FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes.
FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes.
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DOI：
10.1007/s11695-015-1834-0
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发表时间：
2016-05
期刊：
影响因子：
2.9
通讯作者：
Korner J
中科院分区：
文献类型：
--
作者：
Sachdev S;Wang Q;Billington C;Connett J;Ahmed L;Inabnet W;Chua S;Ikramuddin S;Korner J
为了量化未控制的2型糖尿病患者成纤维细胞生长因子19(FGF19)和胆汁酸(BAS)的变化，随机分为Roux-en-Y胃旁路手术(RYGB)和强化内科治疗(IMM)，并在治疗1年后匹配HbA1c的类似降低。血液样本取自在IMM(n=15)或RYGB(n=15)前和1年后接受试餐挑战的患者。平均糖化血红蛋白从9.7%降至6.4%，IMM组从9.1%降至6.1%。12个月时，RYGB组的人均糖尿病用药次数(2.5±0.5)少于IMM组(4.6±0.3)。治疗后空腹(93±15)pg/ml至152±19 pg/ml(P=0.008)和餐后状态(AUC10.8±1.9至23.4±4.1pg×hr/ml×10~3；P=0.006)FGF19均升高，但无明显变化。治疗后BAS升高(AUC×1036.63±1.3至15.16±2.56M×h；P=0.003)，IMM后下降(AUC×1038.22±1.24至5.70±0.70；P=0.01)。12-α-羟基/非-12-α-羟基化BA的比例没有变化。治疗后FGF19AUC与bas呈正相关(r=0.5 4，P=0.0 4)，与HbA1c呈负相关(r=−0.44；P=0.0 9)；在血糖控制方面取得类似改善的受试者中，RYGB治疗后BA和FGF19水平升高，但IMM治疗后不增加。有必要进行进一步的研究，以确定这些激素变化是否有助于改善血糖稳态。
To quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment. Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n=15) or RYGB (n=15). Mean HbA1c decreased from 9.7 to 6.4% after RYGB and from 9.1 to 6.1% in the IMM group. At 12 mo the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB FGF19 increased in the fasted (93±15 to 152±19 pg/ml; P=0.008) and postprandial states (AUC, 10.8 ± 1.9 to 23.4 ± 4.1 pg × hr/ml × 103; P=0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC × 103, 6.63 ± 1.3 to 15.16 ± 2.56 M × h; P=0.003) and decreased after IMM (AUC × 103 8.22 ±1.24 to 5.70 ± 0.70; P=0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r=0.54, P=0.04) and trended negatively with HbA1c (r=−0.44; P=0.09); these associations were not observed after IMM. BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.