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Thyroid cancer and insulin resistance. 甲状腺癌和胰岛素抵抗。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-02-01 Epub Date: 2023-11-14 DOI: 10.1007/s11154-023-09849-7
Gabriela Brenta, Fernando Di Fermo

Thyroid cancer has shown a parallel increase with diabetes in the last few years. This narrative review aims to explain the association between these two entities, focusing on insulin resistance as the mediator and exploring the effects of antidiabetic agents on thyroid cancer incidence and progression.We searched Pubmed for English-written articles on insulin resistance, diabetes, antidiabetic treatments, and thyroid cancer reported from January 2019 to April 2023. Exclusion criteria were preclinical and clinical studies involving a population with thyroid dysfunction, benign nodular goiter, or those that only analyzed thyroid cancer's association with obesity.The results of the narrative literature review revealed 96 articles. Additionally, four studies from a manual search were retrieved. After the exclusion criteria were applied, we included 20 studies. Out of 8 studies on insulin-resistant or Metabolic Syndrome patients, all suggest a positive association with thyroid cancer. At the same time, for diabetes, four out of five publications support a link with thyroid cancer. The seven remaining studies on antidiabetics suggest that metformin might benefit thyroid cancer. In contrast, the evidence for an association between Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and increased thyroid cancer findings is limited.In conclusion, the association between thyroid cancer and diabetes may be explained by insulin resistance, as shown in observational studies. However, the causal role is yet to be defined. Although the wide use of different antidiabetic agents has been related to thyroid cancer prevalence and progression, future research with drugs such as metformin or GLP-1 RA is still needed.

在过去的几年里,甲状腺癌的发病率与糖尿病的发病率呈平行增长。本文旨在解释这两个实体之间的关联,重点关注胰岛素抵抗作为中介,并探讨抗糖尿病药物对甲状腺癌发病率和进展的影响。我们在Pubmed检索了2019年1月至2023年4月期间关于胰岛素抵抗、糖尿病、抗糖尿病治疗和甲状腺癌的英文文章。排除标准是涉及甲状腺功能障碍、良性结节性甲状腺肿或仅分析甲状腺癌与肥胖关联的人群的临床前和临床研究。叙事性文献综述的结果为96篇。此外,从人工检索中检索了四项研究。应用排除标准后,我们纳入了20项研究。在8项针对胰岛素抵抗或代谢综合征患者的研究中,均表明胰岛素抵抗与甲状腺癌呈正相关。与此同时,对于糖尿病,五分之四的出版物支持与甲状腺癌的联系。剩下的七项关于抗糖尿病的研究表明二甲双胍可能对甲状腺癌有益。相比之下,胰高血糖素样肽-1受体激动剂(GLP-1 RA)与甲状腺癌发病率增加之间的关联证据有限。总之,观察性研究表明,甲状腺癌和糖尿病之间的关系可能与胰岛素抵抗有关。然而,因果关系还有待确定。尽管不同降糖药的广泛使用与甲状腺癌的患病率和进展有关,但未来仍需要对二甲双胍或GLP-1 RA等药物进行研究。
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引用次数: 0
Thirty years of active surveillance for low-risk thyroid cancer, lessons learned and future directions. 30年来对低风险甲状腺癌症的积极监测,经验教训和未来方向。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-02-01 Epub Date: 2023-10-14 DOI: 10.1007/s11154-023-09844-y
Anabella Smulever, Fabian Pitoia

Active Surveillance is a non-invasive strategy designed to identify a minority of patients with low-risk papillary thyroid carcinoma who might experience clinical progression and benefit from additional definitive treatments. Global experience suggests that these tumors typically show minimal changes in size during active surveillance, often demonstrating very slow growth or even size reduction. Moreover, the rate of lymph node metastases is low and can be effectively managed through rescue surgery, without impacting cancer-related mortality. However, despite 30 years of experience demonstrating the safety and feasibility of active surveillance for appropriately selected patients, this approach seems to have limited adoption in specific contexts. This limitation can be attributed to various barriers, including disparities in access to accurate information about the indolent nature of this disease and the prevalence of a maximalist mindset among certain patients and medical settings. This review aims to revisit the experience from the last three decades, provide current insights into the clinical outcomes of active surveillance trials, and propose a systematic approach for its implementation. Furthermore, it intends to emphasize the importance of precise patient selection and provides new perspectives in the field.

主动监测是一种非侵入性策略,旨在识别少数低风险甲状腺乳头状癌患者,这些患者可能会经历临床进展并受益于额外的明确治疗。全球经验表明,在积极监测期间,这些肿瘤的大小变化通常很小,通常表现出生长非常缓慢,甚至缩小。此外,淋巴结转移率低,可以通过抢救性手术进行有效管理,而不会影响癌症相关死亡率。然而,尽管30年的经验证明了对适当选择的患者进行主动监测的安全性和可行性,但这种方法在特定情况下的应用似乎有限。这种限制可归因于各种障碍,包括在获得有关这种疾病懒惰性质的准确信息方面的差异,以及在某些患者和医疗环境中普遍存在的最大主义心态。这篇综述旨在回顾过去三十年的经验,对主动监测试验的临床结果提供当前的见解,并提出一种系统的实施方法。此外,它旨在强调精确选择患者的重要性,并为该领域提供新的视角。
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引用次数: 0
Advances in the management of anaplastic thyroid carcinoma: transforming a life-threatening condition into a potentially treatable disease. 治疗甲状腺无节细胞癌的进展:将威胁生命的疾病转变为可治疗的疾病。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-02-01 Epub Date: 2023-08-31 DOI: 10.1007/s11154-023-09833-1
Inés Califano, Anabella Smulever, Fernando Jerkovich, Fabian Pitoia

Anaplastic thyroid cancer (ATC) is an infrequent thyroid tumor that usually occurs in elderly patients. There is often a history of previous differentiated thyroid cancer suggesting a biological progression. It is clinically characterized by a locally invasive cervical mass of rapid onset. Metastases are found at diagnosis in 50% of patients. Due to its adverse prognosis, a prompt diagnosis is crucial. In patients with unresectable or metastatic disease, multimodal therapy (chemotherapy and external beam radiotherapy) has yielded poor outcomes with 12-month overall survival of less than 20%. Recently, significant progress has been made in understanding the oncogenic pathways of ATC, leading to the identification of BRAF V600E mutations as the driver oncogene in nearly 40% of cases. The combination of the BRAF inhibitor dabrafenib (D) and MEK inhibitor trametinib (T) showed outstanding response rates in BRAF-mutated ATC and is now considered the standard of care in this setting. Recently, it was shown that neoadjuvant use of DT followed by surgery achieved 24-month overall survival rates of 80%. Although these approaches have changed the management of ATC, effective therapies are still needed for patients with BRAF wild-type ATC, and high-quality evidence is lacking for most aspects of this neoplasia. Additionally, in real-world settings, timely access to multidisciplinary care, molecular testing, and targeted therapies continues to be a challenge. Health policies are warranted to ensure specialized treatment for ATC.The expanding knowledge of ATC´s molecular biology, in addition to the ongoing clinical trials provides hope for the development of further therapeutic options.

甲状腺无细胞癌(ATC)是一种不常见的甲状腺肿瘤,通常发生在老年患者身上。患者通常有分化型甲状腺癌的病史,这表明该病存在生物学进展。其临床特征是发病迅速的局部浸润性宫颈肿块。50%的患者在确诊时发现有转移。由于预后不良,及时诊断至关重要。对于无法切除或已转移的患者,多模式疗法(化疗和体外放射治疗)的疗效不佳,12 个月的总生存率不到 20%。最近,人们在了解 ATC 的致癌途径方面取得了重大进展,发现 BRAF V600E 突变是近 40% 病例的驱动致癌基因。BRAF抑制剂达拉非尼(D)和MEK抑制剂曲美替尼(T)的联合治疗在BRAF突变的ATC中显示出卓越的应答率,目前被认为是这种情况下的标准治疗方法。最近的研究表明,新辅助使用 DT 后再进行手术的 24 个月总生存率达到 80%。虽然这些方法改变了 ATC 的治疗,但 BRAF 野生型 ATC 患者仍然需要有效的治疗方法,而且这种肿瘤的大多数方面都缺乏高质量的证据。此外,在现实世界中,及时获得多学科治疗、分子检测和靶向治疗仍然是一项挑战。除了正在进行的临床试验,人们对 ATC 分子生物学的了解也在不断扩大,这为开发更多治疗方案带来了希望。
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引用次数: 0
Molecular imaging and related therapeutic options for medullary thyroid carcinoma: state of the art and future opportunities. 甲状腺髓样癌的分子成像和相关治疗方案:技术现状与未来机遇。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-02-01 Epub Date: 2023-09-16 DOI: 10.1007/s11154-023-09836-y
Alessio Imperiale, Valentina Berti, Mickaël Burgy, Roberto Luigi Cazzato, Arnoldo Piccardo, Giorgio Treglia

Due to its rarity and non-specific clinical presentation, accurate diagnosis, and optimal therapeutic strategy of medullary thyroid carcinoma (MTC) remain challenging. Molecular imaging provides valuable tools for early disease detection, monitoring treatment response, and guiding personalized therapies. By enabling the visualization of molecular and cellular processes, these techniques contribute to a deeper understanding of disease mechanisms and the development of more effective clinical interventions. Different nuclear imaging techniques have been studied for assessing MTC, and among them, PET/CT utilizing multiple radiotracers has emerged as the most effective imaging method in clinical practice. This review aims to provide a comprehensive summary of the current use of advanced molecular imaging modalities, with a particular focus on PET/CT, for the management of patients with MTC. It aims to guide physicians towards a rationale for the use of molecular imaging also including theranostic approaches and novel therapeutical opportunities. Overall, we emphasize the evolving role of nuclear medicine in MTC. The integration of diagnostics and therapeutics by in vivo molecular imaging represents a major opportunity to personalize treatment for individual patients, with targeted radionuclide therapy being one representative example.

由于甲状腺髓样癌(MTC)的罕见性和非特异性临床表现,其准确诊断和最佳治疗策略仍具有挑战性。分子成像为早期疾病检测、监测治疗反应和指导个性化疗法提供了宝贵的工具。通过将分子和细胞过程可视化,这些技术有助于加深对疾病机制的理解,并开发出更有效的临床干预措施。目前已研究出不同的核成像技术用于评估 MTC,其中利用多种放射性核素的 PET/CT 已成为临床实践中最有效的成像方法。本综述旨在全面总结目前在 MTC 患者管理中使用先进分子成像模式的情况,尤其侧重于 PET/CT。它旨在引导医生了解分子成像的使用原理,包括治疗方法和新的治疗机会。总之,我们强调核医学在 MTC 中不断发展的作用。活体分子成像将诊断和治疗结合在一起,为患者的个性化治疗提供了重要机会,放射性核素靶向治疗就是一个很有代表性的例子。
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引用次数: 0
Current practice in intermediate risk differentiated thyroid cancer - a review. 中危分化型甲状腺癌的治疗现状综述。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI: 10.1007/s11154-023-09852-y
Rosalia do Prado Padovani, Fernanda Barbosa Duarte, Camila Nascimento

Although the overall prognosis for differentiated thyroid cancer (DTC) is excellent, a subset of patients will experience disease recurrence or may not respond to standard treatments. In recent years, DTC management has become more personalized in order to enhance treatment efficacy and avoid unnecessary interventions.In this context, major guidelines recommend post-surgery staging to assess the risk of disease persistence, recurrence, and mortality. Consequently, risk stratification becomes pivotal in determining the necessity of postoperative adjuvant therapy, which may include radioiodine therapy (RIT), the degree of TSH suppression, additional imaging studies, and the frequency of follow-up.However, the intermediate risk of recurrence is a highly heterogeneous category that encompasses various risk criteria, often combined, resulting in varying degrees of aggressiveness and a recurrence risk ranging from 5 to 20%. Furthermore, there is not enough long-term prognosis data for these patients. Unlike low- and high-risk DTC, the available literature is contradictory, and there is no consensus regarding adjuvant therapy.We aim to provide an overview of intermediate-risk differentiated thyroid cancer, focusing on criteria to consider when deciding on adjuvant therapy in the current context of personalized approach, including molecular analysis to enhance the accuracy of patient management.

虽然分化型甲状腺癌(DTC)的总体预后很好,但一部分患者会经历疾病复发或可能对标准治疗无效。近年来,为了提高治疗效果,避免不必要的干预,DTC的管理越来越个性化。在这种情况下,主要的指南推荐手术后分期来评估疾病持续、复发和死亡的风险。因此,风险分层在确定术后辅助治疗的必要性时至关重要,辅助治疗可能包括放射性碘治疗(RIT)、TSH抑制程度、额外的影像学检查和随访频率。然而,复发的中度风险是一个高度异质性的类别,包括各种风险标准,通常合并,导致不同程度的侵袭性和复发风险从5%到20%不等。此外,这些患者的长期预后数据不足。与低风险和高风险的DTC不同,现有的文献是矛盾的,关于辅助治疗没有共识。我们的目标是提供一个中等风险分化甲状腺癌的概述,重点是在当前个性化方法的背景下决定辅助治疗时考虑的标准,包括分子分析以提高患者管理的准确性。
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引用次数: 0
Efficacy of antiresorptive agents in fibrous dysplasia and McCune Albright syndrome, a systematic review and meta-analysis. 抗吸收药物治疗纤维发育不良和mcune - Albright综合征的疗效:系统回顾和荟萃分析。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-08-26 DOI: 10.1007/s11154-023-09832-2
Hélios Bertin, Mahmoud S Moussa, Svetlana Komarova

Fibrous dysplasia (FD) is a rare skeletal disorder in which normal bone is replaced by a fibro-osseous tissue, resulting in possible deformities and fractures. The aim of this systematic review and meta-analysis was to synthesize the available evidence on the use of antiresorptive drugs in FD in terms of changes in bone turnover markers (BTMs), bone mineral density (BMD), and reducing pain. Three databases were searched in October 2022, with an update in July 2023. Of the 1037 studies identified, 21 were retained after eligibility assessment. A random-effects model was used to calculate global effect size and the corresponding standard error. Pamidronate and Denosumab were the most reported drugs in a total of 374 patients assessed. The initiation of treatments was accompanied by an average reduction of 40.5% [CI95% -51.6, -29.3] in the bone resorption parameters, and 22.0% [CI95% -31.9, -12.1] in the parameters of bone formation after 6-12 months. BMD was increased in both FD lesions and in the unaffected skeleton. Pain was reduced by 32.7% [CI95% -52.7, -12.6] after 6-12 months of treatment, and by 44.5% [CI95% -65.3, -23.6] after a mean 41.2 months of follow-up. The variation in pain was highly correlated to variation in bone resorption (R2 = 0.08, p < 0.0001) and formation parameters (R2 = 0.17, p < 0.0001). This study supports the overall efficacy of antiresorptive therapies in terms of reducing bone remodeling, improving bone density, and pain in FD.

纤维性发育不良(FD)是一种罕见的骨骼疾病,其中正常骨骼被纤维骨组织取代,导致可能的畸形和骨折。本系统综述和荟萃分析的目的是综合FD中使用抗吸收药物在改变骨转换标志物(BTMs)、骨矿物质密度(BMD)和减轻疼痛方面的现有证据。在2022年10月检索了三个数据库,并在2023年7月进行了更新。在确定的1037项研究中,21项在合格性评估后被保留。采用随机效应模型计算全局效应大小和相应的标准误差。帕米膦酸钠和Denosumab是374例患者中报告最多的药物。治疗开始后6-12个月骨吸收参数平均下降40.5% [CI95% -51.6, -29.3],骨形成参数平均下降22.0% [CI95% -31.9, -12.1]。在FD病变和未受影响的骨骼中,骨密度均增加。治疗6-12个月后疼痛减轻32.7% [CI95% -52.7, -12.6],平均随访41.2个月后疼痛减轻44.5% [CI95% -65.3, -23.6]。疼痛的变化与骨吸收的变化高度相关(R2 = 0.08, p 2 = 0.17, p
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引用次数: 0
Ectopic insulinoma: a systematic review. 异位胰岛素瘤:系统综述。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-07-12 DOI: 10.1007/s11154-023-09824-2
Fernando Guerrero-Pérez, Nuria Vilarrasa, Lidia V Huánuco, Juli Busquets, Lluis Secanella, José L Vercher-Conejero, Noemi Vidal, Silvia Näf Cortés, Carles Villabona

Knowledge of ectopic insulinomas comes from single cases. We performed a systematic review through PubMed, Web of Science, Embase, eLibrary and ScienceDirect of all cases reported in the last four decades. We also describe one unreported patient. From 28 patients with ectopic insulinoma, 78.6% were female and mean age was 55.7 ± 19.2 years. Hypoglycaemia was the first symptom in 85.7% while 14.3% complained of abdominal pain or genital symptoms. Median tumour diameter was 27.5 [15-52.5] mm and it was localised by CT (73.1%), MRI (88.9%), [68Ga]Ga-DOTA-exedin-4 PET/CT (100%), 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC (100%), somatostatin receptor scintigraphy (40%) and endoscopic ultrasound (50%). Ectopic insulinomas were located at duodenum (n = 3), jejunum (n = 2), and one respectively at stomach, liver, appendix, rectum, mesentery, ligament of Treitz, gastrosplenic ligament, hepatoduodenal ligament and splenic hilum. Seven insulinomas were affecting the female reproductive organs: ovary (n = 5), cervix (n = 2) and remaining tumours were at retroperitoneum (n = 3), kidney (n = 2), spleen (n = 1) and pelvis (n = 1). 89.3% underwent surgery (66.7% surgery vs. 33.3% laparoscopy) and 16% underwent an ineffective pancreatectomy. 85.7% had localized disease at diagnosis and 14.3% developed distant metastasis. Median follow-up time was 14.5 [4.5-35.5] months and mortality was reported in 28.6% with median time until death of 60 [5-144] months. In conclusion, ectopic insulinomas are presented as hypoglycaemia with female preponderance. Functional imaging [68Ga]Ga-DOTA-exedin-4 PET/CT and 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC have very high sensitivity. Clinicians should be alert to the possibility of extra-pancreatic insulinomas when classic diagnostic tests and intraoperative pancreas exploration failed to locate the tumour.

异位胰岛素瘤的知识来自单个病例。我们通过PubMed、Web of Science、Embase、library和ScienceDirect对过去40年报告的所有病例进行了系统回顾。我们还描述了一个未报告的病人。28例异位胰岛素瘤患者中,78.6%为女性,平均年龄55.7±19.2岁。85.7%的患者以低血糖为首发症状,14.3%的患者主诉腹痛或生殖器症状。肿瘤中位直径为27.5 [15-52.5]mm,通过CT(73.1%)、MRI(88.9%)、[68Ga]Ga-DOTA-exedin-4 PET/CT(100%)、68Ga标记- dota -共轭生长抑素类似物PET/TC(100%)、生长抑素受体显像(40%)和内镜超声(50%)进行定位。异位胰岛素瘤分别位于十二指肠(3例)、空肠(2例)和胃、肝、阑尾、直肠、肠系膜、Treitz韧带、胃脾韧带、肝十二指肠韧带和脾门各1例。7例胰岛素瘤累及女性生殖器官:卵巢(n = 5)、子宫颈(n = 2),其余肿瘤位于腹膜后(n = 3)、肾脏(n = 2)、脾脏(n = 1)和骨盆(n = 1)。89.3%行手术(66.7%手术vs 33.3%腹腔镜),16%行无效胰切除术。85.7%诊断时有局限性病变,14.3%有远处转移。中位随访时间为14.5[4.5 ~ 35.5]个月,死亡率为28.6%,中位至死亡时间为60[5 ~ 144]个月。总之,异位胰岛素瘤表现为低血糖,女性居多。功能成像[68Ga]Ga-DOTA-exedin-4 PET/CT和68Ga标记的dota -共轭生长抑素类似物PET/TC具有非常高的灵敏度。当经典诊断检查和术中胰腺探查未能定位肿瘤时,临床医生应警惕胰腺外胰岛素瘤的可能性。
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引用次数: 0
Drug-induced hyperinsulinemic hypoglycemia: An update on pathophysiology and treatment. 药物性高胰岛素性低血糖:病理生理学和治疗的最新进展。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-08-08 DOI: 10.1007/s11154-023-09828-y
Evelina Maines, Silvana Anna Maria Urru, Letizia Leonardi, Elisabetta Fancellu, Annalisa Campomori, Giovanni Piccoli, Arianna Maiorana, Massimo Soffiati, Roberto Franceschi

The initial step for the differential diagnosis of hypoglycemia is to determine whether it is hyperinsulinemic or non hyperinsulinemic. Existing literature discusses drug-related hypoglycemia, but it misses a focus on drug-induced hyperinsulinemic hypoglycemia (DHH). Here we reviewed the association existing between drugs and hyperinsulinemic hypoglycemia. We primarily selected on the main electronic databases (MEDLINE, EMBASE, Web of Science, and SCOPUS) the reviews on drug-induced hypoglycemia. Among the drugs listed in the reviews, we selected the ones linked to an increase in insulin secretion. For the drugs missing a clear association with insulin secretion, we investigated the putative mechanism underlying hypoglycemia referring to the original papers. Our review provides a list of the most common agents associated with hyperinsulinemic hypoglycemia (HH), in order to facilitate both the recognition and the prevention of DHH. We also collected data about the responsiveness of DHH to diazoxide or octreotide.

低血糖鉴别诊断的第一步是确定是高胰岛素血症还是非高胰岛素血症。现有文献讨论了药物相关性低血糖,但对药物性高胰岛素性低血糖(DHH)缺乏关注。本文综述了药物与高胰岛素性低血糖之间的关系。我们主要从主要的电子数据库(MEDLINE, EMBASE, Web of Science, SCOPUS)中选择有关药物性低血糖的综述。在综述中列出的药物中,我们选择了与胰岛素分泌增加有关的药物。对于与胰岛素分泌缺乏明确关联的药物,我们参考原始文献对低血糖的可能机制进行了研究。我们的综述提供了与高胰岛素性低血糖(HH)相关的最常见药物清单,以促进DHH的识别和预防。我们还收集了DHH对二氮唑或奥曲肽的反应性数据。
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引用次数: 0
Non-alcoholic fatty liver disease and gut microbial dysbiosis- underlying mechanisms and gut microbiota mediated treatment strategies. 非酒精性脂肪肝和肠道微生物失调——潜在机制和肠道微生物群介导的治疗策略。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-10-16 DOI: 10.1007/s11154-023-09843-z
Muthukumaran Jayachandran, Shen Qu

Non-alcoholic fatty liver disease (NAFLD) is by far the most prevalent form of liver disease worldwide. It's also the leading cause of liver-related hospitalizations and deaths. Furthermore, there is a link between obesity and NAFLD risk. A projected 25% of the world's population grieves from NAFLD, making it the most common chronic liver disorder. Several factors, such as obesity, oxidative stress, and insulin resistance, typically accompany NAFLD. Weight loss, lipid-lowering agents, thiazolidinediones, and metformin help prominently control NAFLD. Interestingly, pre-clinical studies demonstrate gut microbiota's potential causal role in NAFLD. Increased intestinal permeability and unhindered transport of microbial metabolites into the liver are the major disruptions due to gut microbiome dysbiosis, contributing to the development of NAFLD by dysregulating the gut-liver axis. Hence, altering the pathogenic bacterial population using probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) could benefit patients with NAFLD. Therefore, it is crucial to acknowledge the importance of microbiota-mediated therapeutic approaches for NAFLD and comprehend the underlying mechanisms that establish a connection between NAFLD and gut microbiota. This review provides a comprehensive overview of the affiliation between dysbiosis of gut microbiota and the progress of NAFLD, as well as the potential benefits of prebiotic, probiotic, synbiotic supplementation, and FMT in obese individuals with NAFLD.

非酒精性脂肪肝(NAFLD)是迄今为止世界范围内最常见的肝病形式。它也是肝脏相关住院和死亡的主要原因。此外,肥胖与NAFLD风险之间存在联系。预计全球25%的人口因非酒精性肝病而悲伤,使其成为最常见的慢性肝病。一些因素,如肥胖、氧化应激和胰岛素抵抗,通常伴随NAFLD。减肥、降脂药、噻唑烷二酮和二甲双胍有助于显著控制NAFLD。有趣的是,临床前研究证明了肠道微生物群在NAFLD中的潜在因果作用。肠道通透性增加和微生物代谢产物不受阻碍地运输到肝脏是肠道微生物组失调造成的主要破坏,通过失调肠肝轴导致NAFLD的发展。因此,使用益生菌、益生元、合生元和粪便微生物群移植(FMT)改变病原菌群可能有利于NAFLD患者。因此,至关重要的是要认识到微生物群介导的NAFLD治疗方法的重要性,并理解在NAFLD和肠道微生物群之间建立联系的潜在机制。这篇综述全面概述了肠道微生物群失调与NAFLD进展之间的关系,以及益生元、益生菌、合生元补充剂和FMT对患有NAFLD的肥胖个体的潜在益处。
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引用次数: 0
Postprandial plasma GLP-1 levels are elevated in individuals with postprandial hypoglycaemia following Roux-en-Y gastric bypass - a systematic review. 一项系统综述:Roux-en-Y胃旁路治疗后餐后低血糖患者餐后血浆GLP-1水平升高。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-07-13 DOI: 10.1007/s11154-023-09823-3
Ryan Joseph Jalleh, Mahesh Michael Umapathysivam, Mark Philip Plummer, Adam Deane, Karen Louise Jones, Michael Horowitz

Background and aims: Bariatric surgery is the most effective treatment in individuals with obesity to achieve remission of type 2 diabetes. Post-bariatric surgery hypoglycaemia occurs frequently, and management remains suboptimal, because of a poor understanding of the underlying pathophysiology. The glucoregulatory hormone responses to nutrients in individuals with and without post-bariatric surgery hypoglycaemia have not been systematically examined.

Materials and methods: The study protocol was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science and the Cochrane databases were searched for publications between January 1990 and November 2021 using MeSH terms related to post-bariatric surgery hypoglycaemia. Studies were included if they evaluated individuals with post-bariatric surgery hypoglycaemia and included measurements of plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, C-peptide and/or glucagon concentrations following an ingested nutrient load. Glycated haemoglobin (HbA1c) was also evaluated. A random-effects meta-analysis was performed, and Hedges' g (standardised mean difference) and 95% confidence intervals were reported for all outcomes where sufficient studies were available. The τ2 estimate and I2 statistic were used as tests for heterogeneity and a funnel plot with the Egger regression-based test was used to evaluate for publication bias.

Results: From 377 identified publications, 12 were included in the analysis. In all 12 studies, the type of bariatric surgery was Roux-en-Y gastric bypass (RYGB). Comparing individuals with and without post-bariatric surgery hypoglycaemia following an ingested nutrient load, the standardised mean difference in peak GLP-1 was 0.57 (95% CI, 0.32, 0.82), peak GIP 0.05 (-0.26, 0.36), peak insulin 0.84 (0.44, 1.23), peak C-peptide 0.69 (0.28, 1.1) and peak glucagon 0.05 (-0.26, 0.36). HbA1c was less in individuals with hypoglycaemia - 0.40 (-0.67, -0.12). There was no evidence of substantial heterogeneity in any outcome except for peak insulin: τ2 = 0.2, I2 = 54.3. No publication bias was evident.

Conclusion: Following RYGB, postprandial peak plasma GLP-1, insulin and C-peptide concentrations are greater in individuals with post-bariatric surgery hypoglycaemia, while HbA1c is less. These observations support the concept that antagonism of GLP-1 would prove beneficial in the management of individuals with hypoglycaemia following RYGB.PROSPERO Registration Number: CRD42021287515.

背景和目的:减肥手术是肥胖患者缓解2型糖尿病最有效的治疗方法。减肥手术后低血糖经常发生,由于对潜在病理生理的了解不足,治疗仍然不够理想。在有或没有减肥手术后低血糖的个体中,血糖调节激素对营养的反应尚未被系统地研究过。材料和方法:研究方案在PROSPERO前瞻性注册。在PubMed、EMBASE、Web of Science和Cochrane数据库中检索1990年1月至2021年11月期间发表的与减肥手术后低血糖相关的MeSH术语。如果研究评估了减肥手术后低血糖患者,并测量了摄入营养负荷后血浆胰高血糖素样肽-1 (GLP-1)、葡萄糖依赖性胰岛素性多肽(GIP)、胰岛素、c肽和/或胰高血糖素浓度,则纳入研究。糖化血红蛋白(HbA1c)也被评估。进行了随机效应荟萃分析,在有足够研究的情况下,报告了所有结果的Hedges' g(标准化平均差)和95%置信区间。使用τ2估计和I2统计量作为异质性检验,并使用基于Egger回归检验的漏斗图来评估发表偏倚。结果:从377篇确定的出版物中,12篇被纳入分析。在所有12项研究中,减肥手术的类型都是Roux-en-Y胃旁路手术(RYGB)。在摄入营养负荷后,比较有和没有减肥手术后低血糖的个体,GLP-1峰的标准化平均差异为0.57 (95% CI, 0.32, 0.82), GIP峰0.05(-0.26,0.36),胰岛素峰0.84 (0.44,1.23),c肽峰0.69(0.28,1.1)和胰高血糖素峰0.05(-0.26,0.36)。低血糖患者的HbA1c较低,为0.40(-0.67,-0.12)。除胰岛素峰值τ2 = 0.2, I2 = 54.3外,其他结果均无显著异质性。没有明显的发表偏倚。结论:RYGB后,减肥手术后低血糖患者餐后血浆GLP-1、胰岛素和c肽浓度峰值较高,而HbA1c较低。这些观察结果支持了GLP-1拮抗剂将被证明对RYGB后低血糖患者的管理有益的概念。普洛斯彼罗注册号:CRD42021287515。
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Reviews in Endocrine & Metabolic Disorders
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