Santiago-Fernández Concepción, García-Serrano Sara, Tome Mónica, Valdes Sergio, Ocaña-Wilhelmi Luis, Rodríguez-Cañete Alberto, Tinahones Francisco J, García-Fuentes Eduardo, Garrido-Sánchez Lourdes
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Spain.
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Malaga, Spain.
Endocrinol Diabetes Nutr. 2017 Aug-Sep;64(7):355-362. doi: 10.1016/j.endinu.2017.05.002. Epub 2017 Jun 23.
Ghrelin is a gastrointestinal peptide involved in regulation of body weight and energy balance. However, its behavior after bariatric surgery and its relationship to insulin resistance are still controversial. A simultaneous assessment was made of the association between changes in ghrelin levels and different variables after three types of bariatric surgery.
Ghrelin levels were measured in 103 morbidly obese subjects before and 6 months after bariatric surgery (Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion of Scopinaro (BPD), and sleeve gastrectomy (SG)), and in 21 non-obese subjects.
Ghrelin levels increased after RYGB (p<0.05), were unchanged after BPD, and decreased after SG (p<0.05). The percent change in ghrelin levels (Δ-ghrelin) was associated to the type of surgery in a multiple linear regression model (p=0.017). When the same analysis was only performed in subjects in whom the gastric fundus was maintained (RYGB and BPD), Δ-ghrelin was negatively associated to Δ-HOMA-IR (p=0.001). In morbidly obese subjects who underwent RYGB and BPD, the odds ratio of a lower Δ-HOMA-IR in patients with Δ-ghrelin in the Q1 quartile versus those with Δ-ghrelin in the Q4 quartile was 8.74 (1.73-44.06) (p=0.009).
Changes in ghrelin levels after bariatric surgery are associated to the presence or absence of the gastric fundus. After bariatric surgery, the decrease in insulin resistance was associated to increased ghrelin levels in procedures in which the fundus is not excluded.
胃饥饿素是一种参与体重和能量平衡调节的胃肠肽。然而，其在减肥手术后的表现及其与胰岛素抵抗的关系仍存在争议。本研究同时评估了三种减肥手术后胃饥饿素水平变化与不同变量之间的关联。
对103例病态肥胖受试者在减肥手术（Roux-en-Y胃旁路术（RYGB）、Scopinaro胆胰转流术（BPD）和袖状胃切除术（SG））前及术后6个月测定胃饥饿素水平，并与21例非肥胖受试者进行比较。
RYGB术后胃饥饿素水平升高（p<0.05），BPD术后无变化，SG术后降低（p<0.05）。在多元线性回归模型中，胃饥饿素水平的百分比变化（Δ-胃饥饿素）与手术类型相关（p=0.017）。当仅对保留胃底的受试者（RYGB和BPD）进行相同分析时，Δ-胃饥饿素与Δ-HOMA-IR呈负相关（p=0.001）。在接受RYGB和BPD的病态肥胖受试者中，Δ-胃饥饿素处于第一四分位数的患者与处于第四四分位数的患者相比，Δ-HOMA-IR较低的优势比为8.74（1.73-44.06）（p=0.009）。
减肥手术后胃饥饿素水平的变化与胃底的存在与否有关。减肥手术后，在未排除胃底的手术中，胰岛素抵抗的降低与胃饥饿素水平的升高有关。
