Endocrine implications of bariatric surgery: a review on the intersection between incretins, bone, and sex hormones.

减肥手术对内分泌的影响：对肠促胰岛素，骨骼和性激素之间相关性的综述。

Abstract

Bariatric surgery is now the most widely used intervention for the treatment of human obesity. A large body of literature has demonstrated its efficacy in sustained weight loss and improvement in its associated comorbidities. Here, we review the effect of bariatric surgery in gut hormone physiology, bone remodeling and the reproductive axis.

Rapid improvements in insulin release and sensitivity appear to be weight loss independent and occur immediately after surgery. These effects on pancreatic beta cells are mostly due to increased gut hormone secretion due to augmented nutrient delivery to the small intestine. Bone remodeling is also affected by gut hormones. Phenotypic skeletal changes observed in mice deficient in GLP-1 or GIP suggest that increased incretins may improve bone density. However, these positive effects may be counterbalanced by the association between weight loss and a reduction in bone density. Finally, studies have shown a marked improvement following bariatric surgery in infertility and PCOS in women and hypogonadism in men. Thus, the net effect on endocrine systems after bariatric surgery will likely vary on an individual basis and depend on factors such as comorbidities, peri-menopausal state, amount of weight loss, and likelihood to adhere to vitamin supplementation after surgery.

现将减肥手术作为治疗人类肥胖症的干预措施。大量文献证明了其在持续减肥和改善其相关合并症方面的功效。在这里，我们回顾减肥手术对肠激素生理学、骨重建和生殖轴的影响。胰岛素释放和敏感性似乎是随体重减轻出现快速改善，并且在手术后立即发生的。这些对胰腺β细胞的影响主要原因是增加的营养物输送到小肠导致的肠激素分泌增加。骨重塑也受肠道激素的影响。在缺乏GLP-1或GIP的小鼠中观察到的表型骨骼变化表明增加的肠促胰岛素可以改善骨密度。然而，体重减轻和骨密度降低之间的关联可以抵消这些正面效果。最后，研究表明，在不育症和女性PCOS（多囊卵巢综合征）以及男性性腺功能减退症的减肥手术后有显著改善。因此，减肥手术后对内分泌系统的净效应可能会因个体而异，并受诸如合并症、围绝经期状态、体重减轻量以及手术后坚持维生素补充的可能性等因素影响。

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