2型糖尿病胃转流术后胰高血糖素样肽-1的变化及其意义

目的 探讨2型糖尿病患者行胃转流术后血清胰高血糖素样肽-1 （GLP-1）的变化及意义.方法 对37例2型糖尿病患者行胃转流术,手术前后检测空腹血糖（FPG）、餐后2h血糖（2 h PG）、糖化血红蛋白（HbA1c）、空腹胰高血糖素样肽-1（FGLP-1）、餐后2h胰高血糖素样肽-1（2 h GLP-1）,并计算胰岛素敏感指数（（ISI）=1/FPG×FIns.结果 37例患者均获随访1年以上,29例达到完全缓解,5例部分缓解,3例无效,总有效率为91.9％.与术前比较,术后FPG、2 h PG、及HbA1c呈显著下降,FGLP-1、2 h GLP-1及ISI则较术前明显升高（P均＜0.05）;FGLP-1、2 h GLP-1与ISI呈正相关（r分别为0.64、0.58,P＜0.01或＜0.05）.结论 胃转流术治疗2型糖尿病有明显效果,其作用机制之一是术后患者肠源性GLP-1的分泌增加进而改善胰岛素敏感性.

Changes of glucagon-like peptide-1 in type 2 diabetic patients after gastric bypass surgery and its significance

Objective To investigate the changes of glucagon-like peptide-1 （ GLP-1 ） in type 2 diabetic patients after gastric bypass surgery. Methods Data were collected from 37 patients with type 2 diabetes who were performed gastric bypass surgery. Collected parameters included fasting plasma glucose （FPG）, 2-hour postprandial blood glucose （2 h PG）, glycosylated hemoglobin （HbAmc）, fasting plasma glucagon-like peptide-1 （FGLP-1） and 2-hour postprandial glucagonlike peptide-1 （2 h GLP-1 ）. The insulin sensitivity index （ISI = 1/fasting plasma glucose x fasting serum insulin） was calculated. Results Of the 37 patients, 29 cases achieved complete remission, 5 cases obtained partial remission, and 3 cases had no remission. In addition, values for FPG, 2 h PG and HbA1c were significantly decreased after surgery. Values for FGLP-1, 2 h GLP-1 and ISI were significantly increased after surgery （all P 〈 0.05）. Values for FGLP-1 and 2 h GLP-1 were positively correlated with IS1 （r=0.64, 0.58; P〈0.01 or P〈0.05, respectively ）. Conclusions Gastric bypass surgery has a significant clinical effect on patients with type 2 diabetes mellitus. One of the potential mechanisms is that the increased endogenous intestinal GLP-1 secretion leads to improvement of insulin sensitivity.