Nosso G, Griffo E, Cotugno M, Saldalamacchia G, Lupoli R, Pacini G, Riccardi G, Angrisani L, Capaldo B
Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
Metabolic Unit, CNR Neuroscience Institute, Padova, Italy.
Horm Metab Res. 2016 May;48(5):312-7. doi: 10.1055/s-0041-111505. Epub 2016 Jan 20.
The aim of the work was to compare the hormonal and the metabolic mechanisms involved in weight loss and remission of T2DM one year after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in morbidly obese type 2 diabetic (T2DM) patients. Insulin sensitivity, insulin secretion, and the gastrointestinal (GI) hormone response to a mixed meal test (MMT) were evaluated before and one year after BS (14 RYGB and 19 VSG). RYGB and VSG groups had similar characteristics at baseline. Weight loss at one year was similar in the 2 groups (ΔBMI%: - 32±10 and - 30±7%, p=0.546). Insulin sensitivity and insulin secretion improved similarly after either procedures with a similar rate in T2DM remission (86% in RYGB and 76% in VSG). Meal-stimulated GLP-1 levels increased after both procedures reaching significantly higher levels after RYGB (p=0.0001). GIP response to MMT decreased to a similar extent after the 2 interventions (p=0.977). Both fasting and post-meal ghrelin concentrations were markedly suppressed after VSG and significantly lower than RYGB (p=0.013 to p=0.035). The improvement of insulin sensitivity and beta-cell function was significantly associated with weight loss (p=0.014 to p=0.035), while no relation was found with the changes in GI hormones. In conclusion, in morbidly obese T2DM patients, RYGB and VSG result in similar improvements of the glucose status in the face of different GI hormonal pattern. Weight loss is the key determinant of diabetes remission one year after surgery.
这项研究的目的是比较病态肥胖的2型糖尿病（T2DM）患者在接受Roux-en-Y胃旁路术（RYGB）和垂直袖状胃切除术（VSG）一年后，体重减轻和T2DM缓解过程中涉及的激素和代谢机制。在进行减重手术（14例RYGB和19例VSG）前及术后一年，评估胰岛素敏感性、胰岛素分泌以及混合餐试验（MMT）后的胃肠（GI）激素反应。RYGB组和VSG组在基线时具有相似的特征。两组一年后的体重减轻情况相似（ΔBMI%：-32±10和-30±7%，p = 0.546）。两种手术术后胰岛素敏感性和胰岛素分泌的改善情况相似，T2DM缓解率也相似（RYGB组为86%，VSG组为76%）。两种手术后餐食刺激的GLP-1水平均升高，RYGB术后升高至显著更高水平（p = 0.0001）。两种干预后GIP对MMT的反应下降程度相似（p = 0.977）。VSG术后空腹和餐后胃饥饿素浓度均显著降低，且明显低于RYGB组（p = 0.013至p = 0.035）。胰岛素敏感性和β细胞功能的改善与体重减轻显著相关（p = 0.014至p = 0.035），而与胃肠激素的变化无关。总之，在病态肥胖的T2DM患者中，尽管胃肠激素模式不同，但RYGB和VSG在改善血糖状态方面效果相似。体重减轻是术后一年糖尿病缓解的关键决定因素。
