肥胖的2型糖尿病患者Roux-en-Y胃分流术后1月肠促胰素的水平和效果明显增强

Incretin Levels and Effect Are Markedly Enhanced 1 Month After Roux-en-Y Gastric Bypass Surgery in Obese Patients With Type 2 Diabetes

Abstract

肥胖的2型糖尿病患者Roux-en-Y胃分流术后1月肠促胰素的水平和效果明显增强海南医学院附属医院内分泌科王新军

OBJECTIVE? Limited data on patients undergoing Roux-en-Y gastric bypass surgery (RY-GBP) suggest that an improvement in insulin secretion after surgery occurs rapidly and thus may not be wholly accounted for by weight loss. We hypothesized that in obese patients with type 2 diabetes the impaired levels and effect of incretins changed as a consequence of RY-GBP.
目的：在患者接受Roux - en - Y胃旁路手术（RY - GBP）的患者中研究的数据提示，术后胰岛素分泌可快速改善，因此可能不完全能解释手术后的体重减轻。我们推测，在肥胖的2型糖尿病患者受损的肠促胰岛素在RY ? GBP手术后会发生改变。
RESEARCH DESIGN AND METHODS? Incretin (gastric inhibitory peptide [GIP] and glucagon-like peptide-1 [GLP-1]) levels and their effect on insulin secretion were measured before and 1 month after RY-GBP in eight obese women with type 2 diabetes and in seven obese nondiabetic control subjects. The incretin effect was measured as the difference in insulin secretion (area under the curve [AUC]) in response to an oral glucose tolerance test (OGTT) and to an isoglycemic intravenous glucose test.

研究设计和方法：在8例女性肥胖的2型糖尿病及7例肥胖的非糖尿病对照个体，测定RY-GBP手术前及术后1月肠促胰素（抑胃肽[GIP]和胰高血糖素样肽1 [GLP - 1）的水平和对胰岛素分泌的影响。肠促胰素的效应以口服糖耐量试验（OGTT）和静脉isoglycemic葡萄糖试验前后胰岛素分泌的差别表示（曲线下面积[AUC]）。
RESULTS? Fasting and stimulated levels of GLP-1 and GIP were not different between control subjects and patients with type 2 diabetes before the surgery. One month after RY-GBP, body weight decreased by 9.2 ± 7.0 kg, oral glucose-stimulated GLP-1 (AUC) and GIP peak levels increased significantly by 24.3 ± 7.9 pmol ? l⁻¹ ? min⁻¹ (P < 0.0001) and 131 ± 85 pg/ml (P = 0.007), respectively. The blunted incretin effect markedly increased from 7.6 ± 28.7 to 42.5 ± 11.3 (P = 0.005) after RY-GBP, at which it time was not different from that for the control subjects (53.6 ± 23.5%, P = 0.284).

结果：手术前空腹和刺激后GLP - 1和GIP水平在2型糖尿病患者和对照组无差异。RY-GBP手术一个月后，体重下降了9.2 ± 7.0kg，口服葡萄糖刺激的GLP - 1（AUC）和GIP的峰值水平分别显著增加24.3 ± 7.9 pmol ? l⁻¹ ? min⁻¹（P <0.0001）和131 ± 85 pg/ml（P = 0.007）。RY-GBP手术后，延迟的肠促胰岛素效应从7.6 ± 28.7显着增加到42.5 ± 11.3（P = 0.005），与对照组相比无明显差别（53.6 ± 23.5％，P = 0.284）。 CONCLUSIONS? These data suggest that early after RY-GBP, greater GLP-1 and GIP release could be a potential mediator of improved insulin secretion.

结论：这些数据表明，RY-GBP手术后早期，更大的GLP - 1和GIP释放可能是一个改善胰岛素分泌的潜在介质。