详细记录  
题名:Removal of Duodenum Elicits GLP-1 Secretion.
作者:MUSCOGIURI G; MEZZA T; PRIOLETTA A; SORICE GP; CLEMENTE G; SARNO G; NUZZO G; PONTECORVI A; HOLST JJ; GIACCARI A;
来源:Diabetes Care. 2013 Jun;36(6):1641-6. doi: 10.2337/dc12-0811. Epub 2013 Feb 7. [ IF= 8.09 ] ]
URL :10.2337/dc12-0811
日期:20130228
摘要:OBJECTIVE To evaluate the effect of removal of the duodenum on the complex
interplay between incretins, insulin, and glucagon in nondiabetic subjects.
RESEARCH DESIGN AND METHODS For evaluation of hormonal secretion and insulin
sensitivity, 10 overweight patients without type 2 diabetes (age 61 +/- 19.3
years and BMI 27.9 +/- 5.3 kg/m(2)) underwent a mixed-meal test and a
hyperinsulinemic-euglycemic clamp before and after pylorus-preserving
pancreatoduodenectomy for ampulloma. RESULTS All patients experienced a reduction
in insulin (P = 0.002), C-peptide (P = 0.0002), and gastric inhibitory peptide
(GIP) secretion (P = 0.0004), while both fasting and postprandial glucose levels
increased (P = 0.0001); GLP-1 and glucagon responses to the mixed meal increased
significantly after surgery (P = 0.02 and 0.031). While changes in GIP levels did
not correlate with insulin, glucagon, and glucose levels, the increase in GLP-1
secretion was inversely related to the postsurgery decrease in insulin secretion
(R(2) = 0.56; P = 0.012) but not to the increased glucagon secretion, which
correlated inversely with the reduction of insulin (R(2) = 0.46; P = 0.03) and
C-peptide (R(2) = 0.37; P = 0.04). Given that the remaining pancreas presumably
has preserved intraislet anatomy, insulin secretory capacity, and alpha- and
beta-cell interplay, our data suggest that the increased glucagon secretion is
related to decreased systemic insulin. CONCLUSIONS Pylorus-preserving
pancreatoduodenectomy was associated with a decrease in GIP and a remarkable
increase in GLP-1 levels, which was not translated into increased insulin
secretion. Rather, the hypoinsulinemia may have caused an increase in glucagon
secretion.

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