52 5 18 1 267 原著 ( 臨床研究 ) LSG ABCD DiaRem LSG 3 93.1 1 7.8 CR37.5 PR33.3 1 ABCD 5 DiaRem 12 LSG ABCD DiaRem LSG 腹腔鏡下スリーブ状胃切除術,ABCD スコア,DiaRem スコア Ⅰ はじめに Bariatric Surgery 2 1 metabolic surgery 2 ABCD 2 3 DiaRem 4 18 8 16 18 9 11 565 871 2 2 54 14 Laparoscopic Sleeve Gastrectomy LSG LSG 図 1 LSG 5 LSG 2 6 LSG LSG 2 ABCD DiaRem
268 LSG 図 1 2 1 Lee ABCD 表 1 4 Age BMI C Duration 1 2 3 1 Still DiaRem 表 1 4 HbA1c 22 4 2 Ⅱ 対象と方法 1 17 LSG 6 3 Excess Weight Loss EWL BMI 25 kg/m 2 HbA1c 1 24 Complete Remission CR HbA1c6. Partial Remission PR HbA1c6. 6.5 HbA1c7. Improve HbA1c7. No Change NC 7 1 2 Ⅲ 結果 / 11/19 45 23 64 112.7 kg 87.3 17 kg BMI43. kg/m 2 33. 58.4 HbA1c7.25 5.5 11.5 C 4.2 1.2 7.7 ng/ml 25.4 7.1 91.8 9 1 3 1 29 表 2 1 46.8 19.5 3 23.5 23.5 6 66.2 25.1 1 67.7 29.1 2 75.2. 図 2 3 93.1 27/29 8/1 HbA1c 1 HbA1c6.2.66 3 HbA1c6.1.75 6 HbA1c6.3 1.1 1 HbA1c6.2.93 2 HbA1c6.6.85 図 2 1 7.8 CR37.5 9/24 PR33.3 8/24 Improve.8 5/24 NC8.3 2/24 87.5 21/24 2 35.3 CR17.6 3/17 PR17.6 3/17 Im-
52 5 18 1 269 表 1 ABCD DiaRem ABCD DiaRem 1 49 1 BMI kg/m 2 5 59 2 27 3 27 34.9 1 HbA1c 35 41.9 2 6.5 42 3 6.5 6.9 2 C ng/ml 7. 8.9 4 2 9. 6 2 2.9 1 3 3.9 2 5 3 3 8 4-8 1 1 3.9 2 1 1 3 表 2 n 3 M/F 11/19 45 23 64 kg 112.7 87.3 17 BMI kg/m 2 43. 33 58.4 HbA1c 7.25 5.5 11.5 C ng/ml 4.2 1.2 7.7 25.4 μu/ml 7.1 91.8 T2DM 9 1 3 33.3 1/3 prove47.1 8/17 NC17.6 3/17 76.5 13/17 1 ABCD 5 2 3 4 57.1 4/7 5 6 72.7 8/11 7 8 4/5 9 1 1 1/1 図 3 DiaRem 5 2 1 2/2 3 7 88.9 8/9 8 12 83.3 5/6 13 17 33.3 1/3 18 22 25 1/4 図 3 2 ABCD 2 3 4 16.7 1/6 5 6 42.9 3/7 7 8 66.7 2/3
27 LSG 超過体重減少率 HbA1cの推移 (%) HbA1c(%) 1 9 9 8.5 8 7 7.5 7 5 6.5 6 3 5.5 5 1 4.5 4 pre 1M 3M 6M 12M 24M pre 1M 3M 6M 12M 24M 図 2 HbA1c ABCD スコア DiaRem スコア 1 1 2 点 3 4 点 5 6 点 7 8 点 9 1 点 2 点 3 7 点 8 12 点 13 17 点 18 22 点 図 3 1 CR PR 9 1 /1 図 4 Dia- Rem 2 5 1/2 3 7 2/5 8 12 2/5 13 17 33.3 1/3 18 22 /2 図 4 Ⅳ 考察 LSG ABCD DiaRem LSG LSG LSG GLP 1 8 GLP 1 LSG 9 L GLP 1 1 Lee ABCD 3 5 6
52 5 18 1 271 1 9 7 5 3 1 ABCD スコア 2 点 3 4 点 5 6 点 7 8 点 9 1 点 1 9 7 5 3 1 DiaRem スコア 2 点 3 7 点 8 12 点 13 17 点 18 22 点 図 4 2 CR PR 2 3 Still DiaRem 7 8 4 LSG 1 ABCD 5 76.5 13/17 4 57.1 4/7 DiaRem 12 88.2 15/17 13 28.6 2/7 2 ABCD 5 45.5 5/11 4 16.7 1/6 DiaRem 12 41.7 5/12 13 1/5 LSG ABCD Dia- Rem 1 CR PR 7.8 2 35.3 11 A UMIN3837 BMI32 ABCD 5 LSG ABCD 5 DiaRem 12 LSG 17 54 文献 1 Halperin F, Goldfine AB Metabolic surgery for type 2
272 LSG diabetes efficacy and risks. Curr Opin Endocrinol Diabetes 2 98 15, 13 2 Lee WJ, Hur KY, Lakadawala M et al. Predicting success of met abolic surgery age, body mass index, C peptide, and duration score. Surg Obes Relat Dis 9 379 384, 13 3 Lee MH, Lee WJ, Chong K et al. Predictors of long term diabetes remission after metabolic surgery. J Gastrointest Surg 19 6 115 121, 15 4 Still CD, Wood GC, Benotti P et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery a retrospective cohort study. Lancet Diabetes Endocrinol 2 38 45, 14 5 4 16 6 Vidal J, Ibarzabal A, Romero F et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg 18 9 177 182, 8 7 5 217 222, 16 8 Peterli R, Wölnerhanssen B, Peters T et al. Improvement in glucose metabolism after bariatric surgery comparison of laparoscopic Roux en Y gastric bypass and laparoscopic sleeve gastrectomy a prospective randomized trial. Ann Surg 25 2 234 241, 9 9 Shah S, Shah P, Todkar J et al. Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half time in morbidly obese patients with type 2 diabetes mellitus. Surg Obes Relat Dis 6 2 152 157, 1 1 Batterham RL, Cummings DE Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery. Diabetes Care 39 6 893 91, 16 11 Lee WJ, Chong K, Lin YH et al. Laparoscopic sleeve gastrectomy versus single anastomosis mini gastric bypass for the treatment of type 2 diabetes mellitus 5 year results of a randomized trial and study of incretin effect. Obes Surg 24 9 1552 1562, 14
52 5 18 1 273 Two scoring systems for predicting type 2 diabetes remission after laparoscopic sleeve gastrectomy at our institution Atsushi Gakuhara, Yasuhiro Miyazaki, Tsuyoshi Takahashi, Yukinori Kurokawa, Koji Tanaka, Tomoki Makino, Makoto Yamasaki, Kiyokazu Nakajima, Masaki Mori, Yuichiro Doki Laparoscopic sleeve gastrectomy LSG for highly obese patients greatly affects type 2 diabetes mellitus in addition to its weight reduction effects. ABCD and DiaRem were originally reported as useful scoring systems for predicting type 2 diabetes mellitus remission after gastric bypass surgery. In this study, we evaluated the effects of LSG on diabetes improvement and the usefulness of these scoring systems for diabetes remission in patients at our hospital. Three months after surgery, 93.1% of patients discontinued diabetic agents and % of the insulin users no longer needed insulin treatment. One year after LSG, the overall diabetes remission rate was 7.8% CR: 37.5%, PR: 33.3%, and the rate of diabetes remission was higher in patients with an ABCD score of 5 or more and a DiaRem score of 12 or less. LSG for obese patients with type 2 diabetes mellitus greatly improved diabetes, and the ABCD and DiaRem scores were both useful for predicting diabetes remission. Laparoscopic sleeve gastrectomy, ABCD score, DiaRem score Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine. 2-2, E-2, Yamadaoka, Suita City, Osaka, 565-871, Japan