胃肠减肥手术治疗糖尿病可能的机制

The Mechanism of Gastrointestinal Bariatric Surgery on the Treatment of T2DM,Overview,Surgical indicationsOperation methodsThe possible mechanismSummary,Surgical indications,Operation methods,The mechanism of Bariatric surgery,Loss weightSecretion of gut hormones after RYGB Changes of insulin sensitivity,Weight lose,Weight changes among patients over a 7-year period,a sharper reduction in FPG and HbA1 after thesurgery,Secretion of gut hormones after RYGB,The gastrointestinal tract releases a number of hormones, including ghrelin and gastrin from the stomach, insulin, glucagon, pancreatic polypeptide and amylin from the pancreas, cholecystokinin, secretin, GIP and motilin from the small intestine, and GLP-1, GLP-2, oxyntomodulin and PYY336from the large intestine. These hormones signal to the periphery and to the central nervous system to regulate a number of biological processes.,The pathways that gut hormones regulate energy homeostasis.,Ghrelin,1、reduces fat use2、increases the expression of enzymes that promote fat storage in adipose tissue3、,The mechanism of GLP-1,stimulates insulin secretion and biosynthesis inhibits glucagon secretionlowers plasma glucose concentrations inhibits gastric emptying and reduces appetite stimulates -cell proliferation and neogenesis。,抑胃肽(GIP),produced by K of small intestinal mucosa cells.Stimulate the islet cells release sugar depend on the function of insulin2、stimulates -cell proliferation,PYY,Slow gastric emptying reduce intestinal peristalsisreduce food intakeweight losslower levels of ghrelin,Changes of insulin sensitivity,The massive weight loss caused by bariatric surgery is associated with improved insulin sensitivityan increased muscle expression of insulin receptors.,Intestinal malabsorption,Reduce the intestinal absorption of fat reduce free fatty acid utilization rate reduce the storage of fat in skeletal muscle cells with i