Ho fokotsa bongata ba dopamine mofuta oa 2 receptor ka mor'a opereishene ea bariatric: liphuputso tsa pele (2010)

Resin ea Boko. 2010 Sep 2; 1350: 123-30. Doi: 10.1016 / j.brainres.2010.03.064. Epub 2010 Mar 31.

Dunn JP, Cowan RL, Volkow ND, Mohiri oa ID, Li R, Williams DB, Kessler RM, Abumrad NN.

mohloli o moholo

Lefapha la Bongaka, Sekolo sa Bongaka sa Vanderbilt University of Medicine, Nashville, TN 37232, USA. [imeile e sirelelitsoe]

inahaneloang

LITLHAHISO:

Dopaminergic neurotransication e khethiloeng e thusa ho fokotsa moputso le boits'oaro bo bobe ba ho ja ka botenya. Ho buoa ka Bariatric ke kalafo e sebetsang ka ho fetisisa bakeng sa botenya mme ka potlako e fokotsa tlala le ho ntlafatsa satiety ka mekhoa e sa tsejoeng. Re ile ra kholoa hore dopaminergic neurotransication e tla ntlafatsoa kamora ho buuoa ka Roux-en-Y-Gastric Bypass (RYGB) le Vertical Sleeve Gastrectomy (VSG) le hore liphetoho tsena li ka susumetsa boits'oaro ba ho ja le ho kenya letsoho liphellong tse ntle tse tsoang ho ts'ebetso ea bongaka ea bariatric.

LITLHAHISO:

Basali ba bahlano ba nang le botenya ba ile ba ithutoa ka tšebeliso le ka nako ea libeke tsa 7 kamora ho buuoa ka RYGB kapa VSG. Dithuto tse tlasa monahanong oa positron emission tomography (PET) e nang le mofuta oa dopamine 2 (DA D2) recolor radioligand eo ho tlama ha eona ho amehang tlholisano le dopamine ea morao-rao. Melao ea lithahasello (ROI) e amanang le boits'oaro ba ho ja e ile ea hlalosoa. Lihormone tsa enteroendocrine tse potlakileng li ile tsa aroloa ka nako e 'ngoe le e' ngoe.

LIKOTSO:

Boima ba 'mele bo ile ba fokotseha joalo ka ha ho ne ho lebeletsoe ka mor'a ho buuoa. Ho fumaneha ha li-receptor tsa DA D2 ho fokotsehile kamora ho buuoa. Ho fokotseha ha tikoloho (ho bolela +/- SEM) e ne e le caudate 10 +/- 3%, putamen 9 +/- 4%, ventral striatum 8 +/- 4%, hypothalamus 9 +/- 3%, substantia nigra 10 +/-NNUMX / XLUMX / 2 / 8 / 2 -9%, le amygdala 3 +/- 62%. Tsena li ne li tsamaisana le ho fokotseha hoa bohlokoa ho plasma insulin (41%) le leptin (XNUMX%).

QETELLO:

Ho fokotseha ha ho fumaneha ha li-receptor tsa DA D2 kamora RYGB le VSG haholo ho bonts'a ho eketseha ha maemo a dopamine a extracellular. Matlafatso ea dopaminergic neurotransication e ka kenya letsoho ho ntlafatseng boitsoaro ba ho ja (mohlala, ho fokotsa tlala le ho ntlafala ha satiety) kamora mekhoa ena ea bariatric.

 

Keywords: dopamine, botenya, ho buuoa ka bariatric, receptor
Eya ho:

1. Selelekela

Ho buoa bakariatric ke kalafo e sebetsang ka ho fetisisa bakeng sa botena. Ho fokotsa boima ba 'mele ka katleho ka lebaka la ho buuoa ho baka ntlafatso e kholo litlamong tsa' mele 'me ho fokotsa lefu (Sjostrom et al., 2007). Sena se fapane le mekhoa ea bongaka e teng e sa sebetseng hantle (Sjostrom et al., 2004). RYGB ke ts'ebetso e atileng haholo ea ho theola boima ba 'mele e etsoang United States (Santry et al., 2005). RYGB e fella ka tahlehelo ea boima ba 'mele ea 60% (Buchwald et al., 2009), mme boholo ba tahlehelo ea boima ba 'mele bo bolokoa nako e telele (Sjostrom et al., 2007). Boholo ba katleho ea RYGB e utloahala e le ka lebaka la phokotso e potlakileng ea phepelo ea lijo e lulang e le maemong a ts'ebetso ea nako e telele (Sjostrom et al., 2004). Morinigo et al a. e tlalehile hore libekeng tsa 6 kamora RYGB, tlala ea fokotseha le ho ikoetlisa ho ntlafala le ha boima ba mmele bo ntse bo tsoela pele (Morinigo et al., 2006). Ts'ebetso ea bongaka ea vertical sleeve gastondolaomy (VSG), e lebisang tahlehelo ea boima ba 'mele le ho fokotsa tlala le ho ntlafatsa satiety e ts'oanang le RYGB (Karamanakos et al., 2008b), e ntse e etsoa ka sekhahla se ntseng se eketseha sa botenya bo hatetseng pele (Iannelli et al., 2008). Mekhoa eo lits'ebetso tsena li ntlafatsang tlala le ho tsofala ha e tsebahale haholo.

Dopaminergic neurotransication e bapala karolo ea bohlokoa ho susumetseng boits'oaro ba takatso ea lijo le ho matlafatseng takatso ea lijo e khothalletsang takatso ea ho ja ho feta litlhoko tsa phepo e nepahetseng (Volkow et al., 2008). Dopamine (DA) e fana ka tšusumetso ea takatso ea lijo le litoeba tsa litoeba tse sa kopaneng DA li bolaoa ke tlala ntle le ha DA e khutlisoa ka har'a dorsal striatum (Szczypka et al., 2001). Wang et al a. o sebelisitse monahano oa PET ka mofuta oa dopamine D2/ D3 (DA D2) radioligand ea ho lekanya ho fumaneha ha li-receptor tsa DA D2 lihloohong tse nang le botenya bo feteletseng (BMI> 40 kg / m2). Ba bonts'itse phokotso ho fumaneha ha li-receptor tsa DA D2 ho striatum (Wang et al., 2001a), joalo ka seo ba se boneng lithutong tse ngata tsa bokhoba ba lithethefatsi (Volkow et al., 1999). Mefuta e fapa-fapaneng ea liphoofolo e tšehetsa li-receptor tsa DA D2 tse fokotsehileng tsa botenyaHamdi et al., 1992; Huang et al., 2006). Li-receptor tse theotsoeng tsa striatal DA D2 boteng le bokhobeng li utloahala li baka ho fokotseha ha methapo ea kutlo ea dopaminergic le ho utloa moputso, 'me li lebisa boitshwarong bo tlatselletsang ba ho ja lijo tse matla kapa ho hlekefetsoa.

Re ikemiselitse ho leka hypothesis hore dopaminergic neurotransication e ntlafala likhoeling tsa pele kamora ho buuoa ka RYGB le VSG bakeng sa kalafo ea botena, ho kenya letsoho meputsong e kholo ea meputso le boits'oaro bo ntlafalitsoeng ba ho ja. Ho utloisisa mokhoa oa ho ja lijo tse ntlafalitsoeng ka mor'a mekhoa e atlehileng ea bariatric qetellong ho tla tšehetsa tsoelo-pele mekhoeng e mecha ea phekolo ea ho phekola botena.

Eya ho:

2. Liphetho

Basali ba bahlano (46 ± 2 ea lilemo li) le boima ba mantlha ba 118 ± 6kg le index ea mmele ea boima (BMI) ea 43 ± 3 kg / m2 ba ithutile ka tšebeliso ea pele le ka mora ho sebetsa (Lethathamo 1). Lethathamo 1 Lintlha tse mabapi le palo ea batho le tsa nalane ea bongaka e nepahetseng. Thutong ea postoperative, ho fokotsa boima ba 'mele e ne e le 14 ± 1 kg, kapa 12 ± 1% ea boima ba' mele ba mantlha, e bakileng phokotso e kholo ea BMI ho 38 ± 3 kg / m2 (ka bobeli p = 0.043). Beck Depression Inventory-II (BDI) e ile ea phethoa ka ts'ebetso le ka morao ho ts'ebeliso e ngata ea 2 ± 1 le 1 N 1 (p = 0.882), ka ho latellana. Pele le ka mor'a ho buuoa, sekhahla sa ho itlopa lijo (Sjostrom et al.) E ne e le lintlha tsa 11 ± 3 le 3 ± 2 (p = 0.109), ka ho latellana.

Lethathamo 1

taba ea Demographics le nalane ea bongaka

Liteko tse phetoang khafetsa tsa phapang li bontšitse ha ho litlamorao tse kholo tsa ho latela morao (lehlakoreng le letšehali kapa ka lehlakoreng le letona) kapa ts'ebetso ea bongaka (pre- vs. postoperative) ka ho sebelisana ha morao (all p≥0.152); ka hona, lintlha tse tsoang libakeng tse ka letsohong le letona le le letšehali li kenyellelitsoe tlhahlobisong e ngoe le e ngoe ea ROI. Ka kakaretso phumano ea li-receptor tsa DA ka kakaretso e fokotsehile ka ts'ebeliso ea batho ka bomong, joalo ka ha ho bonts'itsoe ho Lethathamo 2, le bakeng sa sehlopha, joalo ka ha ho bonts'itsoe Lethathamo 3. Ho bile le phokotseho e kholo ea bokhoni bo tlamang (BP)ND) ho substantia nigra (Setšoantšo sa 1) ha e khalemeloa ho bapisoa ka makhetlo a mangata, 'me ho fokotseha ho ne ho le bohlokoa ho caudate, hypothalamus, medial thalamus le amygdalae ha p-boleng li ne li sa lokisoe bakeng sa papiso e ngata (Lethathamo 3).

Setšoantšo sa 1Setšoantšo sa 1

Boloi [18F] fallypride parameetric litšoantšo tsa BPND maemong a substantia nigra (a) pele le (b) 7 libeke kamora ho buuoa ka bariatric.
Lethathamo 2

liphesente li fetoha ka tikoloho kapa phaello bakeng sa batho ka bomong ho tloha ts'ebetsong ho ea ho opereishene ea bariatric.
Lethathamo 3

Potoloho ea Regional Binding Potential (bolelang ± SEM) le kamora ts'ebetso ea bongaka ea bariatric bakeng sa sehlopha, liperesente tse bolelang ho fokotseha kamora ts'ebetso ea bongaka, le boemo ba bohlokoa ka liteko tsa ba babeli le Wilcoxon litlhahlobo tse tekenneng maemong a botsoali.

Mehlala e ile ea bokelloa bakeng sa li-hormone tsa ho itima lijo pele ho scan e 'ngoe le e' ngoe. Lithuto tse peli, e ngoe e le ea mantlha le e 'ngoe ea postoperative ha ea ka ea potlakela ho qeta lihora tsohle tsa 8 pele ho PET scan. Lintlha tsa Hormone tsa lithuto tsena tsa 2 ha lia ka tsa kenyelletsoa tlhahlobisong, e ileng ea fella ka matla a fokotsehileng a lipalo bakeng sa liteko tsena. Ha rea ​​ka ra leboha hore ho khutsufatsoa ho potlakileng ka linako tsena tsa 2 ho susumetse sephetho sa monahano. Lithutong tsa 3 tse nang le data ea paired, maemo a insulin a ne a fokotsehile ho tloha 34 ± 7 microU / ml pele ho ts'ebetso ea opereishene ho ea 13 ± 1 MicroU / ml (p = 0.109) kamora ho buuoa. Mekha ea Leptin e boetse e fokotsehile ka ho buuoa, ho tloha 51 ± 7 ng / ml ho 39 ± 11 ng / ml (p = 0.109). Ha ho na phetoho maemong ohle a ghrelin (637 ± 248 vs. 588 ± 140 pg / ml, p = 1.0).

Eya ho:

3. Puisano

Ho fumaneha ha li-receptor tsa DA D2 ho ile ha fokotseha libekeng tsa 7 kamora ho buuoa ka bariatric libakeng tse ngata tse maleba bakeng sa boits'oaro ba ho ja. Re fetolela phumaneho ea receptor ea DA D2 e fokotsehileng ho emela maemo a eketsehang a kantle ho DA a tlholisano le radioligand. Boemo ba ho fokotseha ha phumaneho ea li-receptor tsa DA D2 tse bonoang thutong ena li ka bapisoa le lithuto tse ling moo re sebelisitseng li-pharmacologic ho eketsa maemo a DA a kantle ho naha (Riccardi et al., 2006). Wang et al a. e senotse hore boteng ba batho ba DA D2 receptor e fokotsehile (Wang et al., 2001b), e lumellanang le lithuto tsa preclinical tse bonts'ang maemo a tlase a li-receptor tsa D2 tsa DA maemong a phetseng hantle a botenya (Hamdi et al., 1992; Huang et al., 2006). Mefuta e metle ea botenya e boetse e fane ka bopaki ba ho theoha ha DA ho fokotsehile (Thanos et al., 2008), leha ho fumaneha hona ha hoa ka ha tiisoa hore ke botena ba batho. Tlhaloso e 'ngoe ea data ea rona ke hore maemo a li-receptor a DA D2 a fokotseha kamora ho buuoa hoo ho ka lebelloang ho ba le phello e mpe boitshwarong ba takatso ea lijo le takatso ea lijo mme o se lumellane le liphetoho tsa kliniki tse bonoang kamora ho buuoa. Lintlafatso litloaelo tsa boits'oaro bo latelang RYGB le ts'ebetso ea VSG li hlalosoa hamolemo ke keketseho ea maemo a DA a tla bonahala ka ho fokotseha ha phihlello ea receptor ea DA.

Satiety e ntlafatsoa kamora RYGB le VSG leha ho fokotsoe boholo ba lijo (Morinigo et al., 2006) (Karamanakos et al., 2008b). Ts'ehetso ea rona ea data e eketsehile maemo a DA ho hypothalamus, e leng sebaka sa bohlokoa taolong ea takatso ea takatso ea lijo, e ka amehang ntlafatsong ena kamora ho buuoa. Litlhotong, ho kenella ha DA sebakeng sa hypothalamic ho etsa hore lijo li fokotsehe ka boholo ba lijo tse fokotsitsoeng (Yang et al., 1997) mohlomong ka ho susumetsa ho satiety pejana. Hypothalamus e fumana tlhahiso ea dopaminergic e khothalletsang boits'oaro ba ho ja ho tloha hoantiantia nigra (Bosoeu, 1986), e leng ROI moo re boneng phetoho e kholo le e kholo ea lipalo. Substantia nigra dopamine neuronal ketso hape e bohlokoa bakeng sa lits'ebetso tsa moputso tsa dorsal striatum (putamen le caudate) (Nakazato, 2005). U sebelisa litšoantšo tsa PET, tse Nyane et al a. e bontšitse hore boemo ba lijo bo khothalletsoang ho lokolloa ha DA ka dorsal striatum bo amana hantle le litlaleho tsa boithati tsa ho natefeloa ke lijo (Tse nyenyane le al., 2003). Ho eketsa thabo ea lijo ho ka bapala karolo ea hore bakuli ba etse liphetoho tse potlakileng le tse makatsang mekhoeng ea bona ea ho ja ka mor'a ho buuoa.

Re boetse re bontsitse ho fokotseha ha phihlello ea receptor ea DA D2 ho amygdala, sebaka sa boko se fanang ka boleng ba maikutlo ho khothaletso e khotsofatsang, mme mmoho le striatum le preortal cortex li bapala karolo ea bohlokoa maemong a maemo (Grimm le See, 2000). Li-amygdala le ventral striatum, hammoho le medial thalamus (mme mohlomong le nantigia e kholo), li hlahisoa ka mokhoa o ikhethileng ke litekanyetso tsa lijo le tebello ea lijo ha e bapisoa le risiti ea 'nete ea lijo (Tse nyenyane le al., 2008). Ho bona hore DA e eketseha libakeng tse ngata tsa boko tse sebetsoang ke menyetla ea lijo le tebello e matlafatsang kutloisiso ea rona ea hore na tikoloho ea rona e teng hona joale e nang le mekhoa e mengata ea lijo le ho pepesa boitšoaro bo bobe ho bakuli ba bangata. Keketseho ea maemo a DA eo re e hlokometseng, e kanna ea bonts'a keketseho ea tšebetso ea DA ea tonic, e sebeletsa ho fumana keketseho ea DA ea phasic e amanang le ho pepeseha pheko ea lijo e bakang takatso ea lijo (Volkow et al., 2002). Ha ho kopanngoa hammoho, maemo a eketsehang a DA libakeng tse amehang tebello ea lijo a ka bapala karolo ea ho theola litakatso tsa lijo kamora ho buuoa ka bariatric.

Joalokaha ho tlalehiloe ke ba bang (Faraj et al., 2003), re hlokometse hore insulin le leptin li fokotseha kamora ho buuoa ka bariatric. Re beha taba ea hore liphetoho tsena tsa lihormone li ka thusa ho fetoheng ha ho buuoa ka dopaminergic kamora ho buuoa. Lithutong tsa pele ho lijo, ho ja lijo tse lekanyelitsoeng ho eketsa maemo a DA le ho fokotsa insulin le leptin (Thanos et al., 2008), hape e ntlafatsa boits'oaro bo amanang le moputso. Dopaminergic neurons li na le insulin le leptin (Figlewicz et al., 2003) li-receptors, le kalafo ka insulin le leptin e hatella boits'oaro bo amanang le moputso (Figlewicz le Benoit, 2009). Insulin e eketsa tšebetso ea morekisi oa dopamine (Figlewicz le Benoit, 2009), ka hona, maemo a phahameng a insulin (joalo ka botenya) a ka lebelloa ho lebisa ho fokotseha ha maemo a DA ho tsoa tekong e ntlafalitsoeng ea dopamine ho ea lefapheng. Phokotso ho plasma leptin kamora ho buuoa ka bariatric le eona e kanna ea kenya letsoho maemong a phahameng a DA. Ho fetola litoeba tsa monokotšoai ho tloha ho mafura a mangata ho ea ho lijo tse mafura a tlase ho fokotseha maemo a plasma leptin le ho eketsa tyrosine hydroxylase (TH, sekhahla se fokotsang enzyme ka dopamine synthesis) polelo ea mRNA sebakeng sa ventral tegmental le theigantia nigra (Li et al., 2009). Leptin e fokotsa ho thunya ha dopaminergic neurons (Hommel et al., 2006), ho hlahisa mochine o mong o ka bang teng mabapi le hore na maemo a DA a ka nyoloha joang kamora ho buuoa ka bariatric.

Ho bohlokoa ho hlokomela hore tlaleho ea rona e fapana le tlhahlobo e le 'ngoe feela e tlalehang DA D2 receptor fumaneha ea post-RYGB (Steele et al., 2009). Steele et al a. e tlalehile keketseho e seng bohlokoa bakeng sa ho fumaneha ha li-receptor tsa DA D2 libeke tsa 6 kamora RYGB ho basali ba bahlano ba nang le BMI e tšoanang ea ts'ebetso le ho theola boima ba 'mele. Phapang e 'maloa ea bohlokoa e teng lipakeng tsa tlaleho ea rona le ea bona. Steele et al a. o sebelisitse radioligand ea DA D2 [11C] raclopride, ha re ntse re sebelisa [18F] fallypride. Ts'ebeliso ea li-radioligand tse fapaneng ha e utloe e kenya letsoho ho arohaneng ha liphetho kaha lingoliloeng li hlahisa liphetho tse tšoanang le [11C] moralo oa leqhubu (Martinez et al., 2003) le [18F] fallypride (Mark et al., 2004; Riccardi et al., 2006) ka li-ROI tse bapisoang. Metsoalle ea batho bao re tloaetseng ho phela le bona ke lilemo tsa 14 tse telele ho feta Steele et al a mme sena se kanna sa susumetsa karabelo ea dopaminergic. Kaha estrogen le progesterone, tse fokotsehang haholo lilemong tse mahareng, li amahantsoe le lithuto tsa preclinical le polelo ea li-receptor tsa DA 2 le ts'ebetso ho ka etsahala hore liphapang tsa lilemo li kenyelelitse phapang liphumantsong lipakeng tsa lithuto tsena ka bobeli (Bazzett le Becker, 1994) (Febo et al., 2003).

Re ikutloa hore phapano e loketseng lipakeng tsa sehlopha sa rona le sa Steele ke hore bafo ba bona ba ne ba e-na le lintlha tse phahameng tsa ts'ebetso ea BDI tse ileng tsa fokotseha haholo ka ts'ebeliso. Ka lehlakoreng le leng lithuto tsa rona li ne li e-na le lintlha tse tlase tsa BDI tse sa fetoheng kamora ho buuoa. Ha a ntse a moo ho na le lintlha tse ngata tsa BDI ho Steel et al a. li ne li le maemong a bobebe 'me li sa tsamaellane le tlhahlobo ea bongaka ea khatello ea maikutlo, ho ka etsahala hore khatello ea maikutlo e sa le pele e ka ba e ferekanyang. Ho sithabela maikutlo ke boemo ba dopaminergic neurotransication (e fokotsang)Dunlop le Nemeroff, 2007); leha ho le joalo, kamano ea DA D2 receptors ea khatello ea maikutlo ha e hlake. Boithuto ba ho khopisa bo hanyetsana 'me tse ling tsa likhohlano li ka hlaha ho tsoa mehlaleng e fapaneng e sebelisitsoeng (D'Haenen H le Bossuyt, 1994; Hirvonen et al., 2008). Ho feta moo, melaoana ea maemo a DA ea kantle ho naha e ka fetoloa ka khatello ea maikutlo (Meyer et al., 2001) hape e ka susumetsa phumano ea li-receptor tsa DA D2. Ho tseba hore khatello ea maikutlo e ka ntlafala kamora ho buuoa ka bariatric (Bocchieri et al., 2002), ha re kenyetse lihlooho tse nang le ngongoreho efe kapa efe bakeng sa lefu la preclinical mme re fuoe lintlha tse tlase haholo le tsa morao-rao tse amanang le khatello ea maikutlo ka hara sehlopha sa rona, liphetoho tsa khatello ea maikutlo ha li utloe li amme litholoana tsa rona.

Ka bobeli lithuto tsena li ne li lekanyelitsoe ka mohlala oa mohlala. Re fumane ho pheta mosebetsi ho le boima ka lebaka la ho ata ha batho ba bariatric ho ata haholo hoa mafu a metabolic le a kelello le ts'ebeliso ea bona e tloaelehileng ea lingaka tse bohareng.Sears et al., 2008). Qobello e 'ngoe ke hore ha rea ​​ka ra hakanya maemo a DA ka kotloloho.Riccardi et al., 2007). Mekhoa ea ho hakanyetsa maemo a DA a tsoang kantle ho naha a hloka ho pepesetsoa mahlaseli a kotsi mme re khethile ho nka mokhoa oa ho boloka lintho ka thuto ena ea pele. Re tšoantšitse bakuli ba bang ba RYGB le mokuli a le mong oa VSG ea ntseng a eketseha heterogeneity. VSG e ntse e eketseha ka bongata 'me e na le ntlafatso e ts'oanang le takatso ea lijo joaloka RYGB; ka hona re ile ra utloa eka ke monyetla oa bohlokoa oa ho nahana ka mokuli ea etsang ts'ebetso ena. Ho khahlisang, liphetoho tse fumanehang ho DA D2 receptor li ne li tšoana kamora VSG (Lethathamo 2, sehlooho sa 3) ha se bapisoa le RYGB le liphetoho tsa pele tsa lihormone tse ling tsa enteroendocrine tse susumetsang dopaminergic neurotransuction li ne li tšoana kamora lits'ebetso ka bobeli (Peterli et al., 2009) (Karamanakos et al., 2008a). Leha ho le joalo, lits'ebetso tsena tse peli li fapane mme re nka linomoro tsa rona tse nyane tseo re nkang seo re se fumaneng e le sa pele. Mosebetsi oa nako e tlang le sehlopha se seholo sa kokelo ho kenyeletsoa papiso e tsoetseng pele ea mekhoa e fapaneng ea bariatric ea hlokahala.

Ka kakaretso, re bonts'a hore kamora ho buoa ha li-bariatric DA D2 fumaneha ea receptor e fokotseha libakeng tse ngata tsa boko tse amanang le boits'oaro ba ho ja le ho fetolela sena e le maemo a DA a ntseng a eketseha. Maemo a ntseng a eketseha a DA a ka lebelloa ho ba le tšusumetso e ntle moputsong mme a ka kenya letsoho mekhoeng e ntlafalitsoeng ea ho ja e etsahalang kamora ts'ebetso ea RYGB le VSG. Lihormone tse ngata tsa enteroendocrine li susumetsa dopaminergic neurotransication mme li fetoloa ke lingaka tsa bariatric. Boithuto ba nako e tlang bo reretsoe ho etsa lipatlisiso mabapi le karolo ea dopaminergic neurotransmission mabapi le melemo ea ho buuoa ka bariatric le hore na liphetoho tsa ho buuoa ka enteroendocrine li bohlokoa. Kutloisiso e eketsehileng mabapi le hore na dopaminergic neurotransuction e ntlafatsa joang ka mor'a ho buuoa ka bariatric e tla etsa hore ho be le mekhoa e metle ea ho phekola botenya.

Eya ho:

4. Tsamaiso ea liteko

Lintho tsa 4.1

Tumello ea Protocol e fumanoe ho Boto ea Tlhatlhobo ea Setheo sa Vanderbilt University mme bankakarolo bohle ba fane ka tumello e ngotsoeng e nang le tsebo. Basali ba bahlano (3 ka letsohong le letona, 2 ka letsohong le letšehali) ba nang le BMI ea pele ho ts'ebetso> 35 kg / m2 li ile tsa boela tsa nkuoa Setsing sa Vanderbilt bakeng sa Tahlehelo ea Boima. Barupeluoa ba ile ba tlameha ho amoheloa bakeng sa bongaka ba RYGB kapa VSG. Lithuto tsohle li sebelisitsoe tlhahlobo ea bongaka le tlhahlobo ea bongaka boithuto ho kenyeletsa nalane e qaqileng ea phumants'o ea lithethefatsi. Lirekoto tsa bongaka li ile tsa hlahlojoa ho kenyelletsa tlhahlobo ea kelello ea sepolesa ho hlahloba lefu le leng le le leng le ka bang teng kelellong. Teko e kenyelelitse li-electrocardiogram le li-laboratories tsa tlhahlobo ea mahlo (phanele e felletseng ea metabolic, palo e felletseng ea mali le phapang, urinalysis, le skine ea moroto oa lithethefatsi) Ha ho etsoa liteko le ka tlase ho lihora tsa 4 pele ho scan e 'ngoe le e' ngoe ea PET, basali ba nang le bokhoni ba ho ba le bana ba ile ba etsa tlhahlobo ea bokhachane ea serum pele. Litekanyetso tsa ho kenyelletsa li kenyelletsa ho hlahlojoa ha lefu la tsoekere kapa ts'ebeliso ea batho ba nang le lefu la tsoekere. Ha re kenyetse ba nang le nalane ea tšebeliso ea hona joale ea koae kapa ea pele, tšebeliso e mpe ea joala, kapa lino tse tahang tse ngata ka beke bakeng sa 7 kapa likhoeli tse eketsehileng, hape le ba nang le kofi ea caffeine e kholo ho feta e lekanang le 6 ofies ka kofi letsatsi. Ha re kenyeletse barupeluoa ba neng ba sebelisitse meriana ea mantlha ea ho sebetsa (mohlala, li-antidepressants, antipsychotic, neuroleptics, dopaminergic agents, li-anorexic agents, li-narcotic) likhoeling tse fetileng tsa 16. Lintho tse kopanetsoeng tse kenyeletso le litekanyetso tsa tlhabollo li tlatselitsoe ho ts'ebetso ea mantlha ea matla a matla a kelello le bonohe (MRI) ea boko.

Lintho tse etselitsoeng ho nahanisisa ka PET li sebetsa esale pele le mokena-lipakeng oa libeke tsa 7 (libeke tsa 6-11) kamora ho buuoa ka boima ba 'mele. Mokuli oa VSG o ne a nahana ka lits'ebetso tsa beke ea 11 ha boima ba hae ba 'mele bo ne bo tšoana le lithuto tsa RYGB ho libeke tsa 6-8. Nako ea lipakeng pakeng tsa scoperative le postoperative scans e ne e le libeke tsa 9 (libeke tsa 8-23). Ka letsatsi le leng le le leng la lithuto tsa ho hlahlojoa ho ile ha kopuoa ho itima lijo bakeng sa lihora tsa 8 pele ho skena. Letsatsi la Scan le 2 matsatsi a pele barupeluoa ba ne ba sa thibeloe ho ikoetlisa kapa joala, 'me ha ho na ho lekana le li-kofi tsa 8 tsa kofi letsatsi le letsatsi. Ka letsatsi le leng le le leng la thuto, barupeluoa ba ile ba tlatsa BDI (Beck et al., 1996) le BES (Ka tlhaho et al., 1982).

Ts'ebetso ea Ts'ebetso ea 4.2

Ho buuoa hohle ho entsoe Setsing sa Bongaka sa Vanderbilt. Ho RYGB mokotla o monyane oa gastric hoo e ka bang 30 ml ka bophahamo e thehiloe ka ho arola mpa e kaholimo. Joale mala a manyane a aroloa, ebe pheletso ea "distal" e tlisoa ebe e hokahana le mokotla oa mpa. Bofelo ba proximal ba mala a manyane a arotsoeng bo bokelloa ka thoko, ho theha letheba la Roux la 100-150 cm, le bolelele bo ipapisitseng le index ea boima ba 'mele oa mokuli (Setšoantšo sa 2a). Ho VSG, karolo e kholo ea mpa e buloa hape, e theha mothapo o tsoang ka mpeng ka ho arola mpa le mochini oa 34 oa French.Setšoantšo sa 2b).

Setšoantšo sa 2Setšoantšo sa 2

(a) Ts'ebetso ea RYGB le (b) Ts'ebetso ea VSG (E ngotsoe ka boitelo ba Ethicon Endo-Surgery, Inc.)

4.3 Ho fana ka maikutlo

Makala a kelello a MRI a ile a phethoa pele ho monahano oa PET oa ho khetholla psychology ea anatomic le ho ingolisa hamorao. Karolo e nyane ea T1 litšoantšo tse boima li ile tsa phethoa ho 1.5T (General Electric, 1.2-1.4 mm silice, ka sefofane sa voxel sa 1 × 1 mm) kapa 3T MRI botekgen, ho sa bolelele ba sefofane. boholo ba 1 × 1 mm). PET e lekola le D2/ D3 radioligand [18F] fallypride e entsoe ho scan ninemangale ea General Electric DTSE e nang le thepa e emisitsoeng e nang le mahlakore a mararo le tokiso ea phetiso ea phetisetso e nang le qeto e hlophisitsoeng bocha ea 5 - 6 mm ka sefofane, 3.25 mm ka ho hlaka, mme e fana ka lifofane tsa 47 holima lefapha la axial la 15 cm ea pono. Meroalo ea serial ea PET e fumanoe ho feta lihora tsa 3.5. Mokhoa oa pele oa ho hlahloba (metsotso ea 70) o ile oa qalisoa ka ente ea bolus fetang metsotsoana ea 15 ea 5.0mCi ea [18F] fallypride (ts'ebetso e ikhethileng> 2,000 Ci / mmol). Tatellano ea scan ea bobeli le ea boraro e qalile ka metsotso e 85 le 150 e nka metsotso e 50 le 60 ka ho latellana, ka likhefutso tsa metsotso e 15 lipakeng tsa tatellano ea scan

4.4. Ts'ebetso ea ho Ts'oara

Li-serial tsa PET tsa serial li ne li ngolisitsoe ka bobeli ho e mong le likarolo tse tšesaane tsa T1 tse boima ba MRI 'me li ne li ngolisitsoe ka tšebeliso ea lintlha tse thata tsa' mele oa algorithm (Maes et al., 1997; Wells et al., 1996). Litšoantšo li ne li hokahantsoe le mola oa anterior commisure-posterior commissure (ACPC). Mokhoa o felletseng oa ho sebelisa libaka o sebelisitsoe ho bala sebaka sa DPNUMX ea receptor BPND (Lammertsma et al., 1996) le "cerebellum" e le sebaka se boletsoeng.

Mebuso e khahlisang, ho kenyelletsa le caudate ea naha e 'ngoe, putamen, ventral striatum, amygdalae, substantia nigra, le medial thalami li ile tsa hlakisoa sekaleng sa MRI sa boko mme tsa fetisetsoa ho li-scET tse ngolisitsoeng ka molao tsa PET joalo ka ha sehlopha sa rona se phatlalalitse pele (Kessler et al., 2009; Riccardi et al., 2008a). Sehlopha sa rona se kile sa supa hypothalamus tlhahlobisong ea litšoantšo tsa parametric (Riccardi et al., 2008b). Re khethile hypothalamus joalo ka a priori tikoloho ea thahasello e ipapisitse le bohlokoa ba eona ho taolo ea takatso ea lijo (Schwartz et al., 2000). Litopo tse anyesang li ne li qheletsoe ka thoko ka lebaka la karolo e fokolang ea tsona boima ba 'mele (Tonkiss le Rawlins, 1992) Haholo-holo ha ho bapisoa le libaka tse ling tsa hypothalamic le ho thibela karolo e sa lekanyetsoang ea likarolo tse bohareng tsa boko haufi le fossa e kenelletseng e kenyelletsa "substantia nigra". Hypothalamus e ne e entsoe ka pono ea coronal ea skrin ea MRI e koahelang karolo e kenang ea ventricle ea boraro (Setšoantšo sa 3a le 3b). Pono ea sagittal e ne e sebelisoa ho theha meeli ea anatomic ho kenyelletsa le sefofane sa lamina terminalis le bokapele ba kamore ea kantle ea boithabiso ba ka ntle le litopo tsa mammillary e le moeli oa kamorao. Ha a ntse a tsoela pele ka morao, sebopeho sa orthogonal sa hypothalamus se ile sa nkuoa hloko (Langevin le Iversen, 1980).

Setšoantšo sa 3

Ho hlakola hypothalamus. (a) Coronal pono ea MRI setšoantšo le (b) setšoantšo sa PON sa Coronal.

4.5. Meputso

Mehlala ea mali e potlakileng e ile ea bokelloa bakeng sa insulin, leptin le ghrelin e felletseng. Sampole ea 10 ml e ile ea bokelloa ka meqomong e nang le 10 microliter / ml ea serine proteinase inhibitor pefabloc sc (4-amidinophenyl-methanesulfonyl fluoride, Roche Applied Science, Germany). Ts'oaetso ea "insulin" e hlahisitsoe ke radioimmunoassay (RIA) (Morgan le Lazarow, 1962) ka selekane se kopaneng sa phapang ea 3% (Lipatlisiso tsa Linco, Inc. St. Charles, MO). Leptin (Millipore, St. Charles, MO) le tsepamiso ea ghrelin (Linco Research, Inc. St. Charles, Mo) le tsona li khethiloe ke RIA. Mehlala eohle e ne e etsoa habeli.

Tlhahlobo ea Statistics ea 4.6

Liteko tse phetoang khafetsa tsa phapang ea ANOVA li sebelisitsoe ho leka, kahare ho ROI e 'ngoe le e' ngoe (ntle le hypothalamus), litlamorao tse kahare tsa ts'ebetso ea ho buuoa (preoperative vs. postoperative) le latellano (lehlakoreng le letšehali le lehlakoreng le letona), le ts'ebetso ea bongaka ka tšebelisano ea moraorao phello (e bonts'a hore na likarabo tsa ts'ebetso ea bongaka ea bariatric li fapana ka mahlakoreng a leqele le a le letona). Liteko tse se nang tataiso tsa ho pepa, ebang ke phello e kholo ea ho buuoa ho tsoa mehatong e phetoang ANOVA kapa tlhahlobo ea t-test (bakeng sa data ea hypothalamus), le liteko tse saenneng tsa saparametric Wilcoxon li sebelisitsoe ho leka litlamorao tsa ho buuoa ka bariatric ho litlamorao tse tlamang ROI. Sebaka sa p-boleng sa 0.007 se sebelisitsoe ho fetolela lipapiso tse nepisitsoeng ka Bonferroni bakeng sa 7 ROI. Teko ea maemo a phahameng ea Wilcoxon e sebelisitsoe ho leka sephetho sa ho buuoa ho boima ba pele le kamora ts'ebetso, BMI, sekala sa kelello le ts'oaro ea li-hormone. Lintlha tsa kakaretso li tlalehiloe e le "± phoso e tloaelehileng ea" (SEM) mme tlhahlobo e entsoe ka ho sebelisa software ea lipalo tsa SPPS (v 17.0, SPSS Inc., IL).

Eya ho:

Liteboho

Re tla rata ho leboha Pamela Marks-Shulman, MS, RD le Joan Kaiser, RN ka mosebetsi oa bona o boima ho tšehetsa thuto ena.

Ts'ehetso ea lithuso:

JPD e fumane tšehetso ho tsoa ho Vanderbilt Environmental Health Science Scholars Programme (NIEHS K12 ESO15855). Mosebetsi ona o tšehelitsoe ke lithuso tsa NIH RO1-DK070860, NIDDK ho NNA Mosebetsi ona o ile oa tšehetsoa hape ke karolo ea Vanderbilt CTSA 1 UL1 RR024975 e tsoang ho NCRR / NIH, Vanderbilt Diabetes Research and Training Center (DK20593), le Vanderbases Digeschges Diges. Setsi (DK058404).

Eya ho:

khutsufalitsoeng

Roi
sebaka sa khahleho
DA
dopamine
DA D2
mofuta oa dopamine D2/ D3
RYGB
Roux en Y Gastric Ho feta
VSG
Vertical Sleeve Gastondolaomy
BDI
Beck ho tepella maikutlong Inventory-II
Sjostrom et al.
Tekanyo ea ho ja lijo tsa binge
BDND
Tlamahano e ka ba teng
Eya ho:

Mongolo o botlaaseng ba leqephe

Boitlhotlhollo ba Mohoeletsi: Ena ke faele ea PDF ea mongolo o ngotsoeng ka letsoho o sa amoheloang o amoheletsoeng bakeng sa ho hatisoa. Joaloka tšebeletso ho bareki ba rona re fana ka phetolelo ena ea pele ea mongolo o ngotsoeng ka letsoho. Mongolo o ngotsoeng ka letsoho o tla ba le ho kopitsa, ho kenya lihlopha le ho hlahloba bopaki bo hlahang pele o hatisoa ka mokhoa oa oona oa ho qetela. Ka kopo hlokomela hore nakong ea mekhoa ea tlhahiso ea lihlahisoa e ka fumanoa e ka amang litaba, le litsebiso tsohle tsa molao tse sebetsang koranteng e amanang le eona.

Eya ho:

Likarabo tsa lingoliloeng

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