Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial.
Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial.
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DOI：
10.1007/s11695-012-0622-3
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发表时间：
2012-05
期刊：
影响因子：
2.9
通讯作者：
Beglinger, Christoph
中科院分区：
文献类型：
--
作者：
Peterli, Ralph;Steinert, Robert E.;Woelnerhanssen, Bettina;Peters, Thomas;Christoffel-Courtin, Caroline;Gass, Markus;Kern, Beatrice;von Fluee, Markus;Beglinger, Christoph
关键词：
腹腔镜Roux-en-Y胃旁路术（LRYGB）或腹腔镜袖状胃切除术（LSG）后早期血糖控制改善的机制尚不完全清楚。在这项前瞻性随机1年试验中，比较了LRYGB和LSG患者的结局，重点关注可能的责任机制。12例患者随机分配至LRYGB组，11例患者随机分配至LSG组。这些非糖尿病患者在术前和术后1周、3个月和12个月进行了研究。在禁食过夜后给予标准试验餐，并在进食前、进食期间和进食后采集血液样品用于激素谱（胆囊收缩素（CCK）、生长激素释放肽、胰高血糖素样肽1（GLP-1）、肽YY（PYY））。在两组中，体重和BMI显著降低，导致异常血糖控制（HOMA指数）的改善相同。手术后，患者餐后血浆GLP-1和PYY水平显著增加（p < 0.05），葡萄糖稳态随之改善。在12个月时，LRYGB ghrelin水平接近术前值。然而，餐后生理波动恢复，而LSG ghrelin水平仍显着减弱。术后1年，LRYGB组试验餐后CCK浓度的增加低于LSG组，后者显示出显著更高的最大CCK浓度（p < 0.012 vs. LRYGB）。前肠扩张并不是改善葡萄糖稳态的唯一机制。前肠（ghrelin，CCK）和后肠（GLP-1，PYY）激素之间的平衡是理解潜在机制的关键。
The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood. In this prospective, randomized 1-year trial, outcomes of LRYGB and LSG patients were compared, focusing on possibly responsible mechanisms. Twelve patients were randomized to LRYGB and 11 to LSG. These non-diabetic patients were investigated before and 1 week, 3 months, and 12 months after surgery. A standard test meal was given after an overnight fast, and blood samples were collected before, during, and after food intake for hormone profiles (cholecystokinin (CCK), ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY)). In both groups, body weight and BMI decreased markedly and comparably leading to an identical improvement of abnormal glycemic control (HOMA index). Post-surgery, patients had markedly increased postprandial plasma GLP-1 and PYY levels (p < 0.05) with ensuing improvement in glucose homeostasis. At 12 months, LRYGB ghrelin levels approached preoperative values. The postprandial, physiologic fluctuation returned, however, while LSG ghrelin levels were still markedly attenuated. One year postoperatively, CCK concentrations after test meals increased less in the LRYGB group than they did in the LSG group, with the latter showing significantly higher maximal CCK concentrations (p < 0.012 vs. LRYGB). Bypassing the foregut is not the only mechanism responsible for improved glucose homeostasis. The balance between foregut (ghrelin, CCK) and hindgut (GLP-1, PYY) hormones is a key to understanding the underlying mechanisms.
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