Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery
Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery
复制标题
DOI：
10.1038/ijo.2009.15
复制
发表时间：
2009-04-01
影响因子：
4.9
通讯作者：
Cummings, D. E.
中科院分区：
文献类型：
--
作者：
Cummings, D. E.
减肥手术是目前促进重大、持续减肥的最有效方法。Roux-en-Y胃旁路手术（RYGB）是最常用的减肥手术，几乎可以改善所有与肥胖相关的合并症，最令人印象深刻的是2型糖尿病（T2DM）的显著解决。RYGB后，84%的T2DM患者的病情完全缓解，而且几乎所有患者的血糖控制都得到了改善。越来越多的证据表明，RYGB对T2DM的影响不能仅仅通过体重减轻和减少能量摄入来解释。RYGB与体重无关的降糖作用是明显的，因为T2DM的快速消退（在体重减轻之前），RYGB后葡萄糖稳态的改善比其他方式的等效体重减轻后更大，偶尔会出现非常晚发的胰腺β细胞功能异常。几种机制可能介导RYGB的直接抗糖尿病作用，包括增强来自下肠的l细胞肽（例如GLP-1）的营养刺激，有趣但仍未表征的现象与排除上肠与摄入的营养物质接触有关，抑制胃饥饿素分泌，很可能还有其他尚未发现的作用。研究旨在优先考虑这些机制，并确定潜在的其他机制，有助于优化手术设计，也可能揭示糖尿病治疗的新药物靶点。
Bariatric surgery is currently the most effective method to promote major, sustained weight loss. Roux-en-Y gastric bypass (RYGB), the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 diabetes mellitus (T2DM). After RYGB, 84% of patients with T2DM experience complete remission of this disease, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Weight-independent antidiabetic actions of RYGB are apparent because of the very rapid resolution of T2DM ( before weight loss occurs), the greater improvement of glucose homeostasis after RYGB than after an equivalent weight loss from other means, and the occasional development of very late-onset, pancreatic beta-cell hyperfunction. Several mechanisms probably mediate the direct antidiabetic impact of RYGB, including enhanced nutrient stimulation of L-cell peptides ( for example, GLP-1) from the lower intestine, intriguing but still uncharacterized phenomena related to exclusion of the upper intestine from contact with ingested nutrients, compromised ghrelin secretion, and very probably other effects that have yet to be discovered. Research designed to prioritize these mechanisms and identify potential additional mechanisms promises to help optimize surgical design and might also reveal novel pharmaceutical targets for diabetes treatment.