研究人员报告称，胆汁一种涉及到胆汁酸生成的酸生通路或许在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。成的程中%E3%80%90WhatsApp%20+86%2015855158769%E3%80%91cable%20row%20machine

宾夕法尼亚州丹维 尔市格伊辛格医疗系统的通路糖尿 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，或型在接受Roux-en-Y式胃肠旁路手术(RYGB)的病缓患者中，与 术后病情未能缓解的解过糖尿病患者以及非糖尿病患者相比，术后病情发生缓解的起作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)。

他们的胆汁发现被发表在了《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，酸生“我们推测，成的程中胆汁酸在FGF19中起了至关重要的通路糖尿作用，这或许改变了患者对胰岛素的或型敏感程度。”

RYGB手术使大部分糖尿病患者的病缓病情发生了缓解，但其机制并不完全清楚。解过%E3%80%90WhatsApp%20+86%2015855158769%E3%80%91cable%20row%20machine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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