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首页> 外文期刊>Surgical Endoscopy >First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis.
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First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis.

机译：肥胖糖尿病患者在进行袖式胃切除术后72小时，其第一阶段的胰岛素分泌，胰岛素敏感性，生长素释放肽，GLP-1和PYY发生变化：胃病假说。

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BACKGROUND: The aim of this study was to evaluate the possible role of sleeve gastrectomy (SG) per se in the reversibility of diabetes. METHODS: Insulin secretion and peripheral insulin sensitivity using the intravenous glucose tolerance test (IVGTT) were assessed in 18 obese type 2 diabetic patients and in 10 nondiabetic obese patients before and 3 days after SG, before any food intake and any weight change occurrence. At the same time, ghrelin, GLP-1, and PYY levels were determined. RESULTS: In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC) significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC) significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups. CONCLUSIONS: Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the antidiabetes effect of SG.
机译：背景：这项研究的目的是评估套管胃切除术（SG）本身在糖尿病可逆性中的可能作用。方法：在SG之前和之后3天，进食量和体重变化发生之前，通过静脉葡萄糖耐量试验（IVGTT）对18位肥胖的2型糖尿病患者和10位非糖尿病肥胖患者的胰岛素分泌和外周胰岛素敏感性进行了评估。同时，测定生长素释放肽，GLP-1和PYY水平。结果：在糖尿病患者中，该疾病的病程少于10.5年，在SG后第一阶段的胰岛素分泌迅速改善。术后IVGTT曲线下的早期胰岛素面积（AUC）显着增加，表明葡萄糖诱导的胰岛素分泌增加。所有组均在SG后胰岛素分泌的第二阶段（晚期AUC）显着降低，表明改善了胰岛素外周敏感性。在所有组中，术前和术后均通过静脉内葡萄糖刺激确定了生长素释放肽值的降低以及GLP-1和PYY值的升高。但是，在病程> 10.5年的患者组中，除晚期胰岛素AUC外，差异无显着性。在所有患者组中，术后基础和静脉内葡萄糖刺激的生长素释放肽水平均低于术前水平。在所有组中，基础和静脉刺激的GLP-1和PYY术后值均高于术前水平。结论：SG肥胖后，任何通过胃肠道的食物通过和体重减轻之前，糖尿病肥胖患者的胰岛素分泌第一阶段的恢复和胰岛素敏感性的改善似乎与ghrelin，GLP-1和PYY激素有关可能起源于胃的变化，与饮食或体重变化均无关。该病的持续时间长达10.5年似乎是SG引起的病理生理变化的主要障碍。可以提出“胃”假说来解释SG的抗糖尿病作用。

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