減肥手術可能減少不肥胖第2型糖尿病的藥物需求


  April 16, 2008 (費城) — 根據美國胃腸道與內視鏡外科學會2008年科學會議與畢業後課程中發表的一篇報告,一種新的減肥手術可以減少第2型糖尿病患的藥物需求。
  
  長期觀察非常肥胖的病患— 身體質量指數(BMI)大於等於35 kg/m2 — 且有第2型糖尿病者,在接受減肥手術之後有比較好的控制;這不難理解,當病患體重越重,其血糖控制越差,因此,必須進行手術輔助減重,以便改善糖尿病控制。
  
  因為不是所有的肥胖病患都罹患第2型糖尿病,也有許多不肥胖者卻有此疾病,可以推斷或許有其他條件引起此狀況;研究者假定,或許胃部中的某個東西會促進第2型糖尿病(一種比較新的第2型糖尿病藥物[Byetta, Amylin 藥廠與Eli Lilly & Co公司] 即根據此一原則作用)。
  
  研究報告鎖定在手術治療之非肥胖(BMI,21 – 29 kg/m2)第2型糖尿病患,總共有69名病患(22名女性、 47名男性),這些病患有至少3年的第2型糖尿病病史,以口服降血糖藥物或者胰島素穩定治療至少12個月。
  
  進行本研究的巴西外科醫師使用比較新的術式,包括腹腔鏡迴腸插入(laparoscopic ileal interposition)以及繞道部分胃切除手術(diverted sleeve gastrectomy);本手術包括將迴腸連結到近端腸道,讓消化道營養在消化過程中離開腸道,因此,大部分未消化的營養相對上較早到達腸道,因此較早分泌各種荷爾蒙。
  
  研究者結論指出,新的手術看起來在控制不肥胖的第2型糖尿病和其併發症有效;手術之後,65%的病患達到血色素Hb A1C 小於 6且無需使用胰島素或者口服藥物;病患的空腹血糖從平均218降到102 mg/dL,餐後血糖值從305降到141 mg/dL,胰島素阻抗性從5.2降到0.77。
  
  糖尿病共病症的測量也顯示有改善;91.3%病患的高血壓獲得控制,85%病患的微量白蛋白尿獲得緩解、95%病患的膽固醇值正常化、92%病患的高三酸甘油脂血症也正常化。
  
  病患平均追蹤21.7個月,但是主要研究者、巴西de Especialidades醫院的胃腸道外科主任Aureo L. de Paula醫師認為還需要更長的追蹤;沒有死亡案例,但有7.3%病患術後併發症;此外,也有短期脫水的報告,且在最初的6個月中,有迴腸片段體外污染的案例,導致胃腸炎和腹瀉。
  
  de Paula醫師向Medscape General Surgery 表示,該手術設計來處理病症的病理原因,例如有問題的早期鹽分分泌,以及荷爾蒙GIP引起的胰島素反應擴大。
  
  Francesco Rubino醫師、紐約市Weill Cornell長老教會醫院胃腸代謝外科主任,相當同意荷爾蒙和其他胃部作用深深地影響第2型糖尿病;他向Medscape General Surgery表示,終究,將近100年來,有一些報告指出,在胃部的潰瘍與癌症手術之後,糖尿病獲得改善,這有點類似現在的胃繞道手術結果;不過,Rubino醫師表示,他對新的術式採嚴謹保留態度。
  
  Rubino醫師表示,他對腹腔鏡迴腸插入及繞道部分胃切除手術感到興趣,他自己目前正利用動物進行此一術式;不過,他向Medscape General Surgery表示,他所關心的是手術的長期效果,而這在目前仍是未知的;此外,此手術比之前的胃繞道手術更複雜,而胃繞道手術已知是個安全有效的手術,且可和新的術式達到一樣的目的。
  
  Rubino醫師表示,我不認為此術式會引起興趣,它是否足以臨床初步運用—我不知道。
  
  de Paula醫師是Covidien的顧問。Rubino 是GI Dynamic的顧問,且接受Covidien的差旅費。
  
  美國胃腸道與內視鏡外科學會2008年科學會議與畢業後課程:摘要S085。發表於2008年4月11日。

Bariatric Surgery May Eliminat

By Ed Ungar
Medscape Medical News

April 16, 2008 (Philadelphia) — A new type of bariatric surgery may eliminate the need for medication in patients with type 2 diabetes, according to a study reported here at the Society of American Gastrointestinal and Endoscopic Surgeons 2008 Annual Scientific Session and Postgraduate Course.

It has long been observed that very obese patients — those with a body mass index (BMI) of 35 kg/m2 or more — with type 2 diabetes have noticeably better control over the disease after undergoing bariatric surgery. This makes sense because the more weight a patient gains, the worse his or her glycemic control becomes. Therefore, surgeries performed to assist in weight reduction should and do lead to improved diabetes management.

Just as not all obese people have type 2 diabetes, many nonobese people do have the disease, and it can be inferred that perhaps something else is triggering this condition. Researchers have posited that perhaps something in the stomach that promotes type 2 diabetes (a relatively new type 2 diabetes drug [Byetta, Amylin Pharmaceuticals Inc and Eli Lilly & Co) works on the basis of this principle).

The study reported here looked at surgical treatment of nonobese (BMI, 21 – 29 kg/m2) patients with type 2 diabetes. A total of 69 patients (22 women and 47 men) were enrolled who had a history of type 2 diabetes mellitus for at least 3 years and had evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months.

The Brazilian surgeons who carried out the study used a relatively new procedure involving laparoscopic ileal interposition associated to a diverted sleeve gastrectomy. This surgery involves connecting the ileum to the proximal intestine, which keeps digestive nutrients away from the bowel early in the digestive process. Thus, mostly undigested nutrients hit that part of the bowel relatively early, and various hormones are therefore secreted earlier than they would be without the surgery.

The researchers conclude that the new surgery appears to be effective in controlling type 2 diabetes and its complications in nonobese patients. After surgery, 65% of patients achieved a hemoglobin A1C test score below 6 without the aid of insulin or oral medications. The patients' fasting glucose levels decreased from a mean of 218 to 102 mg/dL, postprandial glucose levels decreased from 305 to 141 mg/dL, and insulin resistance decreased from 5.2 to 0.77.

Measures of comorbidities of diabetes also showed improvement. Hypertension was controlled in 91.3% of the patients, microalbuminuria was resolved in 85%, cholesterol levels were normalized in 95%, and hypertriglyceridemia was normalized in 92% of the patients.

Average patient follow-up was 21.7 months, but lead investigator Aureo L. de Paula, MD, director of gastrointestinal surgery at Hospital de Especialidades, Goiania, Brazil, recommended longer follow-up. There were no deaths, but postoperative complications occurred in 7.3% of patients. There also were reports of short-term dehydration, and in the first 6 months there were cases of external contamination of the ileal segment, which can lead to gastroenteritis and diarrhea.

Dr. de Paula told Medscape General Surgery that the procedure is designed to deal with "the pathophysiology of the disease, such as the defective early phase in saline secretion and the defective amplification of the insulin response by the hormone GIP."

Francesco Rubino, MD, chief of gastrointestinal metabolic surgery at Weill Cornell Presbyterian Hospital, New York City, strongly agreed that hormonal and other action in the stomach profoundly affects type 2 diabetes. After all, he told Medscape General Surgery, for almost 100 years, there have been reports of diabetes improvement after stomach surgery for ulcers and cancer, which are in some ways similar procedures to modern gastric bypass surgery. However, Dr. Rubino said he has serious reservations concerning the new procedure.

Dr. Rubino said he is interested in laparoscopic Ileal interposition associated to a diverted sleeve gastrectomy and is currently performing the procedure on animals himself. However, he told Medscape General Surgery, that he is concerned about the long-term effects of the surgery, which are, at present, unknown. In addition, the surgery is much more complicated to perform than gastric bypass, which is already known to be a safe and effective procedure that accomplishes much the same thing as the new procedure.

"I do think [the procedure] is an intriguing operation. Whether it is ready for clinical prime time as a primary application — that I don't know," Dr. Rubino said.

Dr. de Paula is a consultant with Covidien. Dr. Rubino is a consultant for GI Dynamics and has received travel grants from Covidien.

Society of American Gastrointestinal and Endoscopic Surgeons 2008 Annual Scientific Session and Postgraduate Course: Abstract S085. Presented April 11, 2008.

    
相關報導
兒科醫師提供的肥胖介入方法難以減少BMI
2016/9/26 下午 03:57:35
即便BMI低 久坐仍與脂肪肝疾病有關
2015/10/2 上午 10:37:49
腸道微生物與高密度脂蛋白、三酸甘油脂及身體質量指數有關
2015/9/25 上午 10:23:47

上一頁
   1   2   3   4   5   6   7   8   9   10  
回上一頁