Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Diabetes and Bone Disease, Mount Sinai School of Medicine, 5 E. 98th St., New York, NY 10029, USA.
Obes Rev. 2012 Apr;13(4):316-28. doi: 10.1111/j.1467-789X.2011.00955.x. Epub 2011 Nov 23.
The objective of this article is to systematically review the changes in insulin resistance after various types of bariatric surgical procedures. A Pubmed and EMBASE search for studies measuring insulin resistance before and after bariatric surgery was done and all original research articles from 1980 to present (2011) were included. Only the currently widely performed bariatric procedures were included. A meta-analysis of change in HOMA-IR was conducted, grouping studies with similar duration of follow-up. The percentage decrease in HOMA-IR at <=2 weeks, 1 month, 3 months, 6 months, 12 months and >16-18 months was found to be (mean ± standard error) -33.48 ± 5.78, -46.43 ± 6.99, -38.79 ± 9.64, -58.62 ± 7.38, -44.91 ± 7.98 and -67.04 ± 10.78%, respectively. RYGB (gastric bypass) and BPD (biliopancreatic diversion) produced a significant decrease in insulin resistance at 2 weeks after surgery, while LSG (sleeve gastrectomy) was strongly trending. LSG produced an earlier decrease in insulin resistance when compared to LAGB (gastric banding). RYGB, BPD and LSG produce an early decrease in insulin resistance through yet unknown mechanisms.
本文旨在系统回顾各种减重手术术后胰岛素抵抗的变化。通过在 Pubmed 和 EMBASE 上检索评估减重手术前后胰岛素抵抗的研究，并纳入所有自 1980 年至今（2011 年）发表的原始研究文章。仅纳入目前广泛应用的减重手术方式。对 HOMA-IR 的变化进行荟萃分析，根据相似的随访时间对研究进行分组。发现术后 2 周、1 个月、3 个月、6 个月、12 个月及>16-18 个月时 HOMA-IR 的降低百分比分别为（平均值±标准误）-33.48±5.78%、-46.43±6.99%、-38.79±9.64%、-58.62±7.38%、-44.91±7.98%和-67.04±10.78%。胃旁路术（RYGB）和胆胰分流术（BPD）在术后 2 周时显著降低胰岛素抵抗，而袖状胃切除术（LSG）则有显著下降的趋势。与胃旁路术（LAGB）相比，LSG 更早地降低了胰岛素抵抗。RYGB、BPD 和 LSG 通过尚未明确的机制早期降低胰岛素抵抗。
