Changes in Bile Acid Profile After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Metabolic Profile and Fatty Liver Disease
Changes in Bile Acid Profile After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Metabolic Profile and Fatty Liver Disease
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DOI：
10.1007/s11695-015-1878-1
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发表时间：
2016-06-01
期刊：
影响因子：
2.9
通讯作者：
Patel, Ameet G.
中科院分区：
文献类型：
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作者：
Belgaumkar, Ajay P.;Vincent, Royce P.;Patel, Ameet G.
背景：胆汁酸(BA)通过在回肠末端产生成纤维细胞生长因子(FGF19)，以反馈方式调节脂肪和葡萄糖代谢。减肥手术后BA的变化可能导致代谢综合征的改善，包括脂肪肝疾病。为探讨腹腔镜袖状胃切除术(LSG)后BA与代谢和炎症的关系。方法对接受LSG手术的患者分别于术前和术后6个月采空腹血样。用细胞角蛋白(CK)18片段检测肝损伤。用液相色谱质谱联用法测定BA。结果18例患者(女性12例)，平均年龄46.3岁(SEM+/-2.9)，BMI 60.1 kg/m(2)(+/-2.6)。6个月后，患者体重减轻39.8公斤(+/-3.1p<；0.001)。14名患者(78%)有脂肪变性。成纤维细胞生长因子-19在6个月时从中位数128.1(IQR89.4-210.1)增加到177.1(121.8-288.9，p=0.045)。在研究期间，虽然总BA没有变化，但初级甘氨酸和牛磺酸结合的BA、胆酸减少，而次级BA、甘氨酸结合的尿脱氧胆酸增加。这些变化与胰岛素抵抗、促炎细胞因子和CK-18水平降低有关。结论LSG后个体BA的形态发生改变。这些变化发生在炎性细胞因子和肝损伤标志物减少的情况下。这项研究支持了最近动物模型的证据，即LSG可能通过改变BA代谢而对脂肪肝产生影响。
Background Bile acids (BA) modulate lipid and glucose metabolism in a feedback loop through production of fibroblast growth factor (FGF) 19 in the terminal ileum. Changes in BA after bariatric surgery may lead to improvements in the metabolic syndrome, including fatty liver disease. This study investigated the relationship between BA and metabolic and inflammatory profiles after laparoscopic sleeve gastrectomy (LSG).Methods Patients undergoing LSG had fasting blood samples taken pre-operatively and 6 months post-surgery. Liver injury was measured using cytokeratin (CK) 18 fragments. BA were measured using liquid chromatography tandem-mass spectrometry. FGF-19 was measured using enzyme-linked immunosorbent assay.Results The study included 18 patients (12 females), with mean age 46.3 years (SEM +/- 2.9) and BMI 60.1 kg/m(2) (+/- 2.6). After 6 months, patients lost 39.8 kg (+/- 3.1; p < 0.001). Fourteen patients (78 %) had steatosis. FGF-19 increased from median 128.1 (IQR 89.4-210.1) to 177.1 (121.8-288.9, p = 0.045) at 6 months. Although total BA did not change, primary glycine- and taurine-conjugated BA, cholic acid decreased, and secondary BA, glycine-conjugated urodeoxycholic acid increased over the study period. These changes are associated with reduction in insulin resistance, pro-inflammatory cytokines and CK-18 levels.Conclusions The profile of individual BA is altered after LSG. These changes occur in the presence of reductions in inflammatory cytokines and markers of liver injury. This study supports evidence from recent animal models that LSG may have an effect on fatty liver through changes in BA metabolism.