[WCIR2009]G.Reaven教授访谈:关于肠促胰岛素作用的一些观点
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专家访谈 综合领域 作者:Reaven 来源:未知 2009/11/24 17:43:00    加入收藏
内容概要:《国际糖尿病》:目前对肠促胰岛素的关注越来越多,并且对它的研究也越来越深入,然而,其在血管功能方面的有益作用却较少为人所知,您能介绍一下其对血管的益处吗?


  《国际糖尿病》:谈到胃肠激素,越来越多的证据似乎表明肠道激素在减重和控制血糖方面起重要作用,而且一些口服肠道激素或其类似物已上市。您认为应用肠道激素治疗肥胖或糖尿病已经成熟还是仍需进一步试验验证?

    International Diabetes :  Speaking of gut hormones, more and more evidence seems to be showing that gut hormones show a crucial role in weight loss and blood glucose normalization so oral medications of gut hormones or their analogs have been put on the market.  Do you think the treatment of diabetes or obesity with gut hormones has become absolute or are further trials needed?

    Gerald Reaven教授:首先回到你说的第一点上,即肠道激素在减重和控制血糖方面起重要作用。这一观点产生于肥胖症治疗手术后。患者术后几天内出现了血糖浓度的极速下降,这提示胃转移—作为这一特定类型的肥胖症治疗术的一部分—在其之后一定产生了一种神奇魔力的物质。几年前我接触了几个严重高血糖的患者,仅仅禁食几天也产生了相同程度的血糖的急剧下降。现在我不相信胃转移术能够对控制胰岛素抵抗和胰岛素分泌的代谢因素带来什么新的独特的效果。除非我看到事实,没有充分的理由我不会相信可能会存在与应用胃肠激素治疗糖尿病、肥胖或者其它疾病相关的、具有独特作用的物质。

    Dr Reaven:  Well going back to the first point that you made.  This is based on bariatric surgery and the argument is that within a few days after bariatric surgery there is a very prompt fallen plasma glucose concentration and that implies that there is something magical that has been going on following the diversion of the gastric diversion which is a part of that particular type of bariatric surgery.  Some years ago we took patients with severe hyperglycemia and just took away food for a few days and got an equally dramatic fall in plasma glucose.  At the moment I am not convinced that there is any new unique effect of gastric diversion surgery on metabolic factors controlling insulin resistance or insulin secretion until I am convinced that is the case I see no great reason to believe that there may be something uniquely useful about using gut hormones to treat diabetes, obesity or anything else.
 
 《国际糖尿病》:那么什么能让您相信呢?

    International Diabetes:  So what would convince you?

    Gerald Reaven教授:一个设计较好的研究:即肥胖症治疗手术后减重与改变饮食的减重进行对比。做几个月对比,减重将不会如此不同。用适当的方法测量一下胰岛素抵抗、胰岛素分泌、全天血浆中胰岛素、葡萄糖的浓度来观察它们的异同。

    Dr Reaven:  A good study in which one compared weight loss following bariatric surgery with weight loss following a variable calorie diet.  You do it for a couple of months; the weight loss would not be that different.  You measure with appropriate methods; insulin resistance, insulin secretion, day long insulin glucose concentrations in plasma following meals and see the difference.
 



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