Miras A D, Herring R, Vusirikala A, Shojaee-Moradi F, Jackson N C, Chandaria S, Jackson S N, Goldstone A P, Hakim N, Patel A G, Umpleby A M, Le Roux C W
Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK.
CEDAR Centre Royal Surrey County Hospital Guildford Surrey UK.
Obes Sci Pract. 2017 Mar;3(1):95-98. doi: 10.1002/osp4.76. Epub 2016 Dec 29.
Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, Roux-en-Y gastric bypass in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction-independent glucose-lowering properties on hepatic insulin sensitivity. In this first human mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity by using the gold standard euglycaemic hyperinsulinaemic clamp methodology.
Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, 1 week after a low-calorie liquid diet and after a further 1 week following insertion of the DJBL whilst on the same diet.
Duodeno-jejunal bypass liner did not improve the insulin sensitivity of hepatic glucose production beyond the improvements achieved with caloric restriction.
Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after Roux-en-Y gastric bypass and explain, at least in part, the rapid improvements in glycaemia.
与胃束带术或袖状胃切除术不同，肠道旁路手术，尤其是Roux-en-Y胃旁路手术，可在术后早期迅速改善血糖水平。近端小肠的旁路对肝脏胰岛素敏感性可能具有独立于体重减轻甚至热量限制的降糖作用。在这项首次人体机制研究中，我们通过使用金标准的正常血糖高胰岛素钳夹技术，研究十二指肠空肠旁路内衬（DJBL；美国GI Dynamics公司）对肝脏胰岛素敏感性的早期影响，以检验这一假设。
7例肥胖患者在基线时、接受低热量流质饮食1周后以及在继续相同饮食的情况下植入DJBL后再过1周，测量肝脏胰岛素敏感性。
十二指肠空肠旁路内衬并未改善肝脏葡萄糖生成的胰岛素敏感性，其改善程度未超过热量限制所达到的效果。
热量限制可能是近端小肠内镜旁路术后早期肝脏胰岛素敏感性增加的主要驱动因素。相同的机制可能在Roux-en-Y胃旁路术后也起作用，并且至少部分解释了血糖水平的迅速改善。
