Ohtsuka Takao, Kitahara Kenji, Kohya Naohiko, Miyoshi Atsushi, Miyazaki Kohji
Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
Pancreas. 2009 Aug;38(6):700-5. doi: 10.1097/MPA.0b013e3181a7c916.
The aim of this study was to investigate the mechanisms of the change in glucose metabolism after a pancreatoduodenectomy (PD).
Oral glucose tolerance tests were performed in 17 patients before and 1 month after a PD. The changes in plasma glucose and insulin concentrations, homeostasis model of insulin resistance, and insulinogenic index (beta-cell function) were analyzed. Two additional factors, gastric emptying function and plasma glucagon-like peptide-1 (GLP-1) concentration, that possibly affect perioperative glucose metabolism were also assessed.
The plasma glucose and insulin concentrations were significantly lower after the operation, especially in preoperative diabetic patients. beta-Cell function did not change after the operation. On the other hand, insulin resistance became normal 1 month after the operation. The value of gastric emptying function after the operation was not statistically different in comparison with that before the operation. Postoperative plasma GLP-1 concentration was significantly higher than the preoperative value.
beta-Cell function is maintained after a PD, whereas the improvement of insulin resistance may cause a short-term transient improvement of the glucose metabolism after the operation. The significance of increased postoperative GLP-1 concentration remains an unsolved issue.
本研究旨在探讨胰十二指肠切除术（PD）后糖代谢变化的机制。
对17例患者在PD术前及术后1个月进行口服葡萄糖耐量试验。分析血浆葡萄糖和胰岛素浓度、胰岛素抵抗稳态模型及胰岛素生成指数（β细胞功能）的变化。还评估了另外两个可能影响围手术期糖代谢的因素，即胃排空功能和血浆胰高血糖素样肽-1（GLP-1）浓度。
术后血浆葡萄糖和胰岛素浓度显著降低，尤其是术前糖尿病患者。术后β细胞功能未发生变化。另一方面，术后1个月胰岛素抵抗恢复正常。术后胃排空功能值与术前相比无统计学差异。术后血浆GLP-1浓度显著高于术前值。
PD术后β细胞功能得以维持，而胰岛素抵抗的改善可能导致术后糖代谢出现短期短暂改善。术后GLP-1浓度升高的意义仍未解决。
