Department of General Surgery, Fengxian Central Hospital, Affiliated Hospital of Southern Medical University, Shanghai, China.
Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
J Diabetes Investig. 2018 Jan;9(1):13-20. doi: 10.1111/jdi.12687. Epub 2017 Jun 12.
Type 2 diabetes mellitus is becoming increasingly prevalent worldwide, and has become one of the greatest threats to global health. Bariatric surgery was initially designed to achieve weight loss, and subsequently was noted to induce improvements or remission of type 2 diabetes. Currently, these bariatric operations, such as Roux-en-Y gastric bypass and sleeve gastrectomy, are the most effective procedures for the treatment of obesity and type 2 diabetes mellitus worldwide. However, the specific mechanism mediating the beneficial effects of metabolic surgery has remained largely unknown. Those mechanical explanations, such as restriction and malabsorption, are challenged by accumulating evidence from human and animal models of these procedures, which points to the weight-independent factors, such as hormones, bile acids, gut microbiota, nervous system and other potential underlying mechanisms. A growing body of evidence suggests that gut microbiota are associated with the development of several metabolic disorders, and bile acids and FXR signaling are important for the metabolic benefits of bariatric surgery. Given the close relationship between bacteria and bile acids, it is reasonable to propose that microbiota-bile acid interactions play a role in the mechanisms underlying the effects of metabolic surgery.
2 型糖尿病在全球范围内日益流行，已成为全球健康的最大威胁之一。减重手术最初旨在实现减肥，随后发现其可改善或缓解 2 型糖尿病。目前，这些减重手术（如 Roux-en-Y 胃旁路术和袖状胃切除术）是全球治疗肥胖和 2 型糖尿病最有效的方法。然而，代谢手术有益效果的确切机制在很大程度上仍不清楚。这些机械解释，如限制和吸收不良，受到来自人类和动物模型的越来越多证据的挑战，这些证据指向体重独立因素，如激素、胆汁酸、肠道微生物群、神经系统和其他潜在的潜在机制。越来越多的证据表明，肠道微生物群与多种代谢紊乱的发生有关，胆汁酸和 FXR 信号对减重手术的代谢益处很重要。鉴于细菌和胆汁酸之间的密切关系，有理由提出微生物群-胆汁酸相互作用在代谢手术效果的机制中发挥作用。
