First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis
First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis
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DOI：
10.1007/s00464-011-1755-5
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发表时间：
2011-11-01
影响因子：
3.1
通讯作者：
Leonetti, F.
中科院分区：
文献类型：
--
作者：
Basso, N.;Capoccia, D.;Leonetti, F.
背景本研究的目的是评估袖状胃切除术（SG）本身在糖尿病可逆性中的可能作用。方法采用静脉葡萄糖耐量试验（IVGTT）对18例肥胖2型糖尿病患者和10例非糖尿病肥胖患者在SG前和SG后3天，在任何食物摄入和任何体重变化发生之前的胰岛素分泌和外周胰岛素敏感性进行了评估。结果糖尿病病程小于10.5年的糖尿病患者，SG后胰岛素分泌第一时相迅速改善。术后IVGTT时早期胰岛素曲线下面积（AUC）显著增加，表明葡萄糖诱导的胰岛素分泌增加。在所有组中，SG后胰岛素分泌的第二时相（晚期AUC）显著降低，表明外周胰岛素敏感性改善。在所有组中，术前和术后，静脉内葡萄糖刺激确定了ghrelin值的降低和GLP-1和PYY值的增加。然而，在病程>10.5年的患者组中，除晚期胰岛素AUC外，差异不显著。术后基础和静脉葡萄糖刺激的ghrelin水平低于术前水平的所有患者组。基础和静脉刺激GLP-1和PYY术后值均高于术前水平在所有group.Conclusions恢复胰岛素分泌的第一时相和改善胰岛素敏感性在糖尿病肥胖患者SG后立即，在任何食物通过胃肠道之前和任何体重减轻之前，似乎与ghrelin，GLP-1，和PYY激素变化可能是胃源性的，既不与进餐也不与体重变化相关。长达10.5年的疾病的持续时间似乎是一个主要的截止SG引起的病理生理变化。SG的抗糖尿病作用可能存在“胃”假说。
Background The aim of this study was to evaluate the possible role of sleeve gastrectomy (SG) per se in the reversibility of diabetes.Methods Insulin secretion and peripheral insulin sensitivity using the intravenous glucose tolerance test (IVGTT) were assessed in 18 obese type 2 diabetic patients and in 10 nondiabetic obese patients before and 3 days after SG, before any food intake and any weight change occurrence. At the same time, ghrelin, GLP-1, and PYY levels were determined.Results In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC) significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC) significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups.Conclusions Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the antidiabetes effect of SG.