Improvement in Glucose Metabolism After Bariatric Surgery: Comparison of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy A Prospective Randomized Trial
Improvement in Glucose Metabolism After Bariatric Surgery: Comparison of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy A Prospective Randomized Trial
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DOI：
10.1097/sla.0b013e3181ae32e3
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发表时间：
2009-08-01
影响因子：
9
通讯作者：
Beglinger, Christoph
中科院分区：
文献类型：
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作者：
Peterli, Ralph;Woelnerhanssen, Bettina;Beglinger, Christoph
工作背景：近端小肠的排除被认为在胃旁路术后糖尿病代谢控制的快速改善中起主要作用。目的：在这项随机、前瞻性、平行组研究中，我们试图评价和比较腹腔镜Roux-en-Y胃旁路术（LRYGB）与腹腔镜袖状胃切除术（LSG）对空腹和餐后胰岛素、血糖、和胰高血糖素样肽-1（GLP-1）水平。方法：13例患者随机接受LRYGB，14例患者随机接受LSG。对大部分非糖尿病患者在术前、术后1周和3个月进行评估。在禁食过夜后给予标准试验餐，并在两组食物摄入前后采集血液样品，用于胰岛素、GLP-1、葡萄糖、PYY和ghrelin浓度。www.clinicaltrials.gov结果：两种方法治疗后，患者体重和体重指数均显著下降（P <0.002），体重指数显著下降（P <0.001），体重指数显著下降（P < 0.002）。3个月时BMI过度下降相似（43.3 +/-12.1% vs. 39.4 +/-9.4%，P > 0.36）。手术后，两种手术后患者的餐后血浆胰岛素和GLP-1水平分别显着增加（P < 0.01），这有利于改善葡萄糖稳态。与LSG相比，LRYGB患者早在术后1周就有早期和增强的胰岛素反应;可能介导早期血糖控制的改善。3个月后，没有显着差异，观察到相对于胰岛素和GLP-1分泌之间的2 procedure.Conclusion：两个程序显着改善葡萄糖稳态：胰岛素，GLP-1，和PYY水平增加后，任何程序相似。我们的研究结果不支持近端小肠介导葡萄糖稳态改善的观点。
Background: The exclusion of the proximal small intestine is thought to play a major role in the rapid improvement in the metabolic control of diabetes after gastric bypass.Objective: In this randomized, prospective, parallel group study, we sought to evaluate and compare the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) with those of laparoscopic sleeve gastrectomy (LSG) on fasting, and meal-stimulated insulin, glucose, and glucagon-like peptide-1 (GLP-1) levels.Methods: Thirteen patients were randomized to LRYGB and 14 patients to LSG. The mostly nondiabetic patients were evaluated before, and I week and 3 months after surgery. A standard test meal was given after an overnight fast, and blood samples were collected before and after food intake in both groups for insulin, GLP-1, glucose, PYY, and ghrelin concentrations. This trial was registered in www.clinicaltrials.gov (NCT00356213) before the first patient was randomized.Results: Body weight and body mass index decreased markedly (P < 0.002) and comparably after either procedure. Excess BMI loss was similar at 3 months (43.3 +/- 12.1 % vs. 39.4 +/- 9.4%, P > 0.36). After surgery, patients had markedly increased postprandial plasma insulin and GLP-1 levels, respectively (P < 0.01) after both of these surgical procedures, which favor improved glucose homeostasis. Compared with LSG, LRYGB patients had early and augmented insulin responses as early as 1-week postoperative; potentially mediating improved early glycemic control. After 3 months, no significant difference was observed with respect to insulin and GLP-1 secretion between the 2 procedures.Conclusion: Both procedures markedly improved glucose homeostasis: insulin, GLP-1, and PYY levels increased similarly after either procedure. Our results do not support the idea that the proximal small intestine mediates the improvement in glucose homeostasis.