戴露倢 1 , 王瑜 2 , 王烈 2 , 黃盛 2
  • 1.安徽醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院（安徽合肥 230032）;;
  • 2.南京軍區(qū)福州總醫(yī)院普通外科（福建福州 350025）;

目的探討胃轉(zhuǎn)流術(shù)（GBP）對(duì)代謝綜合征（MS）的影響及其作用機(jī)理。方法通過復(fù)習(xí)文獻(xiàn)，回顧分析GBP對(duì)糖脂代謝和血壓變化的影響。結(jié)果GBP術(shù)后數(shù)天內(nèi)，70%以上MS患者血糖、血脂達(dá)正常水平，血壓控制有明顯改善，而體重減輕遲于血糖、血脂變化。 飲食、胃腸激素、脂肪細(xì)胞因子、脂肪分布等因素的改變參與GBP對(duì)MS的改善作用。結(jié)論GBP似乎對(duì)控制MS有原發(fā)的、獨(dú)立的影響，而非繼發(fā)于對(duì)肥胖癥的治療。

引用本文： 戴露倢,王瑜,王烈,黃盛. 胃轉(zhuǎn)流術(shù)對(duì)代謝綜合征改善作用的研究進(jìn)展. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(2): 216-219. doi: 復(fù)制

1. Iannelli A, Anty R, Piche T, et al. Impact of laparoscopic RouxenY gastric bypass on metabolic syndrome, inflammation, and insulin resistance in super versus morbidly obese women [J]. Obes Surg, 2009, 19(5): 577582.
2. Alberti KG, Zimmet P, Shaw J, et al. The metabolic syndrome-a new worldwide definition [J]. Lancet, 2005, 366(9491): 10591062.
3. Sjstrm L, Narbro K, Sjstrm CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects [J]. N Engl J Med, 2007, 357(8): 741752.
4. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13 871 morbidly obese patients from a national registry [J]. Ann Surg, 2007, 246(6): 10021009.
5. Yarbrough DE, Leath RR, Leeth TD, et al. Longterm improvement of gastrointestinal complaints following weight loss in patients undergoing laparoscopic RouxenY gastric bypass (LRYGBP) [J]. ASMBS, 2006, 2(3): 296297.
6. Bose M, Oliván B, Teixeira J, et al. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: What are the evidence? [J]. Obes Surg, 2009, 19(2): 217229.
7. Puzziferri N, AustrheimSmith IT, Wolfe BM, et al. Threeyear followup of a prospective randomized trial comparing laparoscopic versus open gastric bypass [J]. Ann Surg, 2006, 243(2): 181188.
8. Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10y followup [J]. Am J Clin Nutr, 1992, 55(2 Suppl): 582S585S.
9. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial [J]. JAMA, 2008, 299(3): 316323.
10. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and metaanalysis [J]. Am J Med, 2009, 122(3): 248256.
11. Rossi M, R Barretto Ferreira da Silva R, Chaves Alcntara G Jr, et al. Remission of metabolic syndrome: a study of 140 patients six months after RouxenY gastric bypass [J]. Obes Surg, 2008, 18(5): 601606.
12. Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following RouxenY gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity [J]. Obes Surg, 2007, 17(2): 176184.
13. Zlabek JA, Grimm MS, Larson CJ, et al. The effect of laparosscopic gastric bypss surgery on dyslipidemia in severely obese patients [J]. Surg Obes Relat Dis, 2005, 1(6): 537542.
14. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and metaanalysis [J]. JAMA, 2004, 292(14): 17241737.
15. Ali MR, Fuller WD, Rasmussen J. Detailed description of early response of metabolic syndrome after laparoscopic RouxenY gastric bypass [J]. Surg Obes Relat Dis, 2009, 5(3): 346351.
16. 鄧治洲, 王烈, 林憶陽, 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 244(9): 466469.
17. Scopinaro N, Papadia F, Marinari G, et al. Longterm control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI <35 kg/m2 [J]. Obes Surg, 2007, 17(2): 185192.
18. Couzin J. Bypassing medicine to treat diabetes [J]. Science, 2008, 320(5875): 438440.
19. DePaula AL, MacedoAL, Schraibman V, et al. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 2034 [J]. Surg Endosc, 2008, 23(8): 17241732.
20. Ballantyne GH, Farkas D, Laker S, et al. Shortterm changes in insulin resistance following weight loss surgery for morbid obesity: laparoscopic adjustable gastric banding versus laparoscopic RouxenY gastric bypass [J]. Obes Surg, 2006, 16(9): 11891197.
21. Haider DG, Schindler K, Schaller G, et al. Increased plasma visfatin concentrations in morbidly obese subjects are reduced after gastric banding [J]. J Clin Endocrinol Metab, 2006, 91(4): 15781581.
22. Koh KK, Quon MJ, Lee SJ, et al. Efonidipine simultaneously improves blood pressure, endothelial function, and metabolic parameters in nondiabetic patients with hypertension [J]. Diabetes Care, 2007, 30(6): 16051607.
23. Pischon T, Girman CJ, Hotamisligil GS, et al. Plasma adiponectin levels and risk of myocardial infarction in men [J]. JAMA, 2004, 291(14): 17301737.
24. Choi KM, Lee J, Lee KW, et al. Serum adiponectin concentrations predict the developments of type 2 diabetes and the metabolic syndrome in elderly Koreans [J]. Clin Endocrinol (Oxf), 2004, 61(1): 7580.
25. Choi EY, Park EH, Cheong YS, et al. Association of Creactive protein with the metabolic risk factors among young and middleaged Korean [J]. Metabolism, 2006, 55(3): 415421.
26. GómezAmbrosi J, Pastor C, Salvador J, et al. Influence of waist circumference on the metabolic risk associated with impaired fasting glucose: effect of weight loss after gastric bypass [J]. Obes Surg, 2007, 17(5): 585591.
27. Kotronen A, SepplLindroos A, Bergholm R, et al. Tissue specificity of insulin resistance in humans: fat in the liver rather than muscle is associated with features of the metabolic syndrome [J]. Diabetologia, 2008, 5(1): 130138.
28. Stearns AT, Balakrishnan A, Tavakkolizadeh A. Impact of RouxenY gastric bypass surgery on rat intestinal glucose transport [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297（5）: G950G957.
29. Rao MN, Mulligan K, Tai V, et al. Effects of insulinlike growth factor (IGF)I/IGFbinding protein3 treatment on glucose metabolism and fat distribution in human immunodeficiency virusinfected patients with abdominal obesity and insulin resistance [J]. J Clin Endocrinol Metab, 2010, 95(9): 43614366.
30. Wang X, Zhang S, Chen Y, et al. APM1 gene variants11377C/G and 4545G/C are associated respectively with obesity and with nonobesity in Chinese type 2 diabetes [J]. Diabetes Res Clin Pract, 2009, 84(3): 205210.
31. Kashyap SR, Defronzo RA. The insulin resistance syndrome: physiological considerations [J]. Diab Vasc Dis Res, 2007, 4(1): 1319.
32. Swarbrick MM, Stanhope KL, AustrheimSmith IT, et al. Longitudinal changes in pancreatic and adipocyte hormone following RouxenY gastric bypass surgery [J]. Diabetolog, 2008, 51(10): 19011911.
33. 周龍翔, 汪昱, 楊喆, 等. 胃癌術(shù)后不同殘胃患者胃腸激素及機(jī)體組成變化 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(4): 290295.
  1. 1. Iannelli A, Anty R, Piche T, et al. Impact of laparoscopic RouxenY gastric bypass on metabolic syndrome, inflammation, and insulin resistance in super versus morbidly obese women [J]. Obes Surg, 2009, 19(5): 577582.
  2. 2. Alberti KG, Zimmet P, Shaw J, et al. The metabolic syndrome-a new worldwide definition [J]. Lancet, 2005, 366(9491): 10591062.
  3. 3. Sjstrm L, Narbro K, Sjstrm CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects [J]. N Engl J Med, 2007, 357(8): 741752.
  4. 4. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13 871 morbidly obese patients from a national registry [J]. Ann Surg, 2007, 246(6): 10021009.
  5. 5. Yarbrough DE, Leath RR, Leeth TD, et al. Longterm improvement of gastrointestinal complaints following weight loss in patients undergoing laparoscopic RouxenY gastric bypass (LRYGBP) [J]. ASMBS, 2006, 2(3): 296297.
  6. 6. Bose M, Oliván B, Teixeira J, et al. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: What are the evidence? [J]. Obes Surg, 2009, 19(2): 217229.
  7. 7. Puzziferri N, AustrheimSmith IT, Wolfe BM, et al. Threeyear followup of a prospective randomized trial comparing laparoscopic versus open gastric bypass [J]. Ann Surg, 2006, 243(2): 181188.
  8. 8. Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10y followup [J]. Am J Clin Nutr, 1992, 55(2 Suppl): 582S585S.
  9. 9. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial [J]. JAMA, 2008, 299(3): 316323.
  10. 10. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and metaanalysis [J]. Am J Med, 2009, 122(3): 248256.
  11. 11. Rossi M, R Barretto Ferreira da Silva R, Chaves Alcntara G Jr, et al. Remission of metabolic syndrome: a study of 140 patients six months after RouxenY gastric bypass [J]. Obes Surg, 2008, 18(5): 601606.
  12. 12. Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following RouxenY gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity [J]. Obes Surg, 2007, 17(2): 176184.
  13. 13. Zlabek JA, Grimm MS, Larson CJ, et al. The effect of laparosscopic gastric bypss surgery on dyslipidemia in severely obese patients [J]. Surg Obes Relat Dis, 2005, 1(6): 537542.
  14. 14. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and metaanalysis [J]. JAMA, 2004, 292(14): 17241737.
  15. 15. Ali MR, Fuller WD, Rasmussen J. Detailed description of early response of metabolic syndrome after laparoscopic RouxenY gastric bypass [J]. Surg Obes Relat Dis, 2009, 5(3): 346351.
  16. 16. 鄧治洲, 王烈, 林憶陽, 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 244(9): 466469.
  17. 17. Scopinaro N, Papadia F, Marinari G, et al. Longterm control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI <35 kg/m2 [J]. Obes Surg, 2007, 17(2): 185192.
  18. 18. Couzin J. Bypassing medicine to treat diabetes [J]. Science, 2008, 320(5875): 438440.
  19. 19. DePaula AL, MacedoAL, Schraibman V, et al. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 2034 [J]. Surg Endosc, 2008, 23(8): 17241732.
  20. 20. Ballantyne GH, Farkas D, Laker S, et al. Shortterm changes in insulin resistance following weight loss surgery for morbid obesity: laparoscopic adjustable gastric banding versus laparoscopic RouxenY gastric bypass [J]. Obes Surg, 2006, 16(9): 11891197.
  21. 21. Haider DG, Schindler K, Schaller G, et al. Increased plasma visfatin concentrations in morbidly obese subjects are reduced after gastric banding [J]. J Clin Endocrinol Metab, 2006, 91(4): 15781581.
  22. 22. Koh KK, Quon MJ, Lee SJ, et al. Efonidipine simultaneously improves blood pressure, endothelial function, and metabolic parameters in nondiabetic patients with hypertension [J]. Diabetes Care, 2007, 30(6): 16051607.
  23. 23. Pischon T, Girman CJ, Hotamisligil GS, et al. Plasma adiponectin levels and risk of myocardial infarction in men [J]. JAMA, 2004, 291(14): 17301737.
  24. 24. Choi KM, Lee J, Lee KW, et al. Serum adiponectin concentrations predict the developments of type 2 diabetes and the metabolic syndrome in elderly Koreans [J]. Clin Endocrinol (Oxf), 2004, 61(1): 7580.
  25. 25. Choi EY, Park EH, Cheong YS, et al. Association of Creactive protein with the metabolic risk factors among young and middleaged Korean [J]. Metabolism, 2006, 55(3): 415421.
  26. 26. GómezAmbrosi J, Pastor C, Salvador J, et al. Influence of waist circumference on the metabolic risk associated with impaired fasting glucose: effect of weight loss after gastric bypass [J]. Obes Surg, 2007, 17(5): 585591.
  27. 27. Kotronen A, SepplLindroos A, Bergholm R, et al. Tissue specificity of insulin resistance in humans: fat in the liver rather than muscle is associated with features of the metabolic syndrome [J]. Diabetologia, 2008, 5(1): 130138.
  28. 28. Stearns AT, Balakrishnan A, Tavakkolizadeh A. Impact of RouxenY gastric bypass surgery on rat intestinal glucose transport [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297（5）: G950G957.
  29. 29. Rao MN, Mulligan K, Tai V, et al. Effects of insulinlike growth factor (IGF)I/IGFbinding protein3 treatment on glucose metabolism and fat distribution in human immunodeficiency virusinfected patients with abdominal obesity and insulin resistance [J]. J Clin Endocrinol Metab, 2010, 95(9): 43614366.
  30. 30. Wang X, Zhang S, Chen Y, et al. APM1 gene variants11377C/G and 4545G/C are associated respectively with obesity and with nonobesity in Chinese type 2 diabetes [J]. Diabetes Res Clin Pract, 2009, 84(3): 205210.
  31. 31. Kashyap SR, Defronzo RA. The insulin resistance syndrome: physiological considerations [J]. Diab Vasc Dis Res, 2007, 4(1): 1319.
  32. 32. Swarbrick MM, Stanhope KL, AustrheimSmith IT, et al. Longitudinal changes in pancreatic and adipocyte hormone following RouxenY gastric bypass surgery [J]. Diabetolog, 2008, 51(10): 19011911.
  33. 33. 周龍翔, 汪昱, 楊喆, 等. 胃癌術(shù)后不同殘胃患者胃腸激素及機(jī)體組成變化 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(4): 290295.