Valverde Isabel, Puente Jesús, Martín-Duce Antonio, Molina Luis, Lozano Oscar, Sancho Verónica, Malaisse Willy Jean, Villanueva-Peñacarrillo María Luisa
Department of Metabolism, Nutrition and Hormones, Fundación Jiménez Díaz, Madrid, Spain.
Obes Surg. 2005 Mar;15(3):387-97. doi: 10.1381/0960892053576613.
Bariatric operations promote weight loss and improve glucose homeostasis. Glucagon-like peptide-1 (GLP-1) is considered as a possible mediator of the antidiabetic effects of such operations.
The present study aimed to gain information on the time course for changes in glucose tolerance, as well as insulin, glucagon and GLP-1 secretion, during an oral glucose tolerance test (OGTT), in 31 obese patients examined 1, 3 and 6 months after Larrad's biliopancreatic diversion (BPD) or 6 months after vertical banded gastroplasty (VBG).
A time-related progressive decrease in body weight coincided with lowering of plasma triglycerides, decrease of basal plasma glucose and its incremental area during OGTT, and reduction of basal plasma insulin together with an increase of its incremental area. The time-related decrease of plasma glucagon during OGTT was comparable before and after surgery. Both the basal plasma GLP-1 concentration and its incremental area during the OGTT increased strikingly after surgery, a steady-state situation being reached 3 months after surgery. The most striking differences between the somewhat older and less glucose-tolerant subjects of VBG compared to BPD after surgery, consisted in a decrease in cholesterol and LDL only observed in BPD and a much more pronounced increase in basal and incremental plasma GLP-1 in BPD. GLP-1, like glucagon, increased lipolysis, but failed to duplicate the lipogenetic action of insulin in isolated adipocytes obtained at the time of surgery.
These findings support the postulated role of GLP-1, secreted by the hindgut, as a key mediator of the antidiabetic effects of bariatric operations.
减肥手术可促进体重减轻并改善葡萄糖稳态。胰高血糖素样肽-1（GLP-1）被认为是此类手术抗糖尿病作用的一种可能介质。
本研究旨在获取31例肥胖患者在口服葡萄糖耐量试验（OGTT）期间葡萄糖耐量以及胰岛素、胰高血糖素和GLP-1分泌变化的时间进程信息；这些患者分别在接受Larrad胆胰转流术（BPD）后1、3和6个月或垂直束带胃成形术（VBG）后6个月接受检查。
体重随时间逐渐下降，同时伴有血浆甘油三酯降低、OGTT期间基础血浆葡萄糖及其增量面积减小、基础血浆胰岛素降低以及其增量面积增加。手术前后OGTT期间血浆胰高血糖素随时间的降低情况相当。手术后，基础血浆GLP-1浓度及其在OGTT期间的增量面积均显著增加，术后3个月达到稳态。与BPD术后相比，VBG术后年龄稍大且葡萄糖耐量较差的患者之间最显著的差异在于，仅在BPD患者中观察到胆固醇和低密度脂蛋白降低以及BPD患者基础和增量血浆GLP-1的增加更为显著。与胰高血糖素一样，GLP-1可增加脂肪分解，但在手术时获取的分离脂肪细胞中未能复制胰岛素的脂肪生成作用。
这些发现支持由后肠分泌的GLP-1作为减肥手术抗糖尿病作用关键介质的假设作用。
