Whitson Bryan A, Leslie Daniel B, Kellogg Todd A, Maddaus Michael A, Buchwald Henry, Billington Charles J, Ikramuddin Sayeed
Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
J Surg Res. 2007 Jul;141(1):31-9. doi: 10.1016/j.jss.2007.02.022.
Alterations in entero-endocrine signaling may play a role in improvements in satiety and glucose tolerance after Roux-en-Y gastric bypass (RYGB). We report our findings of gut hormone secretion in a cohort of diabetic and nondiabetic morbidly obese patients.
Ten morbidly obese subjects who underwent uncomplicated RYGB were studied: 5 were diabetic and 9 were female. Nonfasting plasma levels of glucagon-like peptide-1 (GLP-1), insulin, desacyl ghrelin, active ghrelin, neuropeptide Y (NPY), and gastric inhibitory polypeptide (GIP) were determined preoperatively and 6 months postoperatively.
Mean patient age was 42 +/- 11 years, and the mean preoperative body mass index was 50 +/- 6 kg/m(2). At 6 months mean BMI fell to 33 +/- 5 kg/m(2) (P < 0.0001), and there were no differences between diabetics and nondiabetics with respect to amount of weight loss. In non-diabetics, compared to preoperative levels, there were significant increases in GLP-1 and desacyl-ghrelin in the nondiabetic patients (P = 0.046 and P = 0.016, respectively); no change in plasma insulin, active ghrelin, NPY, or GIP was demonstrated. In contrast, when compared to preoperative levels, there were no significant changes in entero-endocrine hormone levels in the diabetic cohort postoperatively.
At 6 months postoperation, RYGB significantly alters the hormone levels for GLP-1 and desacyl-ghrelin in morbidly obese nondiabetic patients. No significant change was noted in a matched cohort of diabetic patients. Weight loss was similar in diabetics and nondiabetics, suggesting that GLP-1 and ghrelin are not the only mechanisms producing weight loss after RYGB.
肠-内分泌信号的改变可能在Roux-en-Y胃旁路术（RYGB）后饱腹感和糖耐量改善中发挥作用。我们报告了一组糖尿病和非糖尿病病态肥胖患者肠道激素分泌的研究结果。
对10例接受无并发症RYGB的病态肥胖受试者进行研究：5例为糖尿病患者，9例为女性。术前及术后6个月测定非空腹血浆中胰高血糖素样肽-1（GLP-1）、胰岛素、去酰基胃饥饿素、活性胃饥饿素、神经肽Y（NPY）和胃抑制多肽（GIP）的水平。
患者平均年龄为42±11岁，术前平均体重指数为50±6kg/m²。6个月时平均体重指数降至33±5kg/m²（P<0.0001），糖尿病患者和非糖尿病患者在体重减轻量方面无差异。在非糖尿病患者中，与术前水平相比，非糖尿病患者的GLP-1和去酰基胃饥饿素显著增加（分别为P=0.046和P=0.016）；血浆胰岛素、活性胃饥饿素、NPY或GIP无变化。相比之下，与术前水平相比，糖尿病组术后肠-内分泌激素水平无显著变化。
术后6个月，RYGB显著改变了病态肥胖非糖尿病患者的GLP-1和去酰基胃饥饿素激素水平。在匹配的糖尿病患者队列中未观察到显著变化。糖尿病患者和非糖尿病患者的体重减轻相似，这表明GLP-1和胃饥饿素不是RYGB后导致体重减轻的唯一机制。
