Changes in Enterohepatic Circulation after Duodenal-Jejunal Bypass and Reabsorption of Bile Acids in the Bilio-Pancreatic Limb
Changes in Enterohepatic Circulation after Duodenal-Jejunal Bypass and Reabsorption of Bile Acids in the Bilio-Pancreatic Limb
复制标题
十二指肠空肠旁路术后肠肝循环的变化以及胆胰管中胆汁酸的重吸收
DOI：
10.1007/s11695-019-03790-y
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发表时间：
2019
期刊：
影响因子：
2.9
通讯作者：
Naitoh Takeshi
中科院分区：
文献类型：
--
作者：
Ise Ichiro;Tanaka Naoki;Imoto Hirofumi;Maekawa Masamitsu;Kohyama Atsushi;Watanabe Kazuhiro;Motoi Fuyuhiko;Unno Michiaki;Naitoh Takeshi
背景和目标十二指肠空肠旁路术（DJB）对减肥和改善糖尿病有很大的效果。此前，我们报道了 Miyachi 等人的报道，胆胰 (BP) 肢在血糖改善和血清胆汁酸 (BA) 水平增加中发挥着重要作用。 （外科杂志 159(5):1360–71, 2016）。本研究旨在探讨DJB后BA升高的机制及其与血压-肢体长度的关系。方法将糖尿病大冢Long-Evans德岛肥胖大鼠随机分为4组：1组假手术组和3组DJB组。根据 BP 肢体长度定义三个 DJB 组：0 厘米、15 厘米和 30 厘米。每个 DJB 组的消化肢和公共通道的长度设置相同。术后评估体重、葡萄糖耐量以及肝脏、胆汁、门静脉和肠内容物中的BA水平。使用标记的 BA 评估 BA 肠肝循环的变化。结果 DJB 后 BA 升高随着 BP 肢体的延长而升高。 30cm组的血清总BA水平以及门静脉、肝脏和胆汁中的BA水平高于其他组。 15厘米和30厘米组的肠肝循环缩短。 结论 BP肢中BA的早期重吸收（而不是胆汁液早期流入回肠）导致的“肠肝循环”缩短是DJB后BA升高的主要原因。因此，DJB 后血糖改善和 BA 浓度升高取决于 BP 肢体长度。
Background and AimsDuodenal–jejunal bypass (DJB) shows great effects on weight loss and diabetes improvement. Previously, we reported that the bilio-pancreatic (BP) limb plays an important role in glycemic improvement and in serum bile acid (BA) level increase as reported by Miyachi et al. (Surgery 159(5):1360–71, 2016). This study aimed to investigate the mechanism of BA elevation after DJB and the relationship between these effects and BP-limb length.MethodsOtsuka Long-Evans Tokushima Fatty rats with diabetes were randomly assigned into four groups: one sham group and three DJB groups. Three DJB groups were defined according to the BP-limb length: 0 cm, 15 cm, and 30 cm. The lengths of the alimentary limb and common channel were set equally in each DJB groups. Body weight, glucose tolerance, and BA levels in the liver, bile juice, portal vein, and intestinal contents were assessed postoperatively. Changes in enterohepatic circulation of BAs were assessed using labeled BA.ResultsBA elevation after DJB was higher with longer BP-limb. In the 30-cm group, the serum total BA level and BA levels in the portal vein, liver, and bile juice were greater than those in other groups. The enterohepatic circulation was shortened in the 15-cm and 30-cm groups.ConclusionsShortening of the “enterohepatic circulation” by early reabsorption of BAs in the BP-limb, not by the early influx of bile juice into the ileum, was the main cause of BA elevation after DJB. Thus, glycemic improvement and elevation of BA concentration after DJB depend on the BP-limb length.