减肥和代谢手术通过胆汁酸调节和肠屏障修复改善2型糖尿病患者的糖脂代谢

摘要(中文译文)

观察2型糖尿病（T2DM）患者在接受减重与代谢手术（BMS）后胆汁酸合成酶活性、结合酶基因及肠黏膜屏障功能（D-LA、Zonulin、MFG-E8）的变化，为BMS的临床优化提供客观意见。纳入2023年10月至2024年8月于我院接受BMS治疗的127例T2DM患者，检测术前及术后6个月的减重及糖脂代谢情况。此外，研究定量检测了参与胆汁酸合成与结合的关键酶（CYP7A1、CYP27A1、FXR、FGF19）的表达水平以及指示肠黏膜屏障功能的标志物（D-LA、Zonulin、MFG-E8）。BMS术后，患者体重显著降低，糖脂代谢显著改善（P<0.05）。此外，术后患者CYP7A1降低，FXR和FGF19升高（P<0.05）。在肠黏膜屏障功能方面，术后患者D-LA和Zonulin降低（P<0.05）。MFG-E8未见显著变化。BMS可有效改善T2DM患者的糖脂代谢并降低体重，其机制与调节胆汁酸代谢及促进肠屏障功能恢复有关。

Abstract

To observe the changes in bile acid synthase activity, conjugation enzyme gene and intestinal mucosal barrier function (D-LA, Zonulin, MFG-E8) in patients with type 2 diabetes mellitus (T2DM) after bariatric and metabolic surgery (BMS), and to provide an objective opinion on the clinical optimisation of BMS. 127 patients with T2DM who had received BMS treatment at our hospital from October 2023 to August 2024 were included in the study, and weight loss glucose-lipid metabolism was detected before surgery and 6 months after surgery. Furthermore, the study quantified the expression levels of key enzymes involved in bile acid synthesis and conjugation (CYP7A1, CYP27A1, FXR, FGF19) and markers indicative of intestinal mucosal barrier function (D-LA, Zonulin, MFG-E8). After BMS, the patient's weight was significantly reduced, and glucolipid metabolism was significantly improved (P&lt; 0.05). In addition, CYP7A1 was decreased, and FXR and FGF19 were elevated in patients after surgery (P &lt; 0.05). Regarding the intestinal mucosal barrier function, D-LA and Zonulin were reduced in patients after surgery (P&lt; 0.05). MFG-E8 was not significantly altered. BMS can effectively improve glucose-lipid metabolism and reduce body weight in T2DM patients, and its mechanism is related to regulating bile acid metabolism and promoting the recovery of intestinal barrier function.

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