Division of Internal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Diabetes Obes Metab. 2009 Nov;11(11):1027-33. doi: 10.1111/j.1463-1326.2009.01089.x. Epub 2009 Jul 13.
Compare the response to oral glucose of the two incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) at 1 year after restrictive vs. malabsorptive bariatric surgery.
Vertical banded gastroplasty (VBG, n = 7) or jejunoileal bypass (JIB, n = 5) was performed in 12 women, aged 26-39 years, with severe obesity [body mass index (BMI) 46.6 +/- 2.3 kg/m(2)]. After 1 year, 75 g glucose was administered and plasma levels of glucose, insulin, GIP and GLP-1 were determined regularly during the following 2 h.
At 1 year after operation, reduction in body weight, actual body weight, fasting glucose or insulin, or the glucose and insulin responses to oral glucose did not differ significantly between the groups. Similarly, fasting GIP and GLP-1 levels did not differ significantly between the groups. In contrast, the GIP and GLP-1 responses to oral glucose were different between the groups in a dissociated pattern. Thus, AUC(GIP) was significantly higher after VBG than after JIB (53 +/- 8 vs. 26 +/- 6 pmol/l/min, p = 0.003). In contrast, AUC(GLP-1) was significantly higher after JIB than after VBG (49 +/- 5 vs. 20 +/- 3 pmol/l/min, p = 0.007).
We conclude that at 1 year after bariatric surgery, the two incretins show dissociated responses in that the GIP secretion is higher after VBG whereas GLP-1 secretion is higher after JIB. This dissociated incretin response is independent from reduction in body weight, glucose tolerance or insulin secretion.
比较两种肠促胰岛素激素（葡萄糖依赖性胰岛素促分泌多肽（GIP）和胰高血糖素样肽-1（GLP-1）对限制型与吸收不良型减肥手术后 1 年的口服葡萄糖反应。
12 名年龄在 26-39 岁的严重肥胖女性（体重指数（BMI）46.6±2.3kg/m2）接受了垂直带胃成形术（VBG，n=7）或空回肠旁路术（JIB，n=5）。术后 1 年，给予 75g 葡萄糖，并在接下来的 2 小时内定期测定血浆葡萄糖、胰岛素、GIP 和 GLP-1 水平。
术后 1 年，两组间体重减轻、实际体重、空腹血糖或胰岛素，或口服葡萄糖的血糖和胰岛素反应均无显著差异。同样，两组间空腹 GIP 和 GLP-1 水平也无显著差异。相反，两组间口服葡萄糖的 GIP 和 GLP-1 反应呈分离模式。因此，VBG 后 GIP 的 AUC（GIP）明显高于 JIB（53±8 对 26±6pmol/l/min，p=0.003）。相反，JIB 后 GLP-1 的 AUC（GLP-1）明显高于 VBG（49±5 对 20±3pmol/l/min，p=0.007）。
我们得出结论，减肥手术后 1 年，两种肠促胰岛素激素表现出分离的反应，即 VBG 后 GIP 分泌增加，而 JIB 后 GLP-1 分泌增加。这种分离的肠促胰岛素反应与体重减轻、葡萄糖耐量或胰岛素分泌无关。
