Objectives To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.
Ｂｙ ｐｅｒｆｕｓｉｎｇ ｌｉｖｅｒｓ ｆｒｏｍ Ｗｉｓｔａｒ ｒａｔｓ ｒｅｎｄｅｒｅｄ ｓｅｐｓｉｓ ｗｉｔｈ ａｃｕｔｅ ｏｂｓｔｒｕｃｔｉｖｅ ｃｈｏｌａｎｇｉｔｉｓ（ＡＯＣ）ｉｎ ｖｉｔｒｏ ｉｎ ａ ｎｏｎｒｅｃｉｒｃｕｌａｔｉｎｇ ｍｏｄｅ，ｗｅ ｍｅａｓｕｒｅｄ ｔｈｅ ｒａｔｅｓ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｆｒｏｍ ｓａｔｕｒａｔｉｎｇ ｃｏｎｃｅｎｔｒａｔｉｏｎ ｏｆ ｌａｃｔａｔｅ （５ ｍｍｏｌ／L) ｐｌｕｓ ｐｙｒｕｖａｔｅ （０５ ｍｍｏｌ／Ｌ） ａｎｄ ｔｈｅ ｒｅｓｐｏｎｓｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｔｏ ｇｌｕｃａｇｏｎ ａｎｄ ｅｐｉｎｅｐｈｒｉｎｅ．Ｗｅ ａｌｓｏ ｓｔｕｄｉｅｄ ｔｈｅ ＡＯＣ ｉｎｄｕｃｅｄ ａｌｔｅｒａｔｉｏｎｓ ｉｎ ｔｈｅ ｍｉｌｉｅｕ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｉｃ （ｇｌｕｃａｇｏｎ，ｅｐｉｎｅｐｈｒｉｎｅ ａｎｄ ｃｏｒｔｉｓｏｌ） ａｎｄ ｃｏｎｔｅｒｒｅｇｕｌａｔｏｒｙ （ｉｎｓｕｌｉｎ） ｈｏｒｍｏｎｅｓ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈｅ ｒａｔｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｏｆ ＡＯＣ ２４ ｈ．ｇｒｏｕｐ ｗａｓ ｓｉｇｎｉｆｉｃａｎｔｌｙ ｒｅｄｕｃｅｄ ａｎｄ ｔｈｉｓ ｒｅｄｕｃｔｉｏｎ ｃｏｕｌｄ ｂｅ ｃｏｍｐｅｎｓａｔｅｄ ｂｙ ｉｎｃｒｅａｓｅｓ ｏｆ ｇｌｕｃｏｓｅ ｐｒｅｃｕｒｓｏｒｓ，ｅｓｐｅｃｉａｌｌｙ ｌａｃｔａｔｅ ａｎｄ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｉｃ ｈｏｒｍｏｎｅｓ ｔｏ ａ ｓｅｒｕｍ ｇｌｕｃｏｓｅ ｌｅｖｅｌ ａｓ ｍｕｃｈ ａｓ ２．５ ｔｉｍｅｓ ｔｈｅ ｎｏｒｍａｌ ｗｈｉｃｈ ｉｓ ｎｅｅｄｅｄ ｉｎ ｓｔｒｅｓｓ ｒｅａｃｔｉｏｎ．Ｔｈｅ ｒａｔｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｏｆ ＡＯＣ ４８ ｈ．ｗａｓ ｆｕｒｔｈｅｒ ｄｅｃｒｅａｓｅｄ ａｎｄ ｔｈｉｓ ｄｅｃｒｅａｓｅ ｃｏｕｌｄ ｎｏｔ ｂｅ ｃｏｍｐｅｎｓａｔｅｄ ｐｒｏｂａｂｌｙ ａｓ ａ ｒｅｓｕｌｔ ｏｆ ｓｅｖｅｒｅ ｄａｍａｇｅ ｔｏ ｈｅｐａｔｏｃｙｔｅｓ． Ｔｈｅ ｒｅｓｕｌｔｓ ｉｎｄｉｃａｔｅ ｔｈａｔ ｔｈｅ ｒｅｄｕｃｅｄ ｇｌｕｃｏｓｅ ｍｅｔａｂｏｌｉｃ ｒｅｓｐｏｎｓｅ ｄｕｅ ｔｏ ＡＯＣ ｍａｙ ｐｌａｙ ａｎ ｉｍｐｏｒｔａｎｔ ｒｏｌｅ ｉｎ ｔｈｅ ｄｅｖｅｌｏｐｍｅｎｔ ｏｆ ｃｈｏｌａｎｇｉｔｉｓｉｎｄｕｃｅｄ ｄｙｓｆｕｎｃｔｉｏｎ ｏｆ ｍｕｌｔｉｐｌｅ ｏｒｇａｎｓ．
Objective To observe the feature of post-operative hyperglycemia after coronary artery bypass grafting(CABG) surgery in department of intensive care unit（ICU） patients.Methods Patients who had CABG surgery in Zhongshan Hospital from January 2005 to December 2005 were enrolled.Data were collected including the history of diabetes，pre-operative and post-operative blood glucose(BG) levels，and the time that post-operative hyperglycemia and peak BG occurred.The patients were divided into diabetic and non-diabetic groups according to the diabetic history.The data were compared and analyzed between the two groups.Results 200 patients were enrolled in this study.The incidence of post-operative hyperglycemia was 77%，and about 99.4% occurred in the first 24 hours admitted to ICU，which was independent on diabetic history (χ2=2.58，P=0.108)，but was related to the BG level above 6.1 mmol/L (χ2=12.31，P=0.000).In 80% of the patients，peak BG occurred in the first 24 hours admitted to ICU，which was significantly earlier in the non-diabetic group compared with the diabetic group (8.5 h vs 18.5 h，P=0.02 ).In the patients who had post-operative hyperglycemia，the median time of the BG peak is 10 hours，and 75.3% of the BG peak occurred in the first 24 hours admitted to ICU.Conclusion There is a high incidence of post-operative hyperglycemia in post-CABG patients which always occur within 24 hours after operation and relate to pre-operative high BG.
Objective To investigate the effects of tight blood glucose control on the shortterm prognosis of the patients after heart valve replacement, in order to improve treatment effectiveness and lower postoperative complications. Methods A total of 240 patients including 150 males and 90 females underwent mitral valve replacement or mitral and aortic valve replacement were enrolled in this study from January 2007 to December 2008 at the cardiac surgery department of Renmin hospital of Wuhan university. The age of these patients ranged from 19 to 65 years old with an average age of 53.33 years. According to insulin administration time and blood glucose control level, they were randomly separated into two groups. In the experimental group, there were 121 patients who received continuous insulin infusion to maintain postoperative glucose level between 4.4 and 6.1 mmol/L, while 119 patients in the control group received insulin infusion when their glucose level went higher than 11.1 mmol/L to control the level between 6.1 and 11.1 mmol/L. Then the postoperative wound infection, malignant arrhythmia rate, the assisted ventilation time, intensive care unit(ICU) stay time and count of neutrophils were compared and analyzed. Results There was no hospitalized death in both groups. The rate of wound infection（3.31% vs.10.08%, χ2=4.430,P=0.035）, the assisted ventilation time（9.02±2.73 h vs. 10.01±3.58 h, t=2.280,P=0.024）, time for count of leukocytes to decrease to the normal level（11.04±3.16 d vs. 12.05±3.76 d, t=2.168,P=0.031）, average hospitalization time（13.49±3.81 d vs. 14.51±4.02 d,t=2.017,P=0.045）, and count of neutrophils on the third day（0.82±0.04 vs. 0.84±0.05, t=2.644,P=0.009） in the experimental group were significantly lower or shorter than those in the control group. But there was no significant difference between both groups in ICU stay time and the rate of malignant arrhythmia. Conclusion Tight blood glucose control can lower the rate of postoperative wound infection, shorten the assisted ventilation time and hospitalization time, and reduce the usage of antibiotics in patients after heart valve replacement. Accordingly, it can enhance the curative effect, reduce overall medical expenses, and improve prognosis.
目的 探讨成都地区中老年人群的腰高比值（WHtR）与血压、血脂、血糖的关系。 方法 2007年5月间在成都市地中老年人群（688人）中用统一编制的调查表记录被调查者的血压、血脂、血糖、WHtR等指标，并用相关统计学数据进行分析。 结果 ① 成都地区中老年人群WHtR≥0.5的高血压、高血脂、高血糖的发病率明显高于对照组（P＜0.05），且有统计学意义。② 年龄、收缩压、舒张压、甘油三酯和血糖水平，WHtR≥0.5组明显高于WHtR＜0.5组，而WHtR≥0.5组高密度脂蛋白水平低于WHtR＜0.5组，且组间差异均有统计学意义。③ logistic 回归分析表明WHtR与年龄、收缩压、舒张压、甘油三酯、空腹血糖水平呈正相关，与高密度脂蛋白水平呈负相关。 结论 成都地区中老年人群WHtR与血压、血脂及血糖关系密切，可能可以通过改善血压、血脂、空腹血糖等指标来减少WHtR，中老年人群要加强对 WHtR 的自我管理, 尽可能将心血管疾病危险因素降到最低。
【摘要】 目的 了解不同糖代谢状态的人群空腹及口服葡萄糖耐量实验（oral glucose tolerance test，OGTT）餐后胰高血糖素样态-1（GLP-1）和葡萄糖依赖的促胰岛素多态（GIP）水平。 方法 将受试者根据OGTT结果分为3组:正常糖耐量组（NGT，n=61例），糖耐量受损组（IGT，n=53）和2型糖尿病组（T2DM， n=66）。采空腹及糖餐后2 h静脉血检测GLP-1和GIP水平。 结果 T2DM组空腹GLP-1水平低于NGT和IGT组（Plt;0.05）。NGT和IGT的空腹GLP-1水平差异无统计学意义（Pgt;0.05）。餐后GLP-1水平三组差异无统计学意义（Pgt;0.05）。空腹及餐后GIP水平在NGT、IGT和T2DM均呈逐渐增加的趋势，而且同OGTT-0 h和OGTT-2 h血糖水平呈正相关（r=0.384，0.426；Plt;0.05）。 结论 不同的GLP-1和GIP水平也许是IGT和T2DM胰岛素分泌能力不同的原因之一。【Abstract】 Objective To investigate the fasting, and after oral glucose tolerance test (OGTT), the postprandial levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) in Chinese people with different degrees of glucose tolerance. Methods Based on the results of OGTT, 180 subjects were divided into three groups: normal glucose tolerance group (NGT group, n=61), impaired glucose tolerance group (IGT group, n=53) and type-2 diabetes mellitus group (T2DM group, n=66). Fasting venous blood and the venous blood 2 hours after OGTT was sampled to detect GLP-1 and GIP levels. Results The fasting GLP-1 level in the T2DM group was significantly lower than that in the NGT and IGT groups (Plt;0.05). There was no significant difference in fasting GLP-1 level between NGT and IGT groups (Pgt;0.05). There was no significant difference in GLP-1 level 2 hours after OGTT among all the three groups (Pgt;0.05). GIP level gradually increased in the order of NGT, IGT and T2DM both before and after glucose load, and it was positively correlated with glucose levels just after OGTT and 2 hours after OGTT (r=0.384,0.426;Plt;0.05). Conclusion Different GLP-1 and GIP levels may be one of the reasons for different insulin secretion ability between IGT and T2DM
ObjectiveTo explore a surgery of effective weight loss concentrating on gut hormone release. MethodsWistar rats were fed with high-fat diet for inducing obesity and which randomly divided into sleeve gastrectomy plus decent jejunoileal bypass (SJB) group (n=12), sleeve gastrectomy (SG) group (n=12), and sham operation (SO) group (n=11), the body weight reduction, food intake, plasma ghrelin level, and glucagon like peptide-1 (GLP-1) level were compared among three groups. ResultsThere were no differences of the body weight and food intake before operation among three groups (Pgt;0.05). Compared with the SO group, the body weight descended and the food intake decreased obviously on 1-8 weeks after operation in the SJB group (Plt;0.05), the body weight of rats on 1-8 weeks after operation in the SJB group significantly descended as compared with the SG group (Plt;0.05), and the food intake of rats on week 3, 6, 7, and 8 in the SJB group signicantly decreased as compared with the SG group (Plt;0.05). There were no differences of the levels of the plasma ghrelin and GLP-1 before operation among three groups (Pgt;0.05). Compared with SO group, the plasma ghrelin level decreased and the GLP-1 level increased in the SJB group and the SG group, meanwhile the SJB group significantly decreased level of plasma ghrelin and elevated level of plasma GLP-1 as compared with the SG group on week 8 after operation(Plt;0.05). ConclusionThe data demonstrate that SJB could represent an effective way of losing weight by interfering with food intake and obesity related hormone levels.
ObjectiveTo investigate the effect and mechanism of sleeve gastrectomy (SG) on reducing blood glucose level. MethodsThirty GK rats were randomly divided into SG group, sham operation (SO) group, pair-fed (PF) group, and blank control (BC) group. The changes of weight, fasting blood glucose, glucose tolerance (oral glucose tolerance test, OGTT), insulin tolerance (insulin tolerance test, ITT), plasma insulin, ghrelin, and glucagon like peptide-1 (GLP-1) were monitored before and 24 weeks after operation respectively. ResultsFrom the 4th week after operation, weight gain in SG group and PF group began to decrease significantly compared with SO group (Plt;0.01). From the 2nd week after operation, fasting blood glucose level in SG group was lower than that in SO, PF, and BC groups (Plt;005), and the glucose tolerance in SG group obviously improved compared with preoperation and the other 3 groups (Plt;0.01). On the 6th week after operation, the insulin sensitivity in SG group obviously improved compared with SO group (Plt;0.05, Plt;0.01). There was no significant difference of insulin level between SG group and SO group (Pgt;0.05), ghrelin level significantly decreased (Plt;0.01) while GLP-1 level significantly increased (Plt;0.01) in SG group compared with SO group during 2-24 weeks after operation. ConclusionsThe effect of SG on reducing blood glucose is definite. SG can directly lower blood glucose independent with weight loss. Postoperative decreased ghrelin level and increased GLP-1 level may be its primary mechanism.
ObjectiveTo investigate the effect and mechanism of gastric bypass surgery (GBP) on fasting bloo-glucose (FBG) in type 2 diabetic rats. MethodsThe models of type 2 diabetic rats were induced by stretozotocin and 20 diabetic rats were randomly divided into two groups: diabetes-operation group (DO group, n=10) and diabetes-control group (DC group, n=10). Another twenty normal rats were randomly divided into two groups: normaloperation group (NO group, n=10) and normal-control group (NC group, n=10). The rats underwent GBP in DO group and NO group and sham operation in DC group and NC group. The FBG levels, serum dipeptidyl peptidase Ⅳ (DPPⅣ), and glucagon-like peptide-1 (GLP-1) concentrations of rats in each group were detected before operation and at 72 h, on 1 week, 4 weeks, and 8 weeks after operation. ResultsThe FBG levels of rats before operation were not significantly different between DO group and DC group or between NO group and NCgroup (Pgt;0.05). After operation, the FBG levels of rats in DO group gradually declined, reached the bottom on 4 weeks after operation and rose slightly on 8 weeks; The FBG levels of rats in DO group were lower after operation than before operation (Plt;0.05); After operation the FBG levels of rats in DO group were higher than that in NO group and NC group at the same time point (Plt;0.05); In DC group, the difference of FBG levels of rats at different time point was not statistically significant (Pgt;0.05); The inter-group and intra-group difference of FPG levels of rats for NO group and NC group was not statistically significant (Pgt;0.05). The concentrations of serum DPP-Ⅳ of rats before operation were not significantly different in each group (Pgt;0.05). After operation, the concentrations of serum DPP-Ⅳ of rats in DO group and NO group gradually decreased and markedly lower than that before operation, respectively (Plt;0.05). The concentrations of serum DPP-Ⅳ of rats after operation in DO group and NO group were significantly lower than that at the same time point in DC group and NC group, respectively (Plt;0.05); The intragroup difference of serum DPP-Ⅳ concentrations of rats for DC group and NC group was not statistically significant (Pgt;0.05). The concentrations of serum GLP-1 of rats before operation were not significantly different between DO group and DC group or between NO group and NC group (Pgt;0.05). After operation, the concentrations of serum GLP-1 of rats in DO group and NO group gradually increased, reached the top on 4 weeks after operation and declined slightly on 8 weeks; The concentrations of serum GLP-1 of rats in DO group and NO group were higher after operation than before operation (Plt;0.05);After operation, the concentrations of serum GLP-1 of rats in NO group were higher than that in NC group (Plt;0.05), but the concentrations of serum GLP-1 of rats at different time point in NO group were not different (Pgt;0.05). The intragroup difference of serum GLP-1 concentrations of rats for DC group and NC group was not statistically significant (Pgt;0.05). ConclusionsThere is obvious hypoglycemic effect of GBP on FBG levels of type 2 diabetic rats other than normal rats, in which high secretion of GLP-1 and low secretion of DPP-Ⅳ may be play an important role.
Objective To observe the curative effect on non-obese type 2 diabetes and the effect on change of glucagon-like peptide-1 (GLP-1) of gastric bypass operation. Methods Thirty-two cases of gastric ulcer with non-obese type 2 diabetes were suffered gastric bypass operation. Plasma glucose concentrations, insulin and GLP-1 were measured respectively in fasting and postprandial conditions before operation and in week 1, 2, 3 and month 1, 3, 6 after gastric bypass operation, and the body mass index (BMI), homeostasis model assessment β cell function index (HBCI) and glycosylated hemoglobin (HbA1c， the index was detected only before operation and in month 3, 6 after operation) were also measured. The turnover of the diabetes condition in the 6th month after surgery was observed. Results Compared with the levels before operation, the fasting and postprandial plasma glucose levels were descending (P＜0.05), fasting and postprandial plasma insulin and GLP-1 levels were ascending (P＜0.05), HBCI was ascending and HbA1c was descending significantly after operation respectively (P＜0.05), while BMI changed un-significantly after operation (Pgt;0.05). The diabetes control rate was 78.1%(25/32) overall six months after operation. Level of GLP-1 was negatively correlated with level of plasma glucose (P＜0.05) and positively correlated with level of insulin (P＜0.05). Conclusions Gastric bypass operation can markedly reduce plasma glucose level on the type 2 diabetes patients with non-obese, and the hypoglycemic effect may be contributed by more GLP-1 secretion that caused more insulin secretion, which doesn’t depend on the loss of weight.