代谢手术对亚洲2型糖尿病患者胰岛功能的影响

Effects of metabolic surgery on islet function in Asian patients with type 2 diabetes

2型糖尿病(T2DM)是当前备受瞩目的全球性公共卫生问题,在亚洲地区尤为突出。发病年龄小、体质指数(BMI)低以及早期出现胰岛功能缺陷是亚洲T2DM患者的特征。代谢手术已经成为T2DM的标准治疗手段,其可通过调节能量稳态和降低体脂质量等多种机制显著改善T2DM。事实上,胰岛功能的恢复在T2DM的缓解过程中同样发挥着不可或缺的作用。代谢手术后,亚洲T2DM患者的胰岛功能显著改善,其短期及长期效果均已获得验证。不仅如此,胰岛功能还是代谢手术前进行患者选择的重要依据和参考指标。代谢手术后胰岛功能改善的机制尚不明确,但术后胃肠道的解剖改变所致的胰高血糖素样肽-1、抑胃肽、酪酪肽、胃饥饿素及胆囊收缩素等激素的变化可能参与其中。笔者分析了目前针对代谢手术对亚洲低BMI T2DM患者胰岛功能的影响及其机制的回顾性和前瞻性研究,总结了关于代谢手术改善亚洲低BMI T2DM患者胰岛功能的临床证据,并探讨其内在机制。这对于实现代谢手术的个性化、精准化治疗,进一步提高其临床效益具有重要意义。

Type 2 diabetes is a high-profile global public health problem,particularly in Asia.The young age of onset,low body mass index,and early appearance of pancreatic islet dysfunction are characteristics of Asian patients with T2DM.Metabolic surgery has become the standard treatment for T2DM patients and can significantly improve T2DM through a variety of mechanisms including modulation of energy homeostasis and reduction of body fat mass.Indeed,restoration of islet function also plays an integral role in the remission of T2DM.After metabolic surgery,islet function in Asian T2DM patients has improved significantly,with proven short-term and long-term effects.In addition,islet function is an important criterion and reference for patient selection prior to metabolic surgery.The mechanism of islet function improvement after metabolic surgery is not clear,but postoperative anatomical changes in the gastrointestinal tract leading to a number of hormonal changes seem to be the potential cause,including glucagon-like peptide-1,gastric inhibitory polypeptide,peptide YY,ghrelin,and cholecystokinin.The authors analyzed the current retrospective and prospective studies on the effect of metabolic surgery on the islet function of Asian T2DM patients with a low BMI and its mechanism,summarized the clinical evidence that metabolic surgery improved islet function in Asian T2DM patients with a low BMI,and discussed its underlying mechanism.It is of great significance for realizing personalized and precise treatment of metabolic surgery and further improving its clinical benefits.