Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
Ann Surg. 2020 Jul;272(1):72-80. doi: 10.1097/SLA.0000000000003614.
To perform a structured systematic review and meta-analysis to evaluate changes in ghrelin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and gastric inhibitory peptide (GIP) gut hormone levels in patients after sleeve gastrectomy.
Despite sleeve gastrectomy becoming the most common surgical weight loss procedure, weight loss mechanisms remain less clear.
Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 1, 2019, in accordance with PRISMA and MOOSE guidelines. Randomized controlled trials and prospective observational studies evaluating pre and post-procedure hormones fasting ghrelin, postprandial GLP-1, postprandial PYY, and fasting GIP levels were included. Hedge g with random-effects models were used to determine pooled effect size and corresponding 95% confidence intervals (CIs).
A total of 28 studies (n = 653; 29.56% male) were included. Mean age was 42.00 ± 5.48 years, with average follow-up of 11.70 ± 11.38 months. Pre-procedure body mass index (BMI) was 46.01 ± 4.07 kg/m with a postsleeve gastrectomy BMI of 34.07 ± 3.73 kg/m, representing total body weight loss of 25.13 ± 4.44% and excess weight loss of 57.48 ± 9.64% (P < 0.001). Ghrelin decreased (Hedge g -1.486, 95% CI -1.884 to -1.089, I = 91.95%), whereas GLP-1 and PYY increased post-procedure (Hedge g 1.095, 95% CI 0.509 to 1.642, I = 84.38%; and Hedge g 1.396, 95% CI 0.781 to 2.011, I = 84.02%, respectively). GIP did not significantly change (Hedge g -0.213, 95% CI -1.019 to 0.592, I = 79.65%).
Fasting ghrelin levels decreased, whereas postprandial GLP-1 and PYY increased after sleeve gastrectomy. Fasting GIP levels remained unchanged. Future studies are needed to assess the role of these gut hormones and relationship to weight loss and metabolic outcomes.
进行系统的综述和荟萃分析，以评估袖状胃切除术患者术后胃饥饿素、胰高血糖素样肽-1（GLP-1）、肽 YY（PYY）和胃抑制肽（GIP）肠道激素水平的变化。
尽管袖状胃切除术已成为最常见的减重手术，但减重机制仍不太清楚。
根据 PRISMA 和 MOOSE 指南，对 PubMed、EMBASE、Web of Science 和 Cochrane Library 数据库进行了 2019 年 4 月 1 日之前的检索。纳入了评估术前和术后空腹胃饥饿素、餐后 GLP-1、餐后 PYY 和空腹 GIP 水平的随机对照试验和前瞻性观察研究。采用 Hedge g 具有随机效应模型来确定汇总效应大小及其相应的 95%置信区间（CI）。
共纳入 28 项研究（n = 653；29.56%为男性）。平均年龄为 42.00 ± 5.48 岁，平均随访时间为 11.70 ± 11.38 个月。术前体质量指数（BMI）为 46.01 ± 4.07 kg/m2，术后 BMI 为 34.07 ± 3.73 kg/m2，代表全身减重 25.13 ± 4.44%，多余体重减轻 57.48 ± 9.64%（P < 0.001）。术后胃饥饿素水平下降（Hedge g -1.486，95%CI -1.884 至 -1.089，I = 91.95%），而 GLP-1 和 PYY 水平升高（Hedge g 1.095，95%CI 0.509 至 1.642，I = 84.38%；Hedge g 1.396，95%CI 0.781 至 2.011，I = 84.02%）。GIP 水平无显著变化（Hedge g -0.213，95%CI -1.019 至 0.592，I = 79.65%）。
袖状胃切除术后空腹胃饥饿素水平下降，而餐后 GLP-1 和 PYY 水平升高。空腹 GIP 水平保持不变。需要进一步研究以评估这些肠道激素的作用及其与减重和代谢结局的关系。
