Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy.
Assistance Publique-Hôpitaux de Paris (AP-HP), Department of digestive and metabolic surgery, Avicenne university hospital, Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France.
Surg Obes Relat Dis. 2018 Mar;14(3):284-290. doi: 10.1016/j.soard.2017.12.009. Epub 2017 Dec 14.
Weight loss (WL) and altered gut hormonal levels are involved in glucose homeostasis after laparoscopic sleeve gastrectomy (LSG).
The aim of this study was to evaluate the time-related effects of WL, ghrelin, and glucacon-like peptide-1 (GLP-1) plasma concentrations on type 2 diabetes resolution after LSG.
University hospital, Italy.
Ninety-one patients who underwent LSG were investigated. Insulin secretion (insulinogenic index [IGI]), insulin resistance, plasma glucose level and percentage glycated hemoglobin using the oral glucose tolerance test were assessed before surgery, on postoperative day 3, and then at 6, 12, 24, and 36 months after LSG. At the same time points, WL, ghrelin, and GLP-1 levels were determined.
During follow-up, the resolution rate of type 2 diabetes was 9.4%, 42.3%, 71.8%, 81.2%, and 91.8%, respectively. Ghrelin plasma concentrations decreased significantly after LSG (271.5 ± 24.5 pg/mL versus 122.4 ± 23.4 pg/mL, P = .04). GLP-1 plasma concentrations increased significantly after LSG (1.7 ± 2.6 pg/mL versus 2.5 ± 3.4 pg/mL, P = .04). The percentage of excess weight loss and IGI presented a positive linear correlation (r) at all follow-up time points with a strong positive correlation at 12 and 24 months. A strong negative correlation between ghrelin and IGI was recorded during the first 3 days after LSG (r = -.9). GLP-1 and IGI presented a strong positive correlation at day 3 and 6 months (i.e., .8 and .8, respectively).
LSG may affect glucose homeostasis by 2 different time-related modes: a first step in which the hormonal changes play a predominant role in glucose homeostasis and a second step in which the percentage excess weight loss determines the metabolic results.
腹腔镜袖状胃切除术（LSG）后，体重减轻（WL）和肠道激素水平改变与葡萄糖稳态有关。
本研究旨在评估 WL、胃饥饿素和胰高血糖素样肽-1（GLP-1）血浆浓度与 LSG 后 2 型糖尿病缓解的时间相关性。
意大利大学医院。
对 91 例行 LSG 的患者进行了研究。在手术前、术后第 3 天以及 LSG 后 6、12、24 和 36 个月时，评估了胰岛素分泌（胰岛素原指数 [IGI]）、胰岛素抵抗、口服葡萄糖耐量试验时的血浆葡萄糖水平和糖化血红蛋白百分比。同时测定了 WL、胃饥饿素和 GLP-1 水平。
在随访期间，2 型糖尿病的缓解率分别为 9.4%、42.3%、71.8%、81.2%和 91.8%。LSG 后胃饥饿素血浆浓度显著下降（271.5±24.5pg/ml 与 122.4±23.4pg/ml，P=0.04）。LSG 后 GLP-1 血浆浓度显著升高（1.7±2.6pg/ml 与 2.5±3.4pg/ml，P=0.04）。IGI 与超重百分比减轻呈正线性相关（r），在所有随访时间点均呈强正相关，在 12 和 24 个月时相关性最强。LSG 后第 3 天和第 6 个月，胃饥饿素与 IGI 之间存在强烈负相关（r=-0.9）。GLP-1 和 IGI 在第 3 天和第 6 个月时呈强正相关（即，r 分别为 0.8 和 0.8）。
LSG 可能通过 2 种不同的时间相关模式影响葡萄糖稳态：第一步，激素变化在葡萄糖稳态中起主导作用；第二步，超重百分比减轻决定代谢结果。
