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十二指肠-空肠完全内镜套管分流术治疗2型糖尿病

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发表于 2008-12-7 23:23:43 | 显示全部楼层 |阅读模式
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来自ADA2008专题。http://ada2008.idiabetes.com.cn/Index.asp

只能看到摘要,注册登陆后能看全文。
http://ada2008.idiabetes.com.cn/View.asp?ID=1726
      
继胃分流术后,十二指肠分流术所致神经激素机制(包括肠降血糖素)日益被认为是快速治疗2型糖尿病的重要机制之一。本研究首次报道了61cm十二指肠-空肠完全内镜套管分流术(DJBS)可特异性治疗2型糖尿病。在52周的单盲研究中,18例2型糖尿病患者被前瞻性的随机分为DJBS组(n=12)或假性内镜治疗组(空白对照组,n=6)。研究起始2周各组患者维持其治疗前热量摄入状况,以后每次随诊给予患者有关热量饮食及健康生活方式的教育。初级终点结果即治疗12、24和52周时患者的HbA1c较治疗前降低。选择性次级终点结果包括同治疗前相比患者的安全性,空腹血糖(FPG),每日7次检测血糖,总体重降低(TBWL)和糖耐量试验后曲线下面积(MTT
      AUC)变化情况。我们已经分析了所有患者接受治疗1周后的试验结果。同治疗前相比,治疗1周后DJBS组和空白对照组的MTT
      AUC的变化分别为-18.6%和+10.1%(p=0.05),FPG分别为-51.6%±43.5mg/dl和+16.5±77.7mg/dl(p=0.17),每日7次检测血糖总体降低分别为-54.8±54.4mg/dl和+1.1±45.7mg/dl(p<0.05)。两组患者的总体重降低(TBWL)无显著差别,分别为-4.5±1.3kg和-3.9±1.3kg(p>0.05)。

      上述1周的研究结果表明十二指肠-空肠分流术可不依赖体重降低或饮食控制而快速降低2型糖尿病患者的血糖,提示存在着直接的十二指肠神经激素机制。DJBS治疗控制患者血糖的长期效应还有待本研究的进一步证实。

      (中日友好医院 侯志强译 李宏亮审校)
      英文原文:
      Interim Report on a Prospective, Randomized Sham Controlled Trial
      Investigating a Completely Endoscopic Duodenal-Jejunal Bypass Sleeve for
      the Treatment of Type 2 Diabetes

      Authors:

      MICHAEL TARNOFF, CHRISTOPHER SORLI, LEONARDO RODRIGUEZ, ALMINO RAMOS,
      MANOEL GALVAO, ELIANA REYES, PILAR FAGALDE, MARIA SOLEDAD OLTRA, JORGE
      SABA, MUNIR ALAMO, CARMEN GLORIA AYLWIN, CAROLINA PRIETO, Boston, MA,
      Billings, MT, Santiago, Chile, Sao Paulo, Brazil

      Results:
      Neurohormonal mechanisms (including incretins) as a result of duodenal
      bypass are increasingly implicated as important components of the rapid
      resolution of type 2 diabetes (T2DM) following gastric bypass surgery.
      This is the first report of a completely endoscopic 61 cm duodenal-jejunal
      bypass sleeve (DJBS) to specifically treat T2DM. In a single blind ongoing
      52 week study, 18 T2DM patients were prospectively randomized to receive
      either the DJBS (n=12) or a sham endoscopy (n=6). Both groups were
      maintained on their baseline caloric intake for the first two weeks and
      are equally counseled about low calorie diet and healthy living at each
      subsequent visit. The primary endpoint is reduction of HbA1c from baseline
      at 12, 24 and 52 weeks. Select secondary endpoints include safety, fasting
      plasma glucose (FPG), 7-point glucose profile, total body weight loss
      (TBWL) and change in the area under the curve after meal tolerance testing
      (MTT AUC) as compared to baseline. One week data have been analyzed for
      all patients. At 1 week, the mean change in MTT AUC was -18.6% and +10.1%
      in device and sham groups respectively (p=0.05), FPG was -51.6 +43.5mg/dl
      and +16.5 + 77.7mg/dl (p=0.17), and the aggregate reduction in 7 point
      glucose profile was -54.8 + 54.5mg/dl and +1.1 + 45.7mg/dl (p<0.05). Total
      body weight loss between groups was similar with -4.5 + 1.3kg and -3.9 +
      1.3kg for device and sham, respectively (p>0.05). The 1 week results
      specifically highlight the ability of duodenal-jejunal bypass to rapidly
      restore glycemic control independent of weight loss or diet, implicating
      direct duodenal neurohormonal mechanisms. The durability of glycemic
      control with the DJBS requires further study, which is ongoing at this
      time.
 楼主| 发表于 2008-12-7 23:24:12 | 显示全部楼层
这个 比GBP先进多了。。。
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发表于 2008-12-8 07:02:01 | 显示全部楼层
GBP是什么沃野不太了解,估计 是 手术的 方法有高级了 一步啊 !
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