Altered glucose metabolism after bariatric surgery: What's GLP-1 got to do with it?
Altered glucose metabolism after bariatric surgery: What's GLP-1 got to do with it?
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DOI：
10.1016/j.metabol.2017.10.014
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发表时间：
2018-06-01
影响因子：
9.8
通讯作者：
Salehi, Marzieh
中科院分区：
文献类型：
--
作者：
Smith, Eric P.;Polanco, Georgina;Salehi, Marzieh
减肥手术是治疗肥胖症的有效方法。两种广泛实施的减肥手术，Roux en-Y胃旁路术（GB）和袖状胃切除术（SG）。改变餐后葡萄糖模式，并在手术后立即增强肠道激素分泌，然后体重显著减轻。GB的这种不依赖于体重减轻的血糖效应归因于加速了营养物质从胃袋到肠道的转运，并增强了促胰岛素肠道因子的分泌;特别是胰高血糖素样肽-1（GLP-1）。与非手术个体相比，GB后患者的膳食诱导的GLP-1分泌高达10倍，并且在餐时抑制GLP-1作用可使GB后的餐后高胰岛素血症减少2至3倍于未手术的人。此外，在GB后出现餐后高胰岛素血症性低血糖的晚期并发症的患者亚组中，GLP 1 R阻断剂通过减少餐后刺激的胰岛素分泌来逆转低血糖。SG（GB的一种越来越受欢迎的替代品）后肠胰岛轴活动的作用尚不清楚，但与GB相似，SG加速了向肠道的营养输送，改善了葡萄糖耐量，并增加了餐后GLP-1分泌。本综述将重点介绍目前支持和反对GLP-1对GB血糖效应作用的证据，并将突出GB和SG之间的差异。(C)2017爱思唯尔公司All rights reserved.
Bariatric surgery is an effective treatment for obesity. The two widely performed weight-loss procedures, Roux en-Y gastric bypass (GB) and sleeve gastrectomy (SG). alter postprandial glucose pattern and enhance gut hormone secretion immediately after surgery before significant weight loss. This weight-loss independent glycemic effects of GB has been attributed to an accelerated nutrient transit from stomach pouch to the gut and enhanced secretion of insulinotropic gut factors; in particular, glucagon-like peptide-1 (GLP-1). Meal-induced GLP-1 secretion is as much as tenfold higher in patients after GB compared to non-surgical individuals and inhibition of GLP-1 action during meals reduces postprandial hyperinsulinemia after GB two to three times more than that in persons without surgery. Moreover, in a subgroup of patients with the late complication of postprandial hyperinsulinemic hypoglycemia after GB, GLP1R blockade reverses hypoglycemia by reducing meal stimulated insulin secretion. The role of enteroinsular axis activity after SG, an increasingly popular alternative to GB, is less understood but, similar to GB, SG accelerates nutrient delivery to the intestine, improves glucose tolerance, and increases postprandial GLP-1 secretion. This review will focus on the current evidence for and against the role of GLP-1 on glycemic effects of GB and will also highlight differences between GB and SG. (C) 2017 Elsevier Inc. All rights reserved.