腹腔镜下袖状胃切除术后胆汁酸对肥胖患者胰岛素抵抗的影响

Effect of Bile Acid on Insulin Resistance of Obese Patients after Laparoscopic Sleeve Gastrectomy

目的研究肥胖患者行腹腔镜下袖状胃切除术(LSG)后胆汁酸(BAs)变化在缓解胰岛素抵抗(IR)中的作用机制。方法回顾性收集2017年12月-2019年2月在安徽医科大学第二附属医院接受LSG的60例肥胖患者手术前后体重指数(BMI)、空腹血糖(FBG)、胰岛素(FINS)、C肽、糖化血红蛋白(HbA1C)、BAs以及成纤维细胞生长因子19(FGFl9)等指标,探析LSG的作用机制。结果术后1个月,60例患者C肽、FINS、胰岛素抵抗指数(HOMA-IR)改善明显(P<0.05)。2型糖尿病(T2DM)组FBG、HbA1C改善明显(P<0.05);术后12个月两组患者胆酸(CA)降低,总胆汁酸(TBA)、鹅去氧胆酸(CDCA)、脱氧胆酸(DCA)、石胆酸(LCA)均明显升高(P<0.05);术后FGFl9升高,且与内源性BAs成正相关,与IR呈负相关(P<0.05)。结论LSG术可能通过增加BAs的水平而促进FGF19的分泌,进而改善肥胖患者胰岛素抵抗,这一研究结果将为肥胖患者IR的治疗提供新思路。

Objective To investigate possible mechanism of bile acid(BAs)in alleviating insulin resistance(IR)of obese patients after laparoscopic sleeve gastrectomy(LSG).Methods The paper reviewed and collected levels of body mass index(BMI),glucose test,fasting blood sugar(FBG),insulin(FINS),C-peptide,glycated hemoglobin,BAs and fibroblast growth factor 19(FGFl9)of 60 obese patients treated with LSG in Anhui Medical University the Second Affiliated Hospital from December 2017 to February 2019,and explored mechanism of LSG.Results One month after surgery,60 patients showed significant improvement in C-peptide,FINS and insulin resistance index(HOMA-IR)(P<0.05).FBG and HbA1C improved significantly in type 2 diabetes(T2DM)group(P<0.05).Cholic acid(CA)decreased and total bile acid(TBA),chenodeoxycholic acid(CDCA),deoxycholic acid(DCA)and lithocholic acid(LCA)were significantly increased in both groups 12 months after operation(P<0.05).Postoperative elevation of FGFl9 was positively correlated with endogenous BAs and negatively correlated with IR(P<0.05).Conclusion LSG surgery may promote secretion of FGF19 by increasing level of BAs,thereby improve insulin resistance of obese patients.The research result may provide new ideas for treatment of IR of obese patients.