Urinary albumin excretion, HMW adiponectin, and insulin sensitivity in type 2 diabetic patients undergoing bariatric surgery.
Urinary albumin excretion, HMW adiponectin, and insulin sensitivity in type 2 diabetic patients undergoing bariatric surgery.
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DOI：
10.1007/s11695-009-0026-1
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发表时间：
2010-03
期刊：
影响因子：
2.9
通讯作者：
Kashyap, Sangeeta R.
中科院分区：
文献类型：
--
作者：
Navaneethan, Sankar D.;Kelly, Karen R.;Sabbagh, Firas;Schauer, Philip R.;Kirwan, John P.;Kashyap, Sangeeta R.
关键词：
微量白蛋白尿预示着糖尿病患者患肾脏和心血管疾病的风险增加。在这项初步研究中，我们确定了不同类型的减肥手术对严重肥胖型2型糖尿病(T2 DM)受试者蛋白尿的影响。连续15例接受Roux-en-Y胃旁路手术(RYGB；N=9)或其他减肥手术(N=6)的T2 DM患者(9例，51±14岁，体重指数(BMI)49±9 kg/m2，HbA1c 7.2±1.1%)在术前2周和术后6个月进行混合餐耐量试验，测定尿白蛋白/肌酐(UACR)、脂肪因子和胰岛素敏感性。治疗后，体重指数(−4.74±−5.05 kg/m2)、空腹血糖、胆固醇和瘦素水平显著降低。胰岛素敏感性(松田指数[12.05±3.81，p=0.003])和高分子脂联素(HMW)显著增加，同时UACR显著降低(中位数，36 mg/g[7-94]vs.27 mg/g[5.5-42.5]，p=0.01)。治疗后UACR的降低与松田指数(r=−0.74，p=0.0 2)和高分子脂联素(r=−0.6 7，p=0.0 4)呈负相关。相比之下，尽管其他类型的减肥手术后体重指数(−4.11±−4.10 kg/m2)降低(n=6)，但胰岛素敏感性(0.88±2.40，p=0.63)、尿微量白蛋白和高分子脂联素水平没有显著改善。在严重肥胖的糖尿病患者中，RYGB与蛋白尿的减少有关，而蛋白尿与胰岛素敏感性和HMW脂联素的改善相关。这些数据表明，需要更大规模的研究来证实这些发现，并评估T2 DM患者不同类型减肥手术的微观-宏观血管益处，包括肾实质益处。
Microalbuminuria portends an increased risk for renal and cardiovascular diseases in diabetes. In this pilot study, we determined the effect of weight loss induced by different types of bariatric surgery on albuminuria in severely obese type 2 diabetic (T2DM) subjects. Fifteen consecutive T2DM patients (9M/6F, 51 ± 14 years, body mass index (BMI) 49±9 kg/m2, HbA1c 7.2±1.1%) undergoing either Roux-en-Y gastric bypass (RYGB; N=9) or other types of bariatric surgery (N=6) underwent determination of urine albumin/creatinine ratio (UACR) and adipokine and insulin sensitivity during a mixed meal tolerance test performed 2 weeks prior to and 6 months following surgery. Following RYGB, there was a significant decrease in BMI (−4.74±−5.05 kg/m2), fasting glucose, cholesterol, and leptin levels. Insulin sensitivity (Matsuda index [12.05± 3.81, p=0.003]) and high molecular weight (HMW) adiponectin increased significantly along with a significant reduction in UACR (median, 36 mg/g [7–94] vs. 27 mg/g [5.5–42.5], p=0.01). The reduction in UACR following RYGB was inversely correlated with the Matsuda index (r=−0.74, p=0.02) and HMW adiponectin (r=−0.67, p=0.04). In contrast, despite reduction in BMI (−4.11±−4.10 kg/m2) following other types of bariatric surgery (n=6), there was no significant improvement in insulin sensitivity (0.88±2.40, p=0.63), UACR, or HMW adiponectin levels. RYGB in severely obese DM subjects is associated with a reduction in albuminuria that correlates to the improvement in insulin sensitivity and HMW adiponectin. The data point to a need for larger studies to confirm these findings and evaluate the micro–macro-vascular benefits including renal parenchymal benefits of different types of bariatric surgery in T2DM.
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影响因子：
16.2
作者：
Stevens, R;Coleman, RL;Holman, RR
通讯作者：
Holman, RR
DOI：
10.1007/s00464-005-0134-5
发表时间：
2006-06-01
影响因子：
3.1
作者：
Cottam, D.;Qureshi, F. G.;Schauer, P.
通讯作者：
Schauer, P.
影响因子：
4.9
作者：
Saiki, A;Nagayama, D;Shirai, K
通讯作者：
Shirai, K
影响因子：
39.2
作者：
COLDITZ, GA;WILLETT, WC;MANSON, JE
通讯作者：
MANSON, JE
影响因子：
9
作者：
Rubino, Francesco;Forgione, Antonello;Marescaux, Jacques
通讯作者：
Marescaux, Jacques