What can bariatric surgery teach us about the pathophysiology of type 2 diabetes?
What can bariatric surgery teach us about the pathophysiology of type 2 diabetes?
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DOI：
10.1016/s1262-3636(09)73456-1
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发表时间：
2009-12-01
影响因子：
7.2
通讯作者：
Mithieux, G.
中科院分区：
文献类型：
--
作者：
Andreelli, F.;Amouyal, C.;Mithieux, G.
减肥手术适用于严重肥胖的病例。然而，以吸收不良为基础的技术（胃分流术和胆胰分流术）。两者都排除了十二指肠和空肠（消化道前方）。但不是限制性技术。呼吁在手术后几天内消除2型糖尿病。这意味着仅仅限制热量摄入并不能完全解释这种效果。后藤- kakizaki的老鼠。2型糖尿病模型。手术切除近端肠可改善血糖平衡。但在同一动物体内，当近端肠重新连接到回路时，情况又会恶化。这种影响与重量无关。这表明肠道本身参与了碳水化合物平衡的即时调节。在人体中，旁路手术后观察到的碳水化合物平衡的快速改善是继发于胰岛素敏感性的增加，而不是胰岛素分泌的增加，后者发生在之后。多种机制参与其中——高甘油三酯血症的消失和循环脂肪酸水平的降低，肝脏和骨骼肌脂肪毒性机制的消失和GLP-1和pyy分泌的增加——这些机制可能错综复杂地联系在一起。在生命中期和体重减轻的同时，脂肪组织炎症的减少（限制性技术也可以看到）也可能涉及代谢改善，其他机制特定于基于吸收不良的技术（提示需要排除部分肠道）。如消化道迷走神经传入活动的变化、肠道菌群的变化和肠道新糖生成的刺激等，也需要更详细的研究。因此。是调节血糖平衡的关键器官，甚至可能参与2型糖尿病的病理生理(C) 2009年出版的Elsevier Masson SAS
Bariatric surgery is indicated in cases of severe obesity. However, malabsorption-based techniques (gastric bypass and biliopancreatic diversion. both of which exclude the duodenum and jejunum front the alimentary circuit). but not restrictive techniques. call abolish type 2 diabetes within days of surgery. even before any significant weight loss has occurred This means that calorie restriction alone cannot entirely account for this effect. In Goto-Kakizaki rats. I type 2 diabetes model. glycaemic equilibrium is improved by surgical exclusion of the proximal Intestine. but deteriorates again when the proximal Intestine is reconnected to the circuit in the same animals. This effect is independent of weight. suggesting that the intestine is itself involved in the Immediate regulation of carbohydrate homoeostasis In humans, the rapid improvement in carbohydrate homoeostasis observed after bypass surgery is secondary to an increase in insulin sensitivity rather than an increase in Insulin secretion, which occurs later. Several mechanisms are involved-disappearance of hypertriglyceridaemia and decrease in levels of circulating fatty acids, disappearance of the mechanisms of lipotoxicity in the liver and skeletal muscle and increases in secretion of GLP-1 and PYY-and may be intricately linked. In lite medium term and in parallel with weight loss, a decrease in fatty tissue inflammation (which is also seen with restrictive techniques) may also be involved in metabolic improvement Other mechanisms specific to malabsorption-based techniques (clue to the required exclusion of Part of the Intestine). Such as changes in the activity of digestive vagal afferents changes in intestinal flora and stimulation of intestinal neoglucogenesis, also need to be studied in greater detail The Intestine is. thus. a key organ in the regulation of glycaemic equilibrium and may even be involved in the pathophysiology of type 2 diabetes (C) 2009 Published by Elsevier Masson SAS