Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass.
Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass.
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DOI：
10.1038/ijo.2009.79
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发表时间：
2009-07
影响因子：
4.9
通讯作者：
Bessler, M.
中科院分区：
文献类型：
--
作者：
Korner, J.;Inabet, W.;Fabres, G.;Conwell, I. M.;McMahon, D. J.;Salas, R.;Taveras, C.;Schrope, B.;Bessler, M.
本研究的目的是量化调节能量和葡萄糖稳态的激素，以便建立可能的机制，使 Roux-en-Y 胃绕道术 (RYGB) 与腹腔镜可调节胃束带术 (LAGB) 相比，在实现减肥和改善胰岛素敏感性方面更有效。对接受 LAGB (n=15) 和 RYGB (n=28) 的患者进行的纵向研究，在手术前以及术后 2、12、26 和 52 周进行研究。每次就诊时均抽取空腹血样。还在手术前以及第 26 周和第 52 周时采集了餐后血样。检测样品中的肽 YY (PYY)、生长素释放肽、胰高血糖素样肽-1 (GLP-1)、葡萄糖、胰岛素、瘦素、促甲状腺激素 (TSH)、游离 T4 和游离 T3。一年后，与 LAGB 患者相比，RYGB 患者的体重减轻幅度更大（30% vs 15%），但最终体重指数相似（34 kg/m2 vs 33 kg/m2）。第 52 周时，RYGB 受试者中 PYY 的曲线下面积 (AUC) 大于 LAGB (P<0.01)。 RYGB 后餐后 30 分钟的 GLP-1 水平是 LAGB 的三倍（P<0.001）。相反，第 52 周 LAGB 后生长素释放肽 AUC 增加（P<0.05），但 RYGB 后趋于下降。随着时间的推移，两组的空腹血糖、胰岛素、瘦素和 HOMA-IR 均下降，但与 LAGB 相比，RYGB 后第 52 周显着降低。瘦素的变化与 LAGB (r=0.86) 和 RYGB (r=0.77) 的体重减轻显着相关，然而，HOMA-IR 仅在 LAGB (r=0.78) 中与体重减轻显着相关，而与 RYGB (r=0.15) 不显着相关。 RYGB后游离T3显着下降（P<0.01）。与 LAGB 相比，肠道激素水平的差异可能在促进 RYGB 后更大的体重减轻和胰岛素敏感性方面发挥作用，然而，体重减轻可能因游离 T3 和瘦素的减少而受到限制。
The objective of this study was to quantify hormones that regulate energy and glucose homeostasis in order to establish possible mechanisms for the greater efficacy of Roux-en-Y gastric bypass (RYGB) compared with laparascopic adjustable gastric banding (LAGB) in achieving weight loss and improved insulin sensitivity. Longitudinal study of patients undergoing LAGB (n=15) and RYGB (n=28) who were studied prior to surgery and at 2, 12, 26 and 52 wks afterwards. Fasting blood samples were drawn at each visit. Postprandial blood samples were also obtained prior to surgery and at 26 and 52 wks. Samples were assayed for peptide YY (PYY), ghrelin, glucagon-like peptide-1 (GLP-1), glucose, insulin, leptin, thyrotropic hormone (TSH), free T4 and free T3. At one year there was greater weight loss in RYGB compared with LAGB patients (30% vs 15%), but final body mass index was similar (34 vs 33 kg/m2). At wk 52, area under the curve (AUC) for PYY in RYGB subjects was greater than LAGB (P<0.01). GLP-1 levels at 30 min post-meal were three-fold greater after RYGB compared with LAGB (P<0.001). Conversely, ghrelin AUC increased after LAGB at wk 52 (P<0.05) but tended to decrease after RYGB. Fasting glucose, insulin, and leptin, and HOMA-IR decreased in both groups over time but were significantly lower at wk 52 after RYGB compared with LAGB. The change in leptin correlated significantly with weight loss in LAGB (r=0.86) and RYGB (r=0.77), however, HOMA-IR correlated significantly with weight loss only in LAGB (r=0.78), and not RYGB (r=0.15). There was a significant decrease in free T3 (P<0.01) after RYGB. Differences in levels of gut hormones may play a role in promoting greater weight loss and insulin sensitivity after RYGB compared with LAGB, however, weight loss may be limited by decreases in free T3 and leptin.
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