Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Paris, France; Sorbonne Universities, University Pierre et Marie Curie-Paris 6, Paris, France; INSERM, UMR S U1166, ICAN, Paris, France.
Sorbonne Universities, University Pierre et Marie Curie-Paris 6, Paris, France; INSERM, UMR S U1166, ICAN, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Endocrine and Oncological Biochemistry, Paris, France.
Surg Obes Relat Dis. 2018 Jul;14(7):929-935. doi: 10.1016/j.soard.2018.03.014. Epub 2018 Mar 19.
Post-bypass postprandial hypoglycemia (PPH) is a frequent complication of Roux-en-Y Gastric Bypass (RYGB) but predictors remain poorly identified and are needed to assess individual risk. After RYGB, exaggerated secretion of glucagon-like peptide-1 (GLP-1) and insulin could lead to PPH, but other proglucagon-derived peptides, including glicentin and glucagon, could also contribute to this phenomenon.
To identify biological hypoglycemia in relation to the secretion of proglucagon-derived peptides during a mixed-meal test (MMT) in RYGB patients.
University hospital.
Twenty RYGB patients reporting symptoms consistent with PPH were examined 36.9 ± 5.1 months after surgery. Plasma levels of glucose, c-peptide, glucagon, GLP-1 and glicentin were assessed before and during MMT. Patients with postprandial hypoglycemia ≤3 mM (54 mg/dL) during MMT were assigned to HYPO group and compared with patients not exhibiting hypoglycemia (NONHYPO group).
Seven patients displayed hypoglycemia ≤3 mM (HYPO) during the MMT. Lower fasting glycemia (4.5 mM versus 5.3 mM, P<.05) and higher fasting glicentin (22.6 pM versus 14.0 pM, P<.05) were observed in HYPO versus NONHYPO patients. Fasting glicentin was inversely correlated with postprandial nadir glucose. Examining the receiver-operating characteristics curve analysis, a cutoff of 17.2 pM for fasting glicentin identified PPH with 85.7% sensitivity and 53.8% specificity. All patients exhibited a similar increase of postprandial GLP-1, glucagon, and glicentin secretions that correlated with each other.
These results suggest that fasting glicentin is a potential biomarker to examine in operated-obese patients at risk of developing PPH. Further studies are needed before proposing fasting glicentin as a predictive factor of PPH.
旁路手术后餐后低血糖（PPH）是 Roux-en-Y 胃旁路术（RYGB）的常见并发症，但预测因素仍未得到很好的确定，需要评估个体风险。RYGB 后，胰高血糖素样肽-1（GLP-1）和胰岛素的过度分泌可能导致 PPH，但其他前胰高血糖素衍生肽，包括胃泌素和胰高血糖素，也可能导致这种现象。
在 RYGB 患者的混合餐测试（MMT）中，确定与前胰高血糖素衍生肽分泌相关的生物学性低血糖。
大学医院。
20 例报告与 PPH 症状一致的 RYGB 患者在手术后 36.9±5.1 个月接受检查。在 MMT 前后评估血糖、C 肽、胰高血糖素、GLP-1 和胃泌素水平。在 MMT 期间出现餐后血糖≤3 mM（54 mg/dL）的患者被分配到 HYPO 组，并与未出现低血糖的患者（NONHYPO 组）进行比较。
7 例患者在 MMT 期间出现≤3 mM（HYPO）的低血糖。HYPO 组患者空腹血糖（4.5 mM 与 5.3 mM，P<.05）和空腹胃泌素（22.6 pM 与 14.0 pM，P<.05）较低。空腹胃泌素与餐后血糖最低点呈负相关。考察受试者工作特征曲线分析，空腹胃泌素的截断值为 17.2 pM 时，PPH 的敏感性为 85.7%，特异性为 53.8%。所有患者均表现出相似的餐后 GLP-1、胰高血糖素和胃泌素分泌增加，且彼此相关。
这些结果表明，空腹胃泌素可能是一种有潜力的生物标志物，可用于检查处于发生 PPH 风险的肥胖手术后患者。在提出空腹胃泌素作为 PPH 的预测因素之前，还需要进一步的研究。
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