Sirio Libanes Hospital, Institute of Orthopedics and Traumatology, Clinical Hospital, University of São Paulo, 74 Adma Jafet St., 16th Floor, 01308050 São Paulo, Brazil.
Am J Surg. 2012 Jun;203(6):785-92. doi: 10.1016/j.amjsurg.2011.08.014. Epub 2012 Mar 10.
Ghrelin is a gastrointestinal peptide hormone (a 28-amino acid peptide) produced primarily by X/A cells in the oxyntic glands of the stomach fundus and cells lining the duodenum cavern. It suppresses insulin secretion and action and commands a significant role in regulating food intake. The aim of the present study was to show that modified laparoscopic sleeve gastrectomy (MLSG), in which a significant part of the gastric fundus and body of the stomach is removed up to 1 inch from the pylorus vein, may contribute to decreasing circulating ghrelin levels.
A study population consisting of 150 individuals was monitored after undergoing a MLSG, with individuals chosen based on a documented history of diabetes mellitus type 2 and metabolic syndrome, clinical results determining a body mass index (BMI) of 35 to 60 kg/m(2), peptide C level greater than 1, negative anti-glutamic acid decarboxylase, negative anti-insulin, and confirmed stability of drug/insulin treatment and glycosylated hemoglobin greater than 6.5% for at least 24 and 3 months, respectively, before enrollment.
Twenty-four months after surgery, 150 patients (86.6%) presented with normal glycemic levels between 77 and 99 mg/dL. All patients improved average serum insulin levels by 9 mU/L and average glycosylated hemoglobin levels by 5.1% (normal range, 4%-6%). All patients tested negative for Helicobacter pylori and stopped using insulin, with 3 patients prescribed twice-daily use of an oral hypoglycemiant. In 14% of cases, patients experienced partial hair loss with low serum zinc levels and were prescribed oral zinc reposition and topical hair stimulants. The average weight loss recorded was 44.6% for patients with a BMI less than 45 kg/m(2) and 58% for patients with a BMI greater than 50 kg/m(2).
The MLSG is a safe procedure with a low morbidity rate (2.7%) (4 cases of fistula and 2 of bleeding) and no surgical mortality in this study. This surgery can promote control of diabetes mellitus type 2 and aid the treatment of exogenous overweight and morbidly obese individuals. The results of this study show that only through resection of the ghrelin-producing gastric area can most obesity cases and diabetes type II conditions be reverted to nonobese and controlled diabetes.
Ghrelin 是一种胃肠肽激素（一种 28 个氨基酸的肽），主要由胃底的 X/A 细胞和十二指肠腔的细胞产生。它抑制胰岛素的分泌和作用，并在调节食物摄入方面发挥重要作用。本研究的目的是表明改良腹腔镜袖状胃切除术（MLSG），其中胃底和胃体的大部分被切除，距离幽门静脉 1 英寸，可能有助于降低循环 ghrelin 水平。
研究人群由 150 名接受 MLSG 的个体组成，选择这些个体的依据是有 2 型糖尿病和代谢综合征的病史记录、临床结果确定身体质量指数（BMI）为 35 至 60 kg/m²、肽 C 水平大于 1、谷氨酸脱羧酶阴性、胰岛素阴性以及确认药物/胰岛素治疗的稳定性和糖化血红蛋白大于 6.5%，分别至少为 24 和 3 个月。
手术后 24 个月，150 例患者（86.6%）血糖水平正常，在 77 至 99mg/dL 之间。所有患者的平均血清胰岛素水平降低 9mU/L，平均糖化血红蛋白水平降低 5.1%（正常范围为 4%-6%）。所有患者均检测出幽门螺杆菌阴性，停止使用胰岛素，有 3 例患者开出处方，每日两次使用口服降糖药。14%的病例患者出现部分脱发，血清锌水平低，开出处方口服补锌和局部毛发刺激剂。BMI 小于 45kg/m²的患者平均体重减轻 44.6%，BMI 大于 50kg/m²的患者平均体重减轻 58%。
MLSG 是一种安全的手术，发病率低（2.7%）（4 例瘘管和 2 例出血），本研究无手术死亡。这种手术可以促进 2 型糖尿病的控制，并有助于治疗外源性超重和病态肥胖个体。本研究结果表明，只有通过切除产生 ghrelin 的胃区域，才能使大多数肥胖病例和 2 型糖尿病病例恢复到非肥胖和控制的糖尿病状态。
