Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety
Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety
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DOI：
10.1002/bjs.5227
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发表时间：
2006-02-01
影响因子：
9.6
通讯作者：
Aylwin, SJB
中科院分区：
文献类型：
--
作者：
Borg, CM;le Roux, CW;Aylwin, SJB
背景：减肥手术是实现病态肥胖患者长期减肥的最有效的治疗方法。本研究旨在探讨Roux-en-Y胃旁路手术(RYGB)后胃肠激素及代谢指标的前瞻性变化。方法：6例患者分别于术前、术后1、3、6个月观察。在禁食12小时后定期采集血液，并在420卡路里的混合餐后定期采集。测定激素反应，并比较基础水平和曲线下面积。结果：平均体重指数由术前的48.3 kg/m(2)降至术后6个月的36(.)4 kg/m(2)。伴随着空腹瘦素(P<；0)和胰岛素(P=0.021)水平的下降。术后1、3、6个月观察YY(P<；0.001)、肠高血糖素(P=0.045)、胰高血糖素样肽1(P=0.042)的递增反应。空腹Ghrelin水平无明显变化(P=0.144)。术后1个月，餐后饱腹感显著增加，并一直维持到研究结束(P<；0(.)001)。RYGB可显著减轻体重，增强餐后饱腹感，维持体重平台期，并相应降低空腹胰岛素和瘦素水平。缺乏作为反调节反应组成部分的食欲和食物摄入量的预期增加，可能是因为肠道适应以及随之而来的促进饱腹感的肠道激素水平的逐步上升。
Background: Bariatric surgery is the most effective treatment for achieving long-term weight loss in morbidly obese patients. This study investigated prospective changes in gut hormones and metabolic indices after Roux-en-Y gastric bypass (RYGB).Methods: Six patients were seen before, and at 1, 3 and 6 months after operation. Blood was collected after a 12-h fast and at regular intervals after a mixed 420-kcal meal. Hormonal responses were determined, and comparisons between basal levels and areas under the curve were made. Visual analogue scores were used to assess satiety, hunger and nausea.Results: Mean body mass index decreased from 48.3 kg/m(2) before surgery to 36(.)4 kg/m(2) 6 months after RYGB. This was accompanied by a decrease in fasting leptin (P < 0(.)001) and insulin (P = 0(.)021) levels. At 1, 3 and 6 months after operation, progressively increasing peptide YY (P < 0.001), enteroglucagon (P = 0(.)045) and glucagon-like peptide 1 (P = 0(.)042) responses were observed. There was no change in fasting ghrelin levels (P = 0(.)144). Postprandial satiety was significantly increased by I month after surgery and this was maintained until the end of the study (P < 0(.)001).Conclusion. RYGB resulted in substantial weight loss with enhanced postprandial satiety, a sustained weight plateau, and proportionate reduction in fasting insulin and leptin levels. Lack of the expected increase in appetite and food intake as components of a counter-regulatory response may be explained by gut adaptation and the consequent graded rise in the levels of gut hormones that promote satiety.