Laparoscopic Greater Curvature Plication in Morbidly Obese Women with Type 2 Diabetes: Effects on Glucose Homeostasis, Postprandial Triglyceridemia and Selected Gut Hormones
Laparoscopic Greater Curvature Plication in Morbidly Obese Women with Type 2 Diabetes: Effects on Glucose Homeostasis, Postprandial Triglyceridemia and Selected Gut Hormones
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DOI：
10.1007/s11695-013-1143-4
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发表时间：
2014-05-01
期刊：
影响因子：
2.9
通讯作者：
Vrbikova, Jana
中科院分区：
文献类型：
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作者：
Bradnova, Olga;Kyrou, Ioannis;Vrbikova, Jana
背景：腹腔镜大曲率折叠术(LGCP)是一种新兴的减肥手术，无需植入装置或胃切除术即可缩小胃体积。本研究旨在探讨2型糖尿病(T2 DM)患者术后1个月和6个月血糖稳态、餐后甘油三酯水平和部分胃肠激素[葡萄糖依赖性促胰岛素多肽(GIP)、胰升糖素样肽-1(GLP-1)、生长激素(Ghrelin)和他汀类药物]的变化。方法前瞻性调查13例T2 DM患者(平均年龄53.2±8.76岁；体重指数40.1+/-4.59 kg/m(2))。结果所有患者在治疗后1个月和6个月均有明显的体重下降(P<0.002)，平均超重百分比为29.7+/-2.9%。6个月后，空腹高血糖和高胰岛素血症显著改善(p<；0.0001)，胰岛素敏感性和糖化血红蛋白水平也同时改善(p<；005)。餐后血糖水平在术后6个月显著降低(p<；0.0001)，餐后甘油三酯血症在6个月随访时也得到改善(p<；0.001)。在LGCP术后1个月和6个月，餐后GIP血浆水平均显著升高(p<；0.0001)，而餐后诱导的GLP-1反应总体上没有显著变化(p>；0.05)。LGCP术后1个月和6个月血浆Ghrelin水平下降(p<；0.0001)，而循环中的Obestatin水平无明显变化。结论在术后6个月内，LGCP可显著减轻肥胖T2 DM患者的体重，改善其代谢状态，同时还可降低循环中的Ghrelin水平，增加膳食诱导的GIP反应。
Background Laparoscopic greater curvature plication (LGCP) is an emerging bariatric procedure that reduces the gastric volume without implantable devices or gastrectomy. The aim of this study was to explore changes in glucose homeostasis, postprandial triglyceridemia, and meal-stimulated secretion of selected gut hormones [glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1), ghrelin, and obestatin] in patients with type 2 diabetes mellitus (T2DM) at 1 and 6 months after the procedure.Methods Thirteen morbidly obese T2DM women (mean age, 53.2 +/- 8.76 years; body mass index, 40.1 +/- 4.59 kg/m(2)) were prospectively investigated before the LGCP and at 1- and 6-month follow-up. At these time points, all study patients underwent a standardized liquid mixed-meal test, and blood was sampled for assessment of plasma levels of glucose, insulin, C-peptide, triglycerides, GIP, GLP-1, ghrelin, and obestatin.Results All patients had significant weight loss both at 1 and 6 months after the LGCP (p a parts per thousand currency signaEuro parts per thousand 0.002), with mean percent excess weight loss (%EWL) reaching 29.7 +/- 2.9 % at the 6-month follow-up. Fasting hyperglycemia and hyperinsulinemia improved significantly at 6 months after the LGCP (p < 0.05), with parallel improvement in insulin sensitivity and HbA1c levels (p < 0.0001). Meal-induced glucose plasma levels were significantly lower at 6 months after the LGCP (p < 0.0001), and postprandial triglyceridemia was also ameliorated at the 6-month follow-up (p < 0.001). Postprandial GIP plasma levels were significantly increased both at 1 and 6 months after the LGCP (p < 0.0001), whereas the overall meal-induced GLP-1 response was not significantly changed after the procedure (p > 0.05). Postprandial ghrelin plasma levels decreased at 1 and 6 months after the LGCP (p < 0.0001) with no significant changes in circulating obestatin levels.Conclusion During the initial 6-month postoperative period, LGCP induces significant weight loss and improves the metabolic profile of morbidly obese T2DM patients, while it also decreases circulating postprandial ghrelin levels and increases the meal-induced GIP response.