Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden.
J Clin Endocrinol Metab. 2011 Jul;96(7):2227-35. doi: 10.1210/jc.2010-2876. Epub 2011 May 4.
Endocrine effects of gastric bypass (GBP) surgery for obesity on glucose homeostasis are not fully understood.
The main objective of the study was to assess the changes in plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), leptin, somatostatin, glucose-dependent insulinotropic peptide, enteroglucagon, and glucagon early after GBP.
Twelve obese subjects (body mass index 45.3 ± 1.9 kg/m(2)) were subjected to a liquid meal without lipids before and 3 d, 2 months, and 1 yr after GBP. Plasma concentrations of glucose, insulin, leptin, and gut peptide hormones were assessed before and for 180 min after the meal. Satiety was measured with visual analog scales. The absorption rate of acetaminophen added to the liquid meal was measured. Insulin resistance was measured by the homeostasis model assessment of insulin resistance.
All subjects lost weight (body mass index 30.3 ± 1.8 kg/m(2) at 1 yr). Fasting glucose was significantly lower on d 3 (P < 0.05). There was a progressive decrease in the homeostasis model assessment of insulin resistance after 2 months postoperatively. Postprandially, there was a progressive rise of GLP-1 and enteroglucagon and a transient increase in pancreatic glucagon release over the study period. There was a leftward shift of the time course of plasma glucose and insulin. Somatostatin release was lower on d 3 (P < 0.05) but then unchanged. The absorption rate of acetaminophen was twice as fast after GBP compared with before surgery and did not change over time. Satiety scores increased markedly postoperatively.
Both enhanced insulin sensitivity and incretin hormones, such as GLP-1, contribute to the early control of glucose homeostasis. Progressively increasing postprandial levels of enteroglucagon (oxyntomodulin) and GLP-1 facilitate weight loss and enhance insulin effectiveness.
胃旁路（GBP）手术治疗肥胖对葡萄糖稳态的内分泌影响尚不完全清楚。
本研究的主要目的是评估 GBP 后早期血浆葡萄糖、胰岛素、胰高血糖素样肽-1（GLP-1）、瘦素、生长抑素、葡萄糖依赖性胰岛素释放肽、肠高血糖素和胰高血糖素的变化。
12 名肥胖受试者（体重指数 45.3 ± 1.9 kg/m²）在 GBP 前和术后 3 天、2 个月和 1 年接受无脂液体餐。在餐前和餐后 180 分钟评估血浆葡萄糖、胰岛素、瘦素和肠道肽激素浓度。用视觉模拟量表测量饱腹感。将液体餐中添加的对乙酰氨基酚的吸收率进行测量。用胰岛素抵抗的稳态模型评估法测量胰岛素抵抗。
所有受试者体重减轻（1 年后体重指数 30.3 ± 1.8 kg/m²）。术后第 3 天空腹血糖明显降低（P < 0.05）。术后 2 个月后，稳态模型评估的胰岛素抵抗逐渐降低。术后，GLP-1 和肠高血糖素逐渐升高，胰高血糖素释放短暂增加。血浆葡萄糖和胰岛素的时间曲线向左移位。术后第 3 天生长抑素释放降低（P < 0.05），但随后保持不变。GBP 后对乙酰氨基酚的吸收率是手术前的两倍，且随时间无变化。术后饱腹感明显增加。
增强的胰岛素敏感性和肠促胰岛素，如 GLP-1，有助于早期控制葡萄糖稳态。餐后逐渐升高的肠高血糖素（oxyntomodulin）和 GLP-1 水平有助于减轻体重并增强胰岛素的有效性。
