从上游探索减重手术治疗代谢综合征的机制

Explore the mechanism of bariatric surgery for metabolic syndrome from the＂ up-stream＂

减重手术可治愈或缓解代谢综合征，但其机制尚不十分明确。目前的假说（包括术后热卡摄入减少、前肠一后肠理论、血清胆汁酸与肠道细菌菌群的改变）不能完全解释不同减重手术方式均能改善代谢综合征的原因。迄今开展的减重手术方式均和胃有关。笔者提出胃中心假说：胃壁可能存在特殊细胞，分泌未知激素。减重手术后食物对胃的刺激减少或缺失，引起上述激素的改变．从而改善代谢性疾病。从胃这一“上游”器官研究减重手术治疗代谢综合征的机制．有可能发现术后代谢综合征改善的根本原因。

Bariatric surgery can cure or alleviate meta- bolic syndrome, of which the mechanism is unclear, however. Several existing hypotheses including decreased caloric intake following the surgeries, foregut and hindgut hypothesis, serum bile acid and bacterial flora changes cannot completely explain the reasons of improvement of metabolic syndrome by various bariatric surgical procedures. Now the bariatric surgeries availa- ble are associated with stomach. The gastric center hypothesis is proposed in this article. There would be some particular cells in the gastric wall to secrete unknown hormones, which would be changed with decrease or deletion of stomach irritaion from food after bariatric surgeries, leading to remission of metabolic diseases. Focusing on the ＂upstream＂ stomach in the research on mechanism of bariatrie surgery for metabolic syndrome, the fundamental cause of improvement of metabolic syndrome may be found out.