Early Postoperative Insulin-Resistance Changes After Sleeve Gastrectomy
Early Postoperative Insulin-Resistance Changes After Sleeve Gastrectomy
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DOI：
10.1007/s11695-009-0017-2
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发表时间：
2010-01-01
期刊：
影响因子：
2.9
通讯作者：
Basso, Nicola
中科院分区：
文献类型：
--
作者：
Rizzello, Mario;Abbatini, Francesca;Basso, Nicola
胆胰分流术和胃转流术与术后几天胰岛素抵抗的快速改善相关。本研究的目的是评价袖状胃切除术（SG）对胰岛素抵抗的短期影响。2007年12月至2008年9月期间，连续17例肥胖2型糖尿病患者（3例男性，平均年龄51.1岁，平均BMI 44.7 kg/m2）接受腹腔镜SG。在术前和术后5、15、30和60天抽取空腹血糖、胰岛素浓度和胰岛素抵抗的稳态模型评估（HOMA IR）。其中7例患者在术后第1、2、3和4天评价了胰岛素敏感性。此外，我们还研究了3名超重和糖尿病患者（1名男性，平均年龄52.1岁，平均BMI 26.8 kg/m2）的对照组，他们接受了腹腔镜胆囊切除术，并接受了相同的饮食方案，在所有肥胖患者中，观察到SG后血清葡萄糖和胰岛素浓度以及HOMA IR值急剧（5天）和显著降低。在7例患者中，术后第3天的血糖和胰岛素浓度以及HOMA IR值显著降低。在术后第15天，血糖和胰岛素浓度以及HOMA IR在没有显著体重改变的情况下仍然显著较低。在术后30天和60天，尽管体重减轻更大，但这些值基本保持不变。在胆囊切除术患者组中，在术后第5天，只有血清葡萄糖浓度显著降低，尽管其值高于术前值的正常值。SG后，胰岛素作用的改善迅速发生，并独立于EWL。本研究的结果证实，激素机制可能有助于SG后胰岛素抵抗的变化。
Biliopancreatic diversion and Gastric bypass are associated with a rapid improvement in insulin resistance few days after surgery. The purpose of this study was to evaluate the short-term effects in insulin resistance following sleeve gastrectomy (SG).Between December 2007 and September 2008, 17 consecutive obese type 2 diabetes mellitus patients (three men, mean age 51.1 years, mean BMI 44.7 kg/m(2)) were submitted to laparoscopic SG. Fasting serum glucose, insulin concentration, and homeostatic model assessment for insulin resistance (HOMA IR) were drawn preoperatively and at 5, 15, 30, and 60 postoperative days. In seven of these patients insulin sensitivity was evaluated on postoperative days 1, 2, 3, and 4. Moreover a control group of three overweight and diabetic patients (one man, mean age 52.1 years and mean BMI 26.8 kg/m(2)) submitted to laparoscopic cholecystectomy and undergoing the same diet protocol was studied.In all obese patients, a sharp (5 days) and significant reduction of serum glucose and insulin concentration and HOMA IR values was observed after SG. In seven patients, serum glucose and insulin concentration and HOMA IR values were significantly lower at third postoperative day. At the 15th postoperative day both serum glucose and insulin concentration and HOMA IR remained significantly lower in the absence of significant weight modifications. At 30 and 60 postoperative days, these values remained substantially unchanged in spite of a greater weight loss. In the cholecystectomy patients group, at postoperative day 5, only the serum glucose concentrations were significantly reduced although with the higher values than normal in respect to the preoperative values.After SG the improvement of insulin action occurred rapidly and independently of EWL. The results of the present study confirm that a hormonal mechanism may contribute to changes in insulin resistance following SG.