Removal of Duodenum Elicits GLP-1 Secretion
Removal of Duodenum Elicits GLP-1 Secretion
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DOI：
10.2337/dc12-0811
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发表时间：
2013-06-01
期刊：
影响因子：
16.2
通讯作者：
Giaccari, Andrea
中科院分区：
文献类型：
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作者：
Muscogiuri, Giovanna;Mezza, Teresa;Giaccari, Andrea
目的：评价切除十二指肠对非糖尿病患者肠促胰岛素、胰岛素和胰高血糖素之间复杂相互作用的影响。研究设计和方法：为了评价激素分泌和胰岛素敏感性，10例超重且无2型糖尿病的患者年龄61 ± 19.3岁，体重指数27.9 ± 5.3 kg/m2）在保留幽门的胰十二指肠壶腹瘤切除术前后进行了混合餐试验和高胰岛素-正葡萄糖钳夹试验。（P = 0.002），C肽（P = 0.0002）和胃抑制肽（GIP）分泌（P = 0.0004），而空腹和餐后血糖水平均增加（P = 0.0001）; GLP-1和胰高血糖素对混合餐的反应在手术后显著增加（P = 0.02和0.031）。虽然GIP水平的变化与胰岛素、胰高血糖素和葡萄糖水平无关，但GLP-1分泌的增加与术后胰岛素分泌的减少呈负相关（R-2 = 0.56; P = 0.012）但与胰高血糖素分泌增加无关，胰高血糖素分泌增加与胰岛素分泌减少呈负相关（R-2 = 0.46; P = 0.03）和C肽（R-2 = 0.37; P = 0.04）。鉴于剩余的胰腺大概有保存intraislet解剖结构，胰岛素分泌能力，α-和β-细胞的相互作用，我们的数据表明，胰高血糖素分泌的增加与全身insulin.CONCLUSIONS-Pylorus-preserving胰腺切除术与GIP的减少和GLP-1水平的显着增加，这是不翻译成增加胰岛素分泌。相反，低胰岛素血症可能导致胰高血糖素分泌增加。
OBJECTIVE-To evaluate the effect of removal of the duodenum on the complex interplay between incretins, insulin, and glucagon in nondiabetic subjects.RESEARCH DESIGN AND METHODS-For evaluation of hormonal secretion and insulin sensitivity, 10 overweight patients without type 2 diabetes (age 61 +/- 19.3 years and BMI 27.9 +/- 5.3 kg/m(2)) underwent a mixed-meal test and a hyperinsulinemic-euglycemic clamp before and after pylorus-preserving pancreatoduodenectomy for ampulloma.RESULTS-All patients experienced a reduction in insulin (P = 0.002), C-peptide (P = 0.0002), and gastric inhibitory peptide (GIP) secretion (P = 0.0004), while both fasting and postprandial glucose levels increased (P = 0.0001); GLP-1 and glucagon responses to the mixed meal increased significantly after surgery (P = 0.02 and 0.031). While changes in GIP levels did not correlate with insulin, glucagon, and glucose levels, the increase in GLP-1 secretion was inversely related to the postsurgery decrease in insulin secretion (R-2 = 0.56; P = 0.012) but not to the increased glucagon secretion, which correlated inversely with the reduction of insulin (R-2 = 0.46; P = 0.03) and C-peptide (R-2 = 0.37; P = 0.04). Given that the remaining pancreas presumably has preserved intraislet anatomy, insulin secretory capacity, and alpha- and beta-cell interplay, our data suggest that the increased glucagon secretion is related to decreased systemic insulin.CONCLUSIONS-Pylorus-preserving pancreatoduodenectomy was associated with a decrease in GIP and a remarkable increase in GLP-1 levels, which was not translated into increased insulin secretion. Rather, the hypoinsulinemia may have caused an increase in glucagon secretion.