c）和稳态模型评估的胰岛素抵抗指数（HOMA-IR）。
结果
所有组的空腹胰岛素水平均改善（糖尿病组基线时 25.5mIU/L，IQR 17.5-38.0，术后 2 年 7.6mIU/L，IQR 5.4-11.1，p<0.001；糖尿病前期组基线时 25.0mIU/L，IQR 17.5-35.0，术后 2 年 6.7mIU/L，IQR 5.3-8.8，p<0.001；非糖尿病组基线时 20.0mIU/L，IQR 14.0-30.0，术后 2 年 6.4mIU/L，IQR 5.0-8.5，p<0.001）。所有组的糖化血红蛋白（HbA1c）均改善（糖尿病组基线时 56mmol/mol，IQR 49-74 [7.3%，IQR 6.6-8.9]，术后 2 年 38mmol/mol，IQR 36-47 [5.6%，IQR 5.4-6.4]，p<0.001；糖尿病前期组基线时 40mmol/mol，IQR 39-42 [5.8%，IQR 5.7-6.0]，术后 2 年 36mmol/mol，IQR 34-38 [5.5%，IQR 5.3-5.6]，p<0.001；非糖尿病组基线时 35mmol/mol，IQR 33-37 [5.4%，IQR 5.2-5.5]，术后 2 年 34mmol/mol，IQR 31-36 [5.3%，IQR 5.0-5.4]，p<0.001）。所有组的稳态模型评估的胰岛素抵抗指数（HOMA-IR）均改善（糖尿病组基线时 9.3mmol/mol，IQR 5.4-12.9，术后 2 年 1.9mmol/mol，IQR 1.4-2.7，p<0.001；糖尿病前期组基线时 7.0mmol/mol，IQR 4.3-9.9，术后 2 年 1.6mmol/mol，IQR 1.2-2.1，p<0.001；非糖尿病组基线时 4.9mmol/mol，IQR 3.4-7.3，术后 2 年 1.4mmol/mol，IQR 1.1-1.9，p<0.001）。
结论
LRYGB 术后所有患者的胰岛素稳态和糖代谢控制均改善，不仅在糖尿病患者中，而且在糖尿病前期和非糖尿病肥胖患者中也是如此，这种改善在术后 2 年持续存在。
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