JCEM：Roux-en-Y胃旁路术术后胰岛素清除增加

Roux-en-Y胃旁路术（RYGB）可以在术后几天内改善糖耐量和减轻空腹高胰岛素血症。肝脏胰岛素敏感性和胰岛素清除的提高可能在这些效果中起重要作用。为了探讨RYGB后胰岛素清除的改变，来自丹麦维兹奥勒医院 内分泌科的 Kirstine N Bojsen-Moller 教授及其团队进行了一项研究，该研究结果在线发表在美国《临床内分泌代谢杂志》（ The journal of clinical endocrinology & metabolism ）上。该研究认为 RYGB 在术后一周内增加胰岛素清除。

该研究是一项前瞻性研究，在RYGB术前和术后一周、三月和一年期间研究空腹肝脏胰岛素清除，并在一个患者亚组中，研究进餐试验后餐后胰岛素清除。该研究在丹麦维兹奥勒的维兹奥勒医院进行。患者包括两组肥胖的RYGB患者：1）2型糖尿病组（T2D）：32例2型糖尿病患者（进餐试验13例）；2)正常糖耐量组（NGT）：32例正常糖耐量的患者（进餐试验12例）。干预措施是RYGB。主要观察结果是空腹肝脏胰岛素清除（空腹C肽／空腹胰岛素）；餐后胰岛素清除（胰岛素分泌率曲线下增值面积／胰岛素曲线下增值面积）。

该研究结果表明，手术后一周（P＜0.01）以及三月（P＜0.01）的空腹肝脏胰岛素清除增加（P＜0.01），并在术后一年保持增加（P＜0.01），在2型糖尿病组和糖耐量正常组之间没有差异。仅在2型糖尿病组有餐后胰岛素清除改变，在术后一周增加（P＜0.01），并在术后三周（P=0.06）和一年（P＜0.01）保持增加。

该研究发现，RYGB在手术后一周内增加胰岛素清除，突出肝脏是术后早期葡萄糖代谢产生有利影响的关键器官。当通过外周血胰岛素浓度，而不是胰岛素分泌率或C肽评估2型糖尿病患者餐后胰岛分泌时，餐后胰岛分泌可能被低估。

与胃旁路术相关的拓展阅读：

• STM：胃旁路术的部分益处可能是肠道微生物变化的结果
• 胃旁路术可使轻度肥胖患者的糖尿病缓解
• 胃旁路术与胆胰转流术均能较好控制糖尿病大鼠血糖水平 更多信息请点击：有关胃旁路术更多资讯

Increased Hepatic Insulin Clearance After Roux-en-Y Gastric Bypass.
Context
Roux-en-Y gastric bypass (RYGB) improves glucose tolerance and ameliorates fasting hyperinsulinemia within days after surgery. Improvements in hepatic insulin sensitivity and insulin clearance could contribute importantly to these effects.
Objective
The objective of the investigation was to study changes in insulin clearance after RYGB.
Design
This was a prospective study of fasting hepatic insulin clearance and, in a subgroup of patients, postprandial insulin clearance after a meal test before and 1 week, 3 months, and 1 year after RYGB.
Setting
The study was conducted at Hvidovre Hospital (Hvidovre, Denmark).
Patients
Patients included 2 groups of obese RYGB-patients: 1) type 2 diabetes (T2D) group: 32 patients with T2D (meal test, n = 13), 2) normal glucose tolerance (NGT) group: 32 patients with NGT (meal test, n = 12).
Intervention
The intervention was RYGB.Main Outcome
Measure
Fasting hepatic insulin clearance (fasting C-peptide/fasting insulin). Postprandial insulin clearance (incremental areas under the curve of insulin secretion rates/incremental areas under the curve of insulin).
Results
Fasting hepatic insulin clearance increased after 1 week (P < .01) and further at 3 months (P < .01), remaining elevated 1 year postoperatively (P < .01) with no difference between the T2D and NGT groups. Postprandial insulin clearance changed only in the T2D group with an increase at 1 week (P < .01) that was maintained at 3 months (P = .06) and 1 year (P < .01).
Conclusions
RYGB increases insulin clearance within 1 week after surgery, highlighting the liver as a key organ involved in the early beneficial effect on glucose metabolism. Postprandial insulin secretion may be underestimated postoperatively in patients with type 2 diabetes when evaluated by peripheral insulin concentrations instead of insulin secretion rates or C-peptide.