Nijhuis Jeroen, van Dielen Francois M H, Buurman Wim A, Greve Jan Willem M
Department of General Surgery, Maastricht University, 6200 MD Maastricht, The Netherlands.
Obes Surg. 2004 Jun-Jul;14(6):783-7. doi: 10.1381/0960892041590980.
Ghrelin is a recently discovered orexigenic gastric hormone, whose production is induced by lack of food in the stomach. In morbidly obese individuals, ghrelin levels are low compared to lean persons. During dieting, plasma ghrelin levels increase, leading to an orexigenic signal, which could explain the lack of success of dieting in morbidly obese individuals. Morbid obesity is best treated with bariatric surgery, in which gastric bypass is reported to be more effective than restrictive surgery. A possible explanation could be the difference in plasma ghrelin levels after both operations for bariatric surgery. In this study, plasma ghrelin levels were investigated during a 2-year follow-up.
17 morbidly obese patients received gastric restrictive surgery. Plasma ghrelin, leptin and insulin levels were evaluated preoperatively and 1 year and 2 years postoperatively.
BMI decreased from 47.5 +/- 6.2 kg/m(2) to 33.2 +/- 5.8 kg/m(2) (P <0.001). Plasma ghrelin levels were significantly increased 1 year (P <0.05) and 2 years (P <0.02) postoperatively. Fasting plasma leptin and insulin levels were significantly lower at 2 years after surgery (P <0.001).
After gastric restrictive surgery, ghrelin levels increased, in contrast to the reported fall in ghrelin levels after gastric bypass. This difference in ghrelin levels between these operations may be the key to understanding the superiority of gastric bypass in sustaining weight loss compared with restrictive surgery.
胃饥饿素是一种最近发现的促食欲胃激素，其分泌由胃内食物缺乏诱导产生。与瘦人相比，病态肥胖个体的胃饥饿素水平较低。节食期间，血浆胃饥饿素水平升高，导致促食欲信号产生，这可能解释了病态肥胖个体节食失败的原因。病态肥胖最好通过减肥手术治疗，据报道胃旁路手术比限制性手术更有效。一个可能的解释是两种减肥手术后血浆胃饥饿素水平的差异。在本研究中，对血浆胃饥饿素水平进行了为期2年的随访调查。
17例病态肥胖患者接受了胃限制性手术。术前、术后1年和2年评估血浆胃饥饿素、瘦素和胰岛素水平。
体重指数从47.5±6.2kg/m²降至33.2±5.8kg/m²（P<0.001）。术后1年（P<0.05）和2年（P<0.02）血浆胃饥饿素水平显著升高。术后2年空腹血浆瘦素和胰岛素水平显著降低（P<0.001）。
与报道的胃旁路手术后胃饥饿素水平下降相反，胃限制性手术后胃饥饿素水平升高。这些手术之间胃饥饿素水平的差异可能是理解胃旁路手术相比限制性手术在维持体重减轻方面优越性的关键。
