| Objective:Through observation and comparison of glucose and lipid metabolism parameters before and after sleeve gastrectomy in patients with obesity type 2 diabetes patients(T2DM): Body mass index(BMI),fasting blood glucose(FPG),2h postmeal blood glucose(2h PG),fasting insulin(FINS),2h postmeal insulin(2h PINS),glycated hemoglobin(Hb A1C),triglyceride(TG),and high-density lipoprotein cholesterol(HDL-C).Calculate the insulin resistance index(HOMA-IR),fasting blood glucose/fasting insulin(FPG/FINS),Atherogenic index of plasma(AIP).To evaluate the effect of sleeve gastrectomy on glucose and lipid metabolism,insulin resistance and plasma arteriosclerosis index in patients with obesity type 2 diabetes patients.It provides a theoretical basis for clinical sleeve gastectomy to improve atherosclerosis in patients with obesity type 2 diabetes patients.Methods:A total of 54 obese patients with type 2 diabetes who underwent sleeve gastrectomy in the general surgery department of Bethune hospital affiliated to shanxi medical university from December 2012 to March 2019 were selected as the study subjects,age 17~ 61,the mean age was 32.76±10.76 years,the average BMI was 43.09±8.34 kg / m2.The diagnosis of T2 DM accords with the diagnostic standard of type 2 diabetes of the World Health Organization(WHO)in 1999.The diagnosis of obesity was in accordance with the guidelines for prevention and control of overweight and obesity in Chinese adults in 2003.BMI ? 28 kg/m2.The clinical and laboratory examination data of patients before operation,1 month and 6 months after operation were collected,including age,height,body mass,body mass index,systolic blood pressure,diastolic blood pressure,glycolipid metabolism parameters(fasting blood glucose,2 hours postprandial blood glucose,fasting insulin,2 hours postprandial insulin,glycosylated hemoglobin,triglyceride,high-density lipoprotein cholesterol),and calculated The parameters of insulin resistance(IR): HOMA-IR,FPG/FINS,and the sensitive parameters of predicting atherosclerosis:(AIP).The continuous data were expressed by means of mean ± standard deviation.ANOVA was used before,1 month after and 6 months after the operation.Pearson correlation analysis was used for correlation analysis.The influencing factors of AIP were analyzed by multiple stepwise regression analysis,and the regression method was used for independent variable selection.The difference was statistically significant(P <0.05).To evaluate the effect of sleeve gastrectomy on insulin resistance and atherogenic index of plasma(AIP),and to explore the correlation between AIP and clinical indexes related to glycolipid metabolism.Results:1.Comparison of general information before and after surgery:Compared with before operation,the body mass of 54 obese patients with type 2 diabetes mellitus decreased 1 or 6 months after operation(123.71±28.74 vs 111.01±26.66,P<0.05;123.71±28.74 vs 94.60±21.35,P<0.05);127.53±30.18 vs 94.60±21.35,P<0.05),the difference is statistically significant.The BMI of 54 obese patients with type 2 diabetes mellitus decreased 1 or 6 months after operation(43.09 ± 8.34 vs 38.67 ±7.77,P<0.05;43.09 ± 8.34 vs 32.98 ± 6.07,P<0.05),the difference is statistically significant.SBP decreased in 54 obese type 2 diabetic patients at 1 and 6 months after operation(134.96±13.89 vs 127.80±13.89,P<0.05;134.96±13.89 vs 124.15±9.57,P<0.05),the difference is statistically significant.The DBP of 54 obese type 2 diabetic patients decreased 1 and 6 months after operation(82.83 ± 13.56 vs 79.41 ± 10.66,P<0.05;82.83±13.56 vs 77.31±7.55,P<0.05),the difference is statistically significant.2.Comparison of glycolipid metabolism parameters before and after operation:The FPG of 54 obese patients with type 2 diabetes mellitus decreased 1 or 6 months after operation compared with that before operation(7.71±3.18 vs 6.38±2.03,P<0.05;7.71± 3.18 vs 5.36 ± 1.33,P<0.05),the difference is statistically significant.The blood glucose of 54 obese patients with type 2 diabetes mellitus decreased 2 hours after operation(12.38±5.93 vs 8.54±3.06,P<0.05;12.38±5.93 vs 7.15±1.82,P<0.05),the difference is statistically significant.Compared with before operation,the fins of 54 obese patients with type 2 diabetes mellitus decreased 1 or 6 months after operation(26.96±14.35 vs 17.08±6.66,P<0.05;26.96±14.35 vs 11.22±3.62,P<0.05),the difference is statistically significant.54 obese patients with type 2 diabetes mellitus had a 2-hour postprandial insulin decrease 1 and 6 months after operation(95.37± 72.50 vs 53.64 ± 41.35,P<0.05;95.37 ± 72.50 vs 30.50± 25.87,P<0.05),the difference is statistically significant.Hb A1 c decreased in 54 obese type 2 diabetic patients at 1 and 6 months after operation compared with that before operation(6.79±1.63 vs6.11±1.28,P<0.05;6.79±1.63 vs 5.64±0.93,P<0.05),the difference is statistically significant.The TG of 54 obese patients with type 2 diabetes mellitus decreased 1 or 6months after operation(2.89±4.39 vs 1.94±2.81,P<0.05;2.89±4.39 vs 1.70±2.33,P<0.05),the difference is statistically significant.The HDL-C level of 54 obese type 2diabetic patients increased 1 and 6 months after operation(0.96±0.17 vs 1.04±0.20,P<0.05;0.96±0.17 vs 1.10±0.18,P<0.05),the difference is statistically significant.3.Comparison of insulin resistance index and plasma arteriosclerosis index before and after operation:Compared with preoperative,HOMA-IR decreased in 54 obese patients with type 2 diabetes mellitus at 1 and 6 months postoperatively(8.80±5.64 vs4.64±1.99,P<0.05;8.80±5.64 vs 2.58±0.80,P<0.05),the difference is statistically significant.The FPG / FINS of 54 obese patients with type 2 diabetes mellitus increased 1and 6 months after operation.(0.45±0.58 vs 0.48±0.48,P<0.05;0.45±0.58 vs 0.57±0.42,P<0.05),the difference is statistically significant.The AIP of 54 obese patients with type 2 diabetes mellitus decreased 1 or 6 months after operation(0.32±0.33 vs 0.15±0.27,P<0.05;0.32 ± 0.33 vs 0.08 ± 0.25,P<0.05),the difference is statistically significant.4.Analysis of the correlation between preoperative plasma arteriosclerosis index and metabolic parameters:AIP was positively correlated with FPG,2 hours postprandial blood glucose,Hb A1 c,TG,HOMA-IR(P < 0.05),and negatively correlated with HDL-C(P < 0.05).5.Multiple stepwise regression analysis results:Through correlation analysis,the risk factors related to AIP indexes before operation were selected as independent variables,and multiple linear stepwise regression analysis was conducted with AIP as dependent variable.The results showed that TG,HDL-C and FPG entered the regression equation(P < 0.05),F=295.5,P<0.001?Y=0.619+0.019×FPG+0.069×TG-0.678×HDL.Conclusion:1.Sleeve gastrectomy can effectively reduce the weight and improve the metabolism of glucose and lipid in obese type 2 diabetic patients in a short period of time.2.Sleeve gastrectomy can reduce insulin resistance and arteriosclerosis index in obese type 2 diabetic patients in a short time.3.Sleeve gastectomy can improve atherosclerosis in obese patients with type 2diabetes mellitus. |
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