Halverson J D, Kramer J, Cave A, Permutt A, Santiago J
Surgery. 1982 Aug;92(2):235-40.
We have studied an otherwise normal group of morbidly obese subjects and compared them with patients who had experienced massive weight loss after loop gastric bypass. Compared to normal controls (NLCs), morbidly obese control patients (OBCs) had abnormal glucose tolerance curves (after glucose ingestion), elevated basal insulin levels, and increased plasma insulin concentrations, suggesting insulin insensitivity. The latter has been corroborated by the measurement of decreased insulin binding in these patients. Postoperative (PO) patients were hyperglycemic after taking oral glucose, but all PO patients had a rapid decrease in plasma glucose concentration, half reaching hypoglycemic levels. PO basal insulin levels and insulin receptor number were not statistically different from those in NLCs, indicating up-regulation of insulin receptors (and therefore, increased insulin sensitivity) postoperatively. Hyperinsulinemia seen in the PO group (greater than that in OBCs, P less than 0.001) after administration of oral glucose occurred simultaneously with a doubling of plasma concentration of gastric inhibitory polypeptide. Massive weight loss in patients after gastric bypass was accompanied by an improvement in insulin receptor number, basal hyperinsulinemia, and glucose tolerance. In addition, postoperative patients demonstrated symptomatic reactive hypoglycemia which may have resulted from the hyperinsulinemia seen subsequent to ingestion of glucose.
我们研究了一组在其他方面均正常的病态肥胖受试者，并将他们与接受胃旁路手术后体重大幅减轻的患者进行了比较。与正常对照组（NLCs）相比，病态肥胖对照组患者（OBCs）的葡萄糖耐量曲线异常（摄入葡萄糖后）、基础胰岛素水平升高且血浆胰岛素浓度增加，提示存在胰岛素抵抗。这些患者胰岛素结合减少的测量结果证实了后者。术后（PO）患者口服葡萄糖后血糖升高，但所有PO患者的血浆葡萄糖浓度迅速下降，半数降至低血糖水平。PO患者的基础胰岛素水平和胰岛素受体数量与NLCs无统计学差异，表明术后胰岛素受体上调（因此胰岛素敏感性增加）。口服葡萄糖后，PO组出现的高胰岛素血症（高于OBCs，P<0.001）与胃抑制多肽血浆浓度加倍同时出现。胃旁路术后患者体重大幅减轻伴随着胰岛素受体数量、基础高胰岛素血症和葡萄糖耐量的改善。此外，术后患者出现了有症状的反应性低血糖，这可能是由于摄入葡萄糖后出现的高胰岛素血症所致。
