Vetter Marion L, Cardillo Serena, Rickels Michael R, Iqbal Nayyar
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Ann Intern Med. 2009 Jan 20;150(2):94-103. doi: 10.7326/0003-4819-150-2-200901200-00007.
Bariatric surgery leads to substantial and durable weight reduction. Nearly 30% of patients who undergo bariatric surgery have type 2 diabetes, and for many of them, diabetes resolves after surgery (84% to 98% for bypass procedures and 48% to 68% for restrictive procedures). Glycemic control improves in part because of caloric restriction but also because gut peptide secretion changes. Gut peptides, which mediate the enteroinsular axis, include the incretins glucagon-like peptide-1 and glucose-dependent insulinotropic peptide, as well as ghrelin and peptide YY. Bariatric surgery (particularly bypass procedures) alters secretion of these gut hormones, which results in enhanced insulin secretion and sensitivity. This review discusses the various bariatric procedures and how they alter the enteroinsular axis. Familiarity with these effects can help physicians decide among the different surgical procedures and avoid postoperative hypoglycemia.
减肥手术可带来显著且持久的体重减轻。接受减肥手术的患者中，近30%患有2型糖尿病，其中许多人的糖尿病在术后得到缓解（旁路手术的缓解率为84%至98%，限制性手术的缓解率为48%至68%）。血糖控制得到改善，部分原因是热量限制，但也因为肠道肽分泌发生了变化。介导肠胰岛轴的肠道肽包括肠促胰岛素胰高血糖素样肽-1和葡萄糖依赖性促胰岛素多肽，以及胃饥饿素和肽YY。减肥手术（尤其是旁路手术）会改变这些肠道激素的分泌，从而导致胰岛素分泌增加和敏感性增强。本文综述讨论了各种减肥手术及其如何改变肠胰岛轴。熟悉这些作用有助于医生在不同的手术方式中做出选择，并避免术后低血糖。
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