胆汁酸生成的通路或在2型糖尿病缓解过程中起作用

研究人员报告称，一种涉及到胆汁酸生成的通路或许在2型糖尿病缓解过程中起作用，这种作用通常会在减肥手术后被观察到。

宾夕法尼亚州丹维 尔市格伊辛格医疗系统的 博士及其同事对来自两项队列研究的数据进行了分析，他们发现，在接受Roux-en-Y式胃肠旁路手术(RYGB)的患者中，与 术后病情未能缓解的糖尿病患者以及非糖尿病患者相比，术后病情发生缓解的糖尿病患者具有最高的成纤维细胞生长因子19(FGF19)和总胆酸水平(P值均 小于0.001)。

他们的发现被发表在了《糖尿病治疗》杂志上并被收录到美国糖尿病学会会议的糖尿病治疗论文集中

“处于缓解期的患者在FGF19和胆汁酸水平上发生了最为显著的改变，” 说，“我们推测，胆汁酸在FGF19中起了至关重要的作用，这或许改变了患者对胰岛素的敏感程度。”

RYGB手术使大部分糖尿病患者的病情发生了缓解，但其机制并不完全清楚。已知FGF19与肝脏分泌胆汁酸的调节有关，于是研究人员推测，该机制或许在病情缓解中发挥了某些作用。

及其同事所评估的数据来自两组接受减肥手术患者的队列：其中一组涉及了66名糖尿病患者和54名非糖尿病患者；另一组涉及了115名糖尿病患者和71名非 糖尿病患者。他们将队列分为三组：非糖尿病的RYGB患者，RYGB术后病情至少缓解了12个月的糖尿病患者和RYGB术后病情无缓解的糖尿病患者。

术前，与非糖尿病患者相比，糖尿病患者具有更低的FGF19水平和更高的胆汁酸水平，“这提示，在糖尿病状态下，肝肠的FGF19-胆汁酸（BA）通路或许存在某种损伤。”研究人员写道。

通过溯源分析发现，在糖尿病患者，较低水平的FGF19与较高水平的肝脏胆固醇7α-羟化酶(，一种胆汁酸生成的调节酶)相关，而在非糖尿病患者中不存在该相关性(P

综上，研究人员发现，在接受减肥手术的各组患者中，绝大多数患者的血清FGF19水平出现了升高，其中，术后病情发生缓解的糖尿病患者该指标增幅最大(P

他 们发现，术后病情缓解的糖尿病患者在总胆酸方面也具有最大的增幅(P

研究人员注意到，胆酸已被证实与胰岛素抵抗呈负相关，这就提示它可能在减肥手术后糖尿病缓解中起到了关键作用。

说，可能的机制或许是，随着手术的完成，胆汁酸分泌进入空的十二指肠并直接转运至远端的小肠，与回肠更加接近，而后者正是FGF19产生的部位。不与食物 相接触的胆汁酸可能更具生物活性，其或许可以改变肝脏葡萄糖氧化并刺激FGF19的产生。他补充说，这或许可以使肝脏重建对FGF19的敏感并继而促进体 内葡萄糖水平的稳定。

没有参与此项研究的纽约莱诺克斯山医院的 博士表示，该研究“非常有效”的证明了已知的观点，即胆汁酸在减肥手术中“是平衡的重要组成部分”。

说：“我并不认为这是胆汁酸或FGF19本身的作用，但我觉得它们是允许细菌或抗炎药物进入患者机体的乘客。”

他补充说，其他炎症性疾病也显示可以通过减肥手术获得缓解，其中包括牛皮癣和类风湿性关节炎。他说：“它们获得了明显的好转，我觉得这是相同的机制参与的结果。”

（丁香园：zf057)

ADA: Bile Acids T2D After Tx

A in the of bile acids may play a role in the of type 2 often seen after , here.

In an of data from two , who went into Roux-en-Y (RYGB) had the in of 19 (FGF19) and the in total bile acids with who did not go into and with non- who had (P

They their in Care and in the Care at the .

" in the in FGF19 and bile acids," said. "We that bile acids play a major role in FGF19, which ... may to ."

RYGB leads to of in a large of , but the this isn't well . FGF19 has been with the of bile acid , so the that this may play a role in that .

and data from two of : one with 66 with and 54 the ; a with 115 and 71 non- .

They split the into three : RYGB , RYGB with who had for at least 12 after , and RYGB with who didn't have of after .

Pre-, with had lower of FGF19 and bile acid than non- , " the of an in the FGF19-[bile acid, (BA)] in the state," the wrote.

In , lower of FGF19 with 7 alpha- () -- a of bile acid -- in , but not in non- (P

, the found that serum FGF19 for the of all of , but who went into had the of all three (P

in also had the in total bile acids, they found (P

The noted that acid has been with , it could play a key role in of after .

said the could be that with , bile acids get into an empty and to the small , which is to the ileum, where FGF19 is .

These bile acids may be more since they don't come in with food, and may be able alter and FGF19 , he said, that this may re- the liver to FGF19 and .

, MD, of Lenox Hill in New York City, who was not in the study, said the is "very valid" given that it's been known that bile acids "are an part of the " in .

"I don't think it's the bile acids or FGF19 , but I think they are that allow or to get into a 's ," said.

He added that other also to be by , and .

"They get ," he said, "and I think the same is ."

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