Changes in Glucose Homeostasis after Roux-en-Y Gastric Bypass Surgery for Obesity at Day Three, Two Months, and One Year after Surgery: Role of Gut Peptides
Changes in Glucose Homeostasis after Roux-en-Y Gastric Bypass Surgery for Obesity at Day Three, Two Months, and One Year after Surgery: Role of Gut Peptides
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DOI：
10.1210/jc.2010-2876
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发表时间：
2011-07-01
影响因子：
5.8
通讯作者：
Naslund, E.
中科院分区：
文献类型：
--
作者：
Falken, Y.;Hellstrom, P. M.;Naslund, E.
背景：肥胖症患者胃旁路手术对血糖稳态的内分泌影响尚不完全清楚。主要目的：本研究的主要目的是评价胃旁路手术后早期血糖、胰岛素、高血糖素样多肽-1(GLP-1)、瘦素、生长抑素、葡萄糖依赖的胰岛素样多肽、肠高血糖素和胰升糖素的变化。方法：12例肥胖者(体重指数45.3+/-1.9 kg/m(2))在GBP前、GBP后3d、2月和1年进行无脂流食。在餐前和餐后180分钟测定血糖、胰岛素、瘦素和肠肽激素的浓度。用视觉模拟标尺测量饱腹感。测定了醋氨酚在液体餐中的吸收速率。结果：所有受试者在1岁时体重指数均下降(体重指数30.3+/-1.8 kg/m(2))。空腹血糖在d3显著降低(P<；0.05)。术后2个月胰岛素抵抗的稳态模型评估逐渐减少。餐后，在研究期间，GLP-1和肠高血糖素逐渐升高，胰腺高血糖素释放一过性增加。血糖和胰岛素的时间进程左移。生长抑素释放在d3较低(P<；0.05)，但随后无变化。术后对乙酰氨基酚的吸收速度是术前的两倍，且不随时间变化。结论：胰岛素敏感性增强和胰岛素分泌激素(如GLP-1)均有助于早期控制血糖稳态。逐渐增加餐后肠高血糖素(氧合酶调节蛋白)和GLP-1的水平有助于减肥和增强胰岛素的有效性。(临床内分泌代谢酶96：2227-2235,2011)
Context: Endocrine effects of gastric bypass (GBP) surgery for obesity on glucose homeostasis are not fully understood.Main Objective: The main objective of the study was to assess the changes in plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), leptin, somatostatin, glucose-dependent insulinotropic peptide, enteroglucagon, and glucagon early after GBP.Method: Twelve obese subjects (body mass index 45.3 +/- 1.9 kg/m(2)) were subjected to a liquid meal without lipids before and 3 d, 2 months, and 1 yr after GBP. Plasma concentrations of glucose, insulin, leptin, and gut peptide hormones were assessed before and for 180 min after the meal. Satiety was measured with visual analog scales. The absorption rate of acetaminophen added to the liquid meal was measured. Insulin resistance was measured by the homeostasis model assessment of insulin resistance.Results: All subjects lost weight (body mass index 30.3 +/- 1.8 kg/m(2) at 1 yr). Fasting glucose was significantly lower on d 3 (P < 0.05). There was a progressive decrease in the homeostasis model assessment of insulin resistance after 2 months postoperatively. Postprandially, there was a progressive rise of GLP-1 and enteroglucagon and a transient increase in pancreatic glucagon release over the study period. There was a leftward shift of the time course of plasma glucose and insulin. Somatostatin release was lower on d 3 (P < 0.05) but then unchanged. The absorption rate of acetaminophen was twice as fast after GBP compared with before surgery and did not change over time. Satiety scores increased markedly postoperatively.Conclusion: Both enhanced insulin sensitivity and incretin hormones, such as GLP-1, contribute to the early control of glucose homeostasis. Progressively increasing postprandial levels of enteroglucagon (oxyntomodulin) and GLP-1 facilitate weight loss and enhance insulin effectiveness. (J Clin Endocrinol Metab 96: 2227-2235, 2011)