Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients
Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients
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DOI：
10.1016/j.jhep.2013.09.012
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发表时间：
2014-02-01
影响因子：
25.7
通讯作者：
Nuutila, Pirjo
中科院分区：
文献类型：
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作者：
Immonen, Heidi;Hannukainen, Jarna C.;Nuutila, Pirjo
背景与目的：减肥手术可以减轻肥胖患者的体重并改善其糖代谢。我们调查了减肥手术对肝脏insulinsensitivity.Methods的影响：23病态肥胖（9糖尿病和14非糖尿病）患者和10名健康，瘦对照组进行了研究，使用正电子发射断层扫描，以评估肝脏葡萄糖摄取在空腹状态和正常血糖高胰岛素血症。进行磁共振波谱分析以测量肝脏脂肪含量，并进行磁共振成像以获得肝脏体积。肥胖患者进行了研究减肥手术前（无论是袖状胃切除术或Roux-en-Y胃旁路术）和6个月后surgery.Results：胰岛素诱导的肝葡萄糖摄取增加了33%，在非糖尿病和36%的糖尿病患者在后续与基线相比，但没有完全正常化。非糖尿病患者的肝脏脂肪含量减少了76%，肝脏体积减少了26%，内源性葡萄糖产生减少了19%。糖尿病患者的变化分别为73%、24%和25%。手术后，肝脏脂肪含量和内源性葡萄糖的生产几乎正常化瘦对照，但肝脏体积仍然大于对照subjects.Conclusions：这项研究表明，减肥手术导致肝脏胰岛素敏感性的显着改善：胰岛素刺激的肝脏葡萄糖摄取改善和内源性葡萄糖的生产减少时，测量，6个月，手术后。这些代谢效应伴随着肝脏体积和脂肪含量的显著减少。总体而言，对于相同的体重减轻，糖尿病患者的肝脏胰岛素敏感性增加与非糖尿病患者非常相似。(C)2013由Elsevier B. V.代表欧洲肝脏研究协会发表。
Background & Aims: Bariatric surgery reduces weight and improves glucose metabolism in obese patients. We investigated the effects of bariatric surgery on hepatic insulin sensitivity.Methods: Twenty-three morbidly obese (nine diabetic and fourteen non-diabetic) patients and ten healthy, lean control subjects were studied using positron emission tomography to assess hepatic glucose uptake in the fasting state and during euglycemic hyperinsulinemia. Magnetic resonance spectroscopy was performed to measure liver fat content and magnetic resonance imaging to obtain liver volume. Obese patients were studied before bariatric surgery (either sleeve gastrectomy or Roux-en-Y gastric bypass) and six months after surgery.Results: Insulin-induced hepatic glucose uptake was increased by 33% in non-diabetic and by 36% in diabetic patients at follow-up compared with baseline, but not totally normalized. The liver fat content was reduced by 76%, liver volume by 26% and endogenous glucose production by 19% in non-diabetic patients. The respective changes in diabetic patients were 73%, 24%, and 25%. Postoperatively, liver fat content and endogenous glucose production were almost normalized to lean controls, but liver volume remained greater than in control subjects.Conclusions: This study shows that bariatric surgery leads to a significant improvement in hepatic insulin sensitivity: insulin-stimulated hepatic glucose uptake was improved and endogenous glucose production reduced when measured, six-months, after surgery. These metabolic effects were accompanied by a marked reduction in hepatic volume and fat content. Overall, the gain in hepatic insulin sensitivity in diabetic patients was quite similar to non-diabetic patients for the same weight reduction. (C) 2013 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.