LIMED/Gastrocentro, R. Carlos Chagas, Department of Surgery, 420, Cidade Universitária, State University of Campinas (UNICAMP), Campinas, São Paulo, 13081-970, Brazil.
J Clin Endocrinol Metab. 2010 Aug;95(8):3871-5. doi: 10.1210/jc.2010-0085. Epub 2010 May 19.
Insulin resistance ameliorates after bariatric surgery, yet there is still a need for data on the acute effect of Roux-en-Y gastric bypass (RYGBP) on insulin sensitivity.
The objective of the study was to describe the acute effect of RYGBP on insulin sensitivity, measured by both the euglycemic-hyperinsulinemic clamp and homeostasis model assessment insulin resistance index (HOMA-IR).
Evaluations were conducted before and 1 month after RYGBP at State University of Campinas (São Paulo, Brazil).
Patients included 19 premenopausal women with metabolic syndrome aged 35.3 (6.7) yr, body mass index 45.50 (3.74) kg/m2 [mean (sd)]. Six had mild type 2 diabetes, seven impaired glucose tolerance, and six normal glucose tolerance.
The volunteers underwent RYGBP either alone or combined with omentectomy. Euglycemic-hyperinsulinemic clamp, HOMA-IR, nonesterified fatty acids, leptin, ultrasensitive C-reactive protein, adiponectin, and IL-6 were assessed at baseline and 4.5 (0.9) wk postoperatively.
Fasting glucose decreased [99.2 (13.1) to 83.6 (8.1) mg/dl, P<0.01] along with a reduction in fasting insulin [30.4 (17.0) to 11.4 (6.3) mU/liter, P<0.01]. M value did not improve postoperatively [25.82 (6.30) to 22.02 (6.05) micromol/kgFFM.min] despite of a decrease in body weight [114.8 (14.5) to 102.3 (14.5) kg, P<0.001]. This finding was discordant to the observation of an improvement in HOMA-IR [3.85 (2.10) to 1.42 (0.76), P<0.01]. Nonesterified fatty acids increased. Leptin and C-reactive protein decreased. IL-6 and adiponectin remained unchanged.
A month after RYGBP, fasting glucose metabolism improves independent of a change in peripheral insulin sensitivity.
减重手术后胰岛素抵抗得到改善，但仍需要关于 Roux-en-Y 胃旁路术（RYGBP）对胰岛素敏感性的急性影响的数据。
本研究的目的是描述 RYGBP 对胰岛素敏感性的急性影响，通过正葡萄糖高胰岛素钳夹和稳态模型评估胰岛素抵抗指数（HOMA-IR）来测量。
在巴西坎皮纳斯州立大学（圣保罗）进行了术前和 RYGBP 后 1 个月的评估。
患者包括 19 名患有代谢综合征的绝经前女性，年龄 35.3（6.7）岁，体重指数 45.50（3.74）kg/m2[平均值（标准差）]。其中 6 人患有轻度 2 型糖尿病，7 人糖耐量受损，6 人血糖正常。
志愿者单独接受 RYGBP 或与网膜切除术联合接受 RYGBP。在基线和术后 4.5（0.9）周时评估了正葡萄糖高胰岛素钳夹、HOMA-IR、非酯化脂肪酸、瘦素、超敏 C 反应蛋白、脂联素和白细胞介素 6。
空腹血糖降低[99.2（13.1）至 83.6（8.1）mg/dl，P<0.01]，空腹胰岛素降低[30.4（17.0）至 11.4（6.3）mU/l，P<0.01]。尽管体重减轻[114.8（14.5）至 102.3（14.5）kg，P<0.001]，但术后 M 值并未改善[25.82（6.30）至 22.02（6.05）µmol/kgFFM.min]。这一发现与 HOMA-IR 的改善观察结果不一致[3.85（2.10）至 1.42（0.76），P<0.01]。非酯化脂肪酸增加。瘦素和 C 反应蛋白减少。白细胞介素 6 和脂联素保持不变。
RYGBP 后 1 个月，空腹血糖代谢改善，而外周胰岛素敏感性没有变化。
