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中华肥胖与代谢病电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 155 -160. doi: 10.3877/cma.j.issn.2095-9605.2023.03.002

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代谢手术在非肥胖型2型糖尿病中的治疗效果及研究进展
汪赓, 夏泽锋, 陶凯雄()   
  1. 430022 武汉,华中科技大学同济医学院附属协和医院胃肠外科
  • 收稿日期:2023-06-12 出版日期:2023-08-30
  • 通信作者: 陶凯雄
  • 基金资助:
    国家自然科学基金资助项目(81700488)

Effects of bariatric surgery on non-obese type 2 diabetes mellitus

Geng Wang, Zefeng Xia, Kaixiong Tao()   

  1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2023-06-12 Published:2023-08-30
  • Corresponding author: Kaixiong Tao
引用本文:

汪赓, 夏泽锋, 陶凯雄. 代谢手术在非肥胖型2型糖尿病中的治疗效果及研究进展[J]. 中华肥胖与代谢病电子杂志, 2023, 09(03): 155-160.

Geng Wang, Zefeng Xia, Kaixiong Tao. Effects of bariatric surgery on non-obese type 2 diabetes mellitus[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(03): 155-160.

代谢手术对肥胖合并2型糖尿病(type 2 diabetes mellitus,T2DM)有良好的治疗效果。但对于非肥胖型T2DM(NO-T2DM)患者,代谢手术的治疗获益与风险尚存争议。笔者根据国内外对于NO-T2DM的研究报道,将BMI<30 kg/m2 T2DM定义为NO-T2DM,并对此类患者手术适应证、手术方式选择、治疗效果、手术安全性及不良反应等进行综述。

Bariatric surgery is one of the important therapies for patients with obesity and type 2 diabetes mellitus (T2DM). It has a promising effect. But for the non-obese T2DM (NO-T2DM) patients, the benefit and risks remained to be discussed. We reviewed the recent studies on this topic and discussed major concerns of the researchers on this topic. According to the definition of the previous reports, in this review, we set BMI<30 kg/m2 as the level for NO-T2DM. We reviewed related reports and discussed issues including indications and contraindications of the surgery, surgical methods, clinical effects, prognosis and side effects.

[1]
Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants [J]. The Lancet, 2021, 397(10287): 1830-1841.
[2]
Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial [J]. The Lancet, 2021, 397(10271): 293-304.
[3]
Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity [J]. JAMA, 2019, 322(13): 1271-1282.
[4]
Shukla AP, Aronne LJ. Bariatric surgery or intensive medical therapy for diabetes after 5 years [J]. The New England journal of medicine, 2017, 376(20): 1995-1996.
[5]
Hanipah ZN, Schauer PR. Bariatric surgery as a long-term treatment for type 2 diabetes/metabolic syndrome[J]. Annual review of medicine, 2020, 71(1): 1-15.
[6]
Yoshino M, Kayser BD, Yoshino J, et al. Effects of diet versus gastric bypass on metabolic function in diabetes [J]. New England Journal of Medicine, 2020, 383(8): 721-732.
[7]
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志, 2020, 30(4): 893-942.
[8]
中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4): 301-306.
[9]
Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery [J]. Obesity Surgery, 2023, 33(1): 3-14.
[10]
Wang G, Zhu L, Li W, et al. Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery? [J]. Surgery for Obesity and Related Diseases, 2016, 12(10): 1890-1895.
[11]
李威杰. 2型糖尿病外科治疗几个焦点问题 [J]. 中国实用外科杂志, 2014, 34(11): 1026-1029.
[12]
Lin S, Yang N, Guan W, et al. Can Chinese T2D patients with BMI 20–32.5 kg/m2 benefit from loop duodenojejunal bypass with sleeve gastrectomy? [J]. Surgery for Obesity and Related Diseases, 2019, 15(9): 1513-1519.
[13]
Heo Y, Ahn JH, Shin SH, et al. The effect of duodenojejunal bypass for type 2 diabetes mellitus patients below body mass index 25 kg/m2: one year follow-up [J]. Journal of the Korean Surgical Society, 2013, 85(3): 109-115.
[14]
余浩, 戴晓江, 张红兵, 等. 手术治疗低体质量指数2型糖尿病患者的临床疗效 [J]. Journal of Southern Medical University, 2017, 37(5): 693.
[15]
Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis [J]. Annals of surgery, 2015, 261(3): 459-467.
[16]
Cummings DE, Cohen RV. Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI< 35 kg/m2 [J]. Diabetes care, 2016, 39(6): 924-933.
[17]
Liang H, Cao Q, Liu H, et al. The predictive factors for diabetic remission in Chinese patients with BMI> 30 kg/m2 and BMI< 30 kg/m2 are different [J]. Obesity surgery, 2018, 28(7): 1943-1949.
[18]
Lee WJ, Almulaifi A, Chong K, et al. The effect and predictive score of gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus patients with BMI< 30 kg/m2 [J]. Obesity surgery, 2015, 25(10): 1772-1778.
[19]
王瑜, 王燕婷, 王烈. 胃转流术对非肥胖型2型糖尿病的治疗作用[J]. 中国普通外科杂志, 2008, 17(10): 14-100.
[20]
邵得志, 冯志毅, 张海生, 等. 胃转流手术治疗非肥胖型2型糖尿病180例疗效观察 [J/CD]. 中华普外科手术学杂(电子版), 2016, 10(1): 50-53.
[21]
王芳, 王润华, 徐开盛, 等. 腹腔镜胃旁路术治疗非肥胖2型糖尿病的疗效与安全性分析 [J/CD]. 中华普外科手术学杂(电子版), 2019, 13(5): 359-362.
[22]
Ke Z, Zhou X, Sun F, et al. Effect of bariatric surgery versus medical therapy on long-term cardiovascular risk in low BMI Chinese patients with type 2 diabetes: a propensity score-matched analysis [J]. Surgery for Obesity and Related Diseases, 2022, 18(4): 475-483.
[23]
Billeter AT, Scheurlen KM, Israel B, et al. Gastric bypass resolves metabolic dysfunction-associated fatty liver disease (Mafld) in low-bmi patients: a prospective cohort study [J]. Annals of Surgery, 2022, 276(5): 814-821.
[24]
Ji G, Li P, Li W, et al. The effect of bariatric surgery on Asian patients with type 2 diabetes mellitus and body mass index< 30 kg/m2: a systematic review and meta-analysis [J]. Obesity Surgery, 2019, 2(8): 2492-2502.
[25]
Huang ZP, Guo Y, Liu CQ, et al. The effect of metabolic surgery on nonobese patients (BMI< 30 kg/m2) with type 2 diabetes: a systematic review [J]. Surgery for Obesity and Related Diseases, 2018, 14(6): 810-820.
[26]
Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetes mellitus in patients with BMI< 30 kg/m2: a systematic review and meta-analysis [J]. PloS one, 2015, 10(7): e0132335.
[27]
Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review [J]. JAMA, 2020, 324(9): 879-887.
[28]
Sharples AJ, Mahawar K. Systematic review and meta-analysis of randomised controlled trials comparing long-term outcomes of Roux-en-Y gastric bypass and sleeve gastrectomy [J]. Obesity surgery, 2020, 30: 664-672.
[29]
Bergman M, Buysschaert M, Medina JL, et al. Remission of T2DM requires early diagnosis and substantial weight reduction [J]. Nature Reviews Endocrinology, 2022, 18(6): 329-330.
[30]
Li M, Zeng N, Liu Y, et al. The choice of gastric bypass or sleeve gastrectomy for patients stratified by diabetes duration and body mass index (BMI) level: results from a national registry and meta-analysis [J]. Obesity Surgery, 2021, 31(9): 3975-3989.
[31]
吴壮炜, 吴良平, 戴晓江, 等. 腹腔镜胃旁路术治疗非肥胖2型糖尿病患者的疗效分析 [J]. Journal of Southern Medical University, 2020, 40(7): 1044.
[32]
Lee WJ, Almalki OM, Ser KH, et al. Randomized controlled trial of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity: comparison of the YOMEGA and Taiwan studies [J]. Obesity surgery, 2019, 29(9): 3047-3053.
[33]
Level L, Rojas A, Pinango S, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial [J]. Langenbeck's archives of surgery, 2021, 406(1): 171-179.
[34]
Di J, Zhang H, Yu H, et al. Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI< 30 kg/m2 [J]. Surgery for Obesity and Related Diseases, 2016, 12(7): 1357-1363.
[35]
Ke Z, Li F, Chen J, et al. Effects of laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus: comparison of BMI> 30 and< 30 kg/m2 [J]. Obesity surgery, 2017, 27(11): 3040-3047.
[36]
Dixon JB, Hur KY, Lee WJ, et al. Gastric bypass in type 2 diabetes with BMI< 30: weight and weight loss have a major influence on outcomes [J]. Diabetic Medicine, 2013, 30(4): e127-e134.
[37]
李梦伊, 刘洋, 刘雁军, 等. 大中华减重与代谢手术数据库2021年度报告 [J]. 中国实用外科杂志, 2022, 42(05): 042-055.
[38]
Lin S, Li C, Guan W, et al. Three-Year Outcomes of Sleeve Gastrectomy Plus Jejunojejunal Bypass: a Retrospective Case-Matched Study with Sleeve Gastrectomy and Gastric Bypass in Chinese Patients with BMI≥ 35 kg/m2 [J]. Obesity Surgery, 2021, 31(1): 3525-3530.
[39]
Hassn A, Luhmann A, Rahmani S, et al. Medium-term results of combined laparoscopic sleeve gastrectomy and modified jejuno-ileal bypass in bariatric surgery [J]. Obesity surgery, 2016, 26(10): 2316-2323.
[40]
Brown WA, de Leon Ballesteros GP, Ooi G, et al. Single anastomosis duodenal-ileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS) IFSO position statement—update 2020 [J]. Obesity Surgery, 2021, 31(1): 3-25.
[41]
殷骏, 毛忠琦, 徐露, 等. 袖状胃切除联合十二指肠-空肠转流术在非肥胖型2型糖尿病中的应用价值 [J/CD]. 中华肥胖与代谢病电子杂志, 2015, 1(1): 16-20.
[42]
杨映弘, 吴艳军, 颜璟, 等. 非肥胖2型糖尿病患者袖状胃切除间置回肠的十二指肠空肠旁路手术后营养状况的评价——3年随访结果 [J]. 中国普外基础与临床杂志, 2015, 22(8): 977-980.
[43]
Seki Y, Kasama K, Yasuda K, et al. The effects of laparoscopic sleeve gastrectomy with duodenojejunal bypass on Japanese patients with BMI< 35 kg/m2 on type 2 diabetes mellitus and the prediction of successful glycemic control [J]. Obesity surgery, 2018, 28(8): 2429-2438.
[44]
Surve A, Cottam D, Medlin W, et al. Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) [J]. Surgery for Obesity and Related Diseases, 2020, 16(11): 1638-1646.
[45]
Spinos D, Skarentzos K, Esagian SM, et al. The effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS): an updated systematic review [J]. Obesity surgery, 2021, 31(4): 1790-1800.
[46]
Wang L, Wuyun Q, Du D, et al. Primary SADI-S in Chinese with diabetes and BMI< 35 kg/m2: a retrospective study with 2-year follow-up [J]. Obesity Surgery, 2021, 31(7): 3116-3122.
[47]
Sang Q, Wang L, Wuyun Q, et al. Retrospective Comparison of SADI-S Versus RYGB in Chinese with Diabetes and BMI< 35 kg/m2: a Propensity Score Adjustment Analysis[J]. Obesity Surgery, 2021, 31(12): 5166-5175.
[48]
Hutch C R, Sandoval D. The role of GLP-1 in the metabolic success of bariatric surgery [J]. Endocrinology, 2017, 158(12): 4139-4151.
[49]
Tymitz K, Engel A, McDonough S, et al. Changes in ghrelin levels following bariatric surgery: review of the literature [J]. Obesity surgery, 2011, 21(1): 125-130.
[50]
Xia Z, Wang G, Li H, et al. Influence of bariatric surgery on the expression of nesfatin-1 in rats with type 2 diabetes mellitus[J]. Current Pharmaceutical Design, 2015, 21(11): 1464-1471.
[51]
[51] Wang W, Cheng Z, Wang Y, et al. Role of bile acids in bariatric surgery [J]. Frontiers in physiology, 2019, 10: 374.
[52]
Brown RM, Guerrero-Hreins E, Brown WA, et al. Potential gut–brain mechanisms behind adverse mental health outcomes of bariatric surgery [J]. Nature Reviews Endocrinology, 2021, 17(9): 549-559.
[53]
Aron-Wisnewsky J, Doré J, Clement K. The importance of the gut microbiota after bariatric surgery[J]. Nature reviews Gastroenterology & hepatology, 2012, 9(10): 590-598.
[54]
Cummings DE, Rubino F. Metabolic surgery for the treatment of type 2 diabetes in obese individuals [J]. Diabetologia, 2018, 61(2): 257-264.
[55]
Franquet E, Watts G, Kolodny GM, et al. PET-CT reveals increased intestinal glucose uptake after gastric surgery [J]. Surgery for Obesity and Related Diseases, 2019, 15(4): 643-649.
[56]
Schauer PR, Mingrone G, Ikramuddin S, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes [J]. Diabetes Care, 2016, 39(6): 902-911.
[57]
汪赓, 李钢, 白洁, 等. 极度肥胖患者减重代谢手术术式选择的争议与思考[J]. 中国普通外科杂志, 2022, 31(10): 1272-1284.
[58]
周训美, 孙芳, 陈静, 等. 不同体质指数2型糖尿病患者胃旁路术后不良事件的随访 [J]. Chinese Journal of Diabetes Mellitus, 2018, 10(3): 5.
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