Frühbeck Gema, Rotellar Fernando, Hernández-Lizoain José Luis, Gil M Jesús, Gómez-Ambrosi Javier, Salvador Javier, Cienfuegos Javier A
Metabolic Research Laboratory and Department of Endocrinology, Clínica Universitaria de Navarra, University of Navarra, Avda Pio XII 36, 31008 Pamplona, Spain.
Obes Surg. 2004 Oct;14(9):1208-15. doi: 10.1381/0960892042386904.
Ghrelin is a gastric peptide with potent orexigenic effects. Circulating ghrelin concentrations are increased in obese subjects, but increase after weight loss. However, in patients undergoing Roux-en-Y gastric bypass (RYGBP), a decrease in ghrelin levels has been reported. The effect of comparable weight loss induced by either adjustable gastric banding (AGB), RYGBP or conventional dietary treatment (Conv) on ghrelinemia was studied.
24 matched obese male patients in whom similar weight loss had been achieved by either AGB (n=8), RYGBP (n=8) or Conv (n=8) were studied before and 6 months after treatment start. The independence of ghrelin concentrations from body mass index (BMI) and weight loss was further analyzed in a group of patients with total gastrectomy (TtGx, n=6).
Comparable weight loss after 6 months exerted significantly different effects on plasma ghrelin concentrations, depending on the procedure applied (AGB: 424.6 +/- 32.8 pg/ml; RYGBP: 131.4 +/- 13.5; Conv: 457.3 +/- 18.7; P<0.001). Without significant differences in body weight and BMI, patients who had undergone the RYGBP exhibited a statistically significant decrease in fasting ghrelin concentrations, while the other two procedures (AGB and Conv) showed a weight loss-induced increase in ghrelin levels. Despite significant differences in BMI between RYGBP and TtGx patients after 6 months (31.9 +/- 2.2 vs 22.0 +/- 0.7 kg/m(2), respectively; P<0.05), both groups showed similar ghrelin concentrations.
The reduction in circulating ghrelin concentrations in RYGBP patients after 6 months of surgery are not determined by an active weight loss or an improved insulin-sensitivity but rather depend on the surgically-induced bypass of the ghrelin-producing cell population of the fundus.
胃饥饿素是一种具有强大促食欲作用的胃肽。肥胖受试者循环中的胃饥饿素浓度会升高，但体重减轻后会增加。然而，据报道，接受Roux-en-Y胃旁路术（RYGBP）的患者胃饥饿素水平会降低。本研究比较了可调节胃束带术（AGB）、RYGBP或传统饮食治疗（Conv）诱导的同等体重减轻对胃饥饿素血症的影响。
24名匹配的肥胖男性患者，通过AGB（n = 8）、RYGBP（n = 8）或Conv（n = 8）实现了相似的体重减轻，在治疗开始前和开始后6个月进行了研究。在一组全胃切除术（TtGx，n = 6）患者中，进一步分析了胃饥饿素浓度与体重指数（BMI）和体重减轻的独立性。
6个月后同等程度的体重减轻对血浆胃饥饿素浓度产生了显著不同的影响，这取决于所采用的手术方式（AGB：424.6±32.8 pg/ml；RYGBP：131.4±13.5；Conv：457.3±18.7；P<0.001）。在体重和BMI无显著差异的情况下，接受RYGBP的患者空腹胃饥饿素浓度有统计学意义的下降，而其他两种手术方式（AGB和Conv）则显示体重减轻导致胃饥饿素水平升高。尽管6个月后RYGBP患者和TtGx患者的BMI存在显著差异（分别为31.9±2.2和22.0±0.7 kg/m²；P<0.05），但两组的胃饥饿素浓度相似。
RYGBP患者术后6个月循环胃饥饿素浓度的降低不是由主动体重减轻或胰岛素敏感性改善所决定的，而是取决于手术导致的胃底产生胃饥饿素的细胞群旁路。
