Is ghrelin the culprit for weight loss gastric bypass surgery? A negative answer
Is ghrelin the culprit for weight loss gastric bypass surgery? A negative answer
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DOI：
10.1381/096089206777822151
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发表时间：
2006-07-01
期刊：
影响因子：
2.9
通讯作者：
Burguera, Bartolome
中科院分区：
文献类型：
--
作者：
Couce, Marta E.;Cottam, Daniel;Burguera, Bartolome
背景：Ghrelin是一种强有力的食欲刺激剂，主要在胃中合成。矛盾的是，肥胖者的血浆Ghrelin水平低于瘦人，尽管他们的Ghrelin水平较低，但他们的体重却增加了。Ghrelin在减肥手术后体重调节中的作用仍然存在争议。这项研究的目的是评估腹腔镜Roux-en-Y胃旁路手术(LRYGBP)后体重的快速减轻是否与血浆Ghrelin水平的变化有关。此外，我们还测定了LRYGBP对胰岛素抵抗和脂联素水平的急性影响。方法：对49例接受LRYGBP治疗的病态肥胖患者进行研究。19例接受其他腹腔镜胃肠道手术的患者作为对照组。分别于术前、术后2小时、10天和6个月测定空腹血浆Ghrelin、胰岛素和脂联素水平。结果：LRYGBP术后2 h，Ghrelin和脂联素水平显著降低，与血糖和胰岛素水平升高相一致。有趣的是，一旦术后6个月血糖和胰岛素水平恢复正常，Ghrelin也恢复正常。脂联素在LRYGBP术后10天达到术前水平，并持续显著升高，直到术后6个月。结论：LRYGBP术后体重减轻，尽管血浆Ghrelin水平没有明显变化。胰岛素抵抗的改善发生在术后10天内，可能与脂联素水平正常化有关。这些数据质疑外周Ghrelin作为LRYGBP后肥胖者体重减轻的原因所起的作用。
Background: Ghrelin is a potent appetite stimulator, mainly synthesized in the stomach. Paradoxically, obese subjects have lower plasma ghrelin than lean subjects and increase their weight in spite of low ghrelin levels. The role of ghrelin in weight regulation after bariatric surgery is still controversial. The aim of this study was to evaluate whether rapid weight loss after laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP), was associated with changes in plasma ghrelin levels. In addition, we determined the acute impact of LRYGBP on insulin resistance and adiponectin levels.Methods: 49 morbidly obese subjects who underwent LRYGBP were studied. 19 subjects who underwent other laparoscopic gastrointestinal surgeries acted as the control group. Fasting plasma levels of ghrelin, insulin and adiponectin were determined preoperatively and 2 hours, 10 days and 6 months postoperatively.Results: At 2 hours after LRYGBP, there was a significant reduction in ghrelin and adiponectin levels, which coincided with elevated plasma glucose and insulin levels. Interestingly, once glucose and insulin levels normalized at 6 months after surgery, ghrelin also normalized. Adiponectin reached pre-surgical levels at 10 days after LRYGBP and continued to significantly rise until 6 months postoperatively.Conclusion: Weight loss after LRYGBP occurs in spite of the absence of significant changes in plasma ghrelin levels. Improvement of insulin resistance occurred within 10 days after surgery, and could be related to the normalization of adiponectin levels. This data questions the role of peripheral ghrelin as a cause of weight loss in obese humans after LRYGBP.