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Diabetes May Be Disorder Of Upper Intestine: Surgery May Correct It
ScienceDaily (Mar. 6, 2008) — Growing evidence shows that surgery may effectively cure Type 2 diabetes — an approach that not only may change the way the disease is treated, but that introduces a new way of thinking about diabetes.
ScienceDaily（2008年3月6日）－越来越多的证据表明，手术对治疗2型糖尿病可能是有效的，这不是改变了对糖尿病的治疗方法，而且也引发了对糖尿病的新的认识。
A new article — published in a special supplement to the February issue of Diabetes Care by a leading expert in the emerging field of diabetes surgery — points to the small bowel as the possible site of critical mechanisms for the development of diabetes.
在糖尿病外科治疗这个新领域处于领先水平的一位专家在糖尿病治疗杂志2月期的增刊上面发表了一篇文章指出，小肠是可能导致糖尿病发病的重要部位。
The study's author, Dr. Francesco Rubino of NewYork-Presbyterian Hospital/Weill Cornell Medical Center, presents scientific evidence on the mechanisms of diabetes control after surgery. Clinical studies have shown that procedures that simply restrict the stomach's size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese.
这个研究的作者，纽约教会医院/ Weill Cornell医学中心的Francesco Rubino医生提供了术后糖尿病控制的机制的科学的证据。临床研究表明，通过减少大量体重，控制胃的大小（也就是胃箍）就可以改善糖尿病。通过在动物模型中研究糖尿病，Rubino博士首次提供了科学的证据，即通过胃肠旁路手术改变常规胃肠道消化路径（胃绕道手术），可以消除糖尿病，即使没有降低体重，甚至对那些根本不胖的个体也有效。
\"By answering the question of how diabetes surgery works, we may be answering the question of how diabetes itself works,\" says Dr. Rubino, who is a professor in the Department of Surgery at Weill Cornell Medical College and chief of gastrointestinal metabolic surgery at NewYork-Presbyterian/Weill Cornell.
Rubino是Weill Cornell医学中心外科的教授和纽约教会医院/ Weill Cornell消化外科的主任，他说，“回答了糖尿病外科手术是怎么起作用的，就回答了糖尿病是怎么发生的了”。
Dr. Rubino's prior research has shown that the primary mechanisms by which gastrointestinal bypass procedures control diabetes specifically rely on the bypass of the upper small intestine — the duodenum and jejunum. This is a key finding that may point to the origins of diabetes.
Rubino博士先前的研究发现，胃肠旁路手术能够控制糖尿病主要靠对上段小肠－十二指肠和空肠的改道。这是对糖尿病病因的最重要的发现。
\"When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem,\" says Dr. Rubino, who is heading up NewYork-Presbyterian/Weill Cornell's Diabetes Surgery Center.
目前在引领纽约教会医院/ Weill Cornell糖尿病外科中心发展的Rubino博士说，“当我们将十二指肠和空肠改道的时候，可能也就同时将糖尿病的发病根源解除了”。
In fact, it has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism. \"It should not surprise anyone that surgically altering the bowel's anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes,\" Dr. Rubino says.
事实上，胃肠道在能量调节方面起着重要作用的这一点越来越明显，许多胃肠道激素都参与糖代谢的调节。Rubino教授认为，“通过外科手术改变肠管的解剖，从而影响调节血糖的机制，最终可以影响糖尿病，这并不奇怪”。
While other gastrointestinal operations may cure diabetes as an effect of changes that improve blood sugar levels, Dr. Rubino's research findings in animals show that procedures based on a bypass of the upper intestine may work instead by reversing abnormalities of blood glucose regulation.
有些胃肠道手术可以通过提高血糖水平来治疗糖尿病，Rubino博士在动物实验的研究发现这种治疗的有效是通过改道上段小肠的手术实现的，而不是通过逆转血糖调节异常的机制来实现的。
In fact, bypass of the upper small intestine does not improve the ability of the body to regulate blood sugar levels. \"When performed in subjects who are not diabetic, the bypass of the upper intestine may even impair the mechanisms that regulate blood levels of glucose,\" says Dr. Rubino. In striking contrast, when nutrients' passage is diverted from the upper intestine of diabetic patients, diabetes resolves.
事实上，改道上段小肠并没有提高机体调节血糖水平的能力。Rubino教授说，“当对那些不是糖尿病的个体进行上段小肠改道手术时，甚至可能破坏调节血糖水平的机制”。与之成鲜明对比的是，当营养物质的传输不再经过糖尿病人的上段小肠时，糖尿病消失了。
This, he explains, implies that the upper intestine of diabetic patients may be the site where an abnormal signal is produced, causing, or at least favoring, the development of the disease.
他解释说，这可能意味着糖尿病人的上段小肠可能是异常信号的发源地，至少，可能它推动了疾病的发展。
How exactly the upper intestine is dysfunctional remains to be seen. Dr. Rubino proposes an original explanation known in the scientific community as the \"anti-incretin theory.\"
上段小肠是如何导致不正常的尚需进一步的研究。Rubino博士提出了学术界最先有过的解释，即“抗激素理论”。
Incretins are gastrointestinal hormones, produced in response to the transit of nutrients, that boost insulin production. Because an excess of insulin can determine hypoglycemia (extremely low levels of blood sugar) — a life-threatening condition — Dr. Rubino speculates that the body has a counter-regulatory mechanism (or \"anti-incretin\" mechanism), activated by the same passage of nutrients through the upper intestine. The latter mechanism would act to decrease both the secretion and the action of insulin.
胃肠道的激素是在营养物质通过胃肠道时产生的，同时会升高胰岛素的产生。由于过量的胰岛素会导致低血糖症（血糖水平非常低），这会威胁人的生命，Rubino教授推测机体有一个相反的调解机制（或者可以称为抗激素机制），这个机制由营养物质通过上段小肠时同时启动，这个机制的启动会降低胰岛素的分泌和胰岛素的功效。
\"In healthy patients, a correct balance between incretin and anti-incretin factors maintains normal excursions of sugar levels in the bloodstream,\" he explains. \"In some individuals, the duodenum and jejunum may be producing too much of this anti-incretin, thereby reducing insulin secretion and blocking the action of insulin, ultimately resulting in Type 2 diabetes.\"
他解释说，“健康人在胃肠道激素和抗激素之间是存在着正确的平衡的，从而维持血流中血糖水平的正常波动；在有些个体中，十二指肠和空肠可能会产生太多这种抗激素，这样的话就会降低胰岛素的分泌，抑制胰岛素的效应，最终导致II型糖尿病”。
Indeed, in Type 2 diabetes, cells are resistant to the action of insulin (\"insulin resistance\"), while the pancreas is unable to produce enough insulin to overcome the resistance.
事实上，II型糖尿病病人的细胞会表现为对胰岛素的效应抵抗（即“胰岛素抵抗”），同时胰腺不能产生足够的胰岛素来消除这种对抗。
After gastrointestinal bypass procedures, the exclusion of the upper small intestine from the transit of nutrients may offset the abnormal production of anti-incretin, thereby resulting in remission of diabetes.
胃肠道改道手术后，营养物质不再通过上段小肠，这样就抵消了抗激素产生的异常，从而达到治愈糖尿病的效果。
In order to better understand these mechanisms, and help make the potential benefits of diabetes surgery more widely available, Dr. Rubino calls for prioritizing research in diabetes surgery. \"Further research on the exact molecular mechanisms of diabetes, surgical control of diabetes and the role played by the bowel in the disease may bring us closer to the cause of diabetes.\"
为了更好的理解这些机制，使得糖尿病外科治疗的优势得到更多认同，Rubino博士号召优先研究糖尿病外科手术，他说，“下一步的研究会包括糖尿病的分子水平的机制、外科手术对糖尿病的控制以及肠管在糖尿病中的角色，这些会使我们更接近糖尿病的真正病因”。
Today, most patients with diabetes are not offered a surgical option, and bariatric surgery is recommended only for those with severe obesity (a body mass index, or BMI, of greater than 35kg).
现在，很多糖尿病患者的治疗方案中都还不包括外科治疗，bariatric手术只推荐给那些严重肥胖的患者（体重指数或BMI，大于35kg的）。
\"It has become clear, however, that BMI cut-offs can no longer be used to determine who is an ideal candidate for surgical treatment of diabetes,\" says Dr. Rubino.
Rubino博士说，“不过很明显，以后BMI分界点不再是确定外科治疗糖尿病的理想的指标了”。
\"There is, in fact, growing evidence that diabetes surgery can be effective even for patients who are only slightly obese or just overweight. Clinical trials in this field are therefore a priority as they allow us to compare diabetes surgery to other treatment options in the attempt to understand when the benefits of surgery outweigh its risks. Clinical guidelines for diabetes surgery will certainly be different from those for bariatric surgery, and should not be based only on BMI levels,\" he notes.
“事实上，有越来越多的证据支持糖尿病手术疗法对那些只是轻微肥胖或是刚刚超重的患者也有效。这个领域的临床试验有优先权，因为这样的试验可以使我们比较糖尿病手术和其他治疗方案，从而找出什么时候手术的好处会多余它的风险。糖尿病外科手术的临床指导一定会与那些bariatric手术的不同，应该不是基于BMI水平的”。
\"The lesson we have learned with diabetes surgery is that diabetes is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease,\" adds Dr. Rubino.
Rubino补充说，“我们从糖尿病外科手术治疗中认识到是糖尿病不再总是慢性病和长期病，那样认识的话，唯一可能的治疗目标就只是控制高血糖症，将并发症的危险降低到最小。胃肠道手术治疗提供了完全治愈糖尿病的可能性，这是我们对治疗糖尿病目标的方法的一个最重要的转变，这在糖尿病历史上是空前的进步”。
Type 2 diabetes, which accounts for 90 to 95 percent of all cases of diabetes, is a growing epidemic that afflicts more than 200 million people worldwide.
II型糖尿病占全部糖尿病的90％～95％，而且患这种类型糖尿病的病人还在继续增加，全球已经有2亿多人患病。
At a time when diabetes is growing epidemically worldwide, Dr. Rubino says that finding new treatment strategies is a race against time. \"At this point, missing the opportunity that surgery offers is not an option.\"
在这个全球的糖尿病患者越来越多的时候，Rubino博士提出，发现新的治疗策略是一个与时间的竞赛，“从这一点上说，不该放弃选择外科手术来治疗糖尿病这个办法”。
In addition to having performed landmark studies in the field of diabetes surgery, Dr. Rubino was the principal organizer of an influential Diabetes Surgery Summit, held in Rome in March 2007. This international consensus conference helped establish the field, making international recommendations for the use of surgery and creating an International Diabetes Surgery Task Force. Dr. Rubino serves as a founding member
Rubino博士不仅在糖尿病外科手术治疗这个领域进行了划时代的研究，而且他还主要负责组织了2007年3月在罗马举行的一个很有影响的糖尿病外科手术治疗最高会议。这个国际性的大会推进了对糖尿病手术治疗的方案的实行，建立了一个国际糖尿病外科治疗先遣部队。Rubino博士作为成立的成员之一。
http://www.sciencedaily.com/releases/2008/03/080305113659.htm |
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发表于 2008-3-10 07:55:58