Gastric Bypass Reduces Symptoms and Hormonal Responses in Hypoglycemia
Gastric Bypass Reduces Symptoms and Hormonal Responses in Hypoglycemia
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DOI：
10.2337/db16-0341
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发表时间：
2016-09-01
期刊：
影响因子：
7.7
通讯作者：
Eriksson, Jan W.
中科院分区：
文献类型：
--
作者：
Abrahamsson, Niclas;Borjesson, Joey Lau;Eriksson, Jan W.
胃旁路手术（GBP）是最常见的减肥手术之一，会引起体重减轻和代谢影响。其机制尚不完全清楚，但减少食物摄入量和对胃肠激素的影响被认为是原因之一。我们最近观察到GBP患者的血糖水平降低，并经常发生无症状的低血糖发作。在这里，我们对接受GBP手术前后的患者进行低血糖检查，并检查症状、激素和自主神经反应。在GBP手术前和手术后23周（范围19-25），采用高胰岛素-低血糖钳夹（逐步至血糖2.7 mmol/L）对12名无糖尿病的肥胖患者（8名女性，平均年龄43.1岁[SD 10.8]，BMI 40.6 kg/m2 [SD 3.1]）进行了检查。钳夹期间爱丁堡低血糖评分的平均变化从术前的10.7（6.4）降至术后的5.2（4.9）。术后胰高血糖素、皮质醇和儿茶酚胺水平以及对低血糖的交感神经反应也明显降低。此外，生长激素表现出延迟的反应，但更高的峰值水平。胰高血糖素样肽1和胃抑制多肽的水平在低血糖期间升高，但与术前相比，术后升高较少。因此，GBP手术导致葡萄糖稳态的重置，这减少了对低血糖的症状和神经激素反应。进一步的研究应该解决潜在的机制以及它们对GBP手术的总体代谢效应的影响。
Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, but reduced food intake and effects on gastrointestinal hormones are thought to contribute. We recently observed that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes. Here, we subjected patients before and after undergoing GBP surgery to hypoglycemia and examined symptoms and hormonal and autonomic nerve responses. Twelve obese patients without diabetes (8 women, mean age 43.1 years [SD 10.8] and BMI 40.6 kg/m(2) [SD 3.1]) were examined before and 23 weeks (range 19-25) after GBP surgery with hyperinsulinemic-hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L). The mean change in Edinburgh Hypoglycemia Score during clamp was attenuated from 10.7 (6.4) before surgery to 5.2 (4.9) after surgery. There were also marked postsurgery reductions in levels of glucagon, cortisol, and catecholamine and the sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. Levels of glucagon-like peptide 1 and gastric inhibitory polypeptide rose during hypoglycemia but rose less postsurgery compared with presurgery. Thus, GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery.