Lakhani Shilen V, Shah Hiral N, Alexander Kenneth, Finelli Frederick C, Kirkpatrick John R, Koch Timothy R
Department of Medicine, Washington Hospital Center, Washington, DC 20010-2975, USA.
Nutr Res. 2008 May;28(5):293-8. doi: 10.1016/j.nutres.2008.03.002.
It has been proposed that thiamine deficiency after gastric bypass surgery in obese patients results from prolonged nausea and emesis. We hypothesized that thiamine deficiency is induced by altered gut ecology. This report includes 2 retrospective studies of obese patients who underwent Roux-en-Y gastric bypass surgery at our institution from 1999 to 2005. In the first study, 80 patients (52 women and 28 men) had measurement of whole-blood thiamine diphosphate level and serum folate level. In these 80 patients, 39 (49%) had thiamine diphosphate levels less than the lower limit of the reference range, and 28 (72%) of the 39 had folate levels higher than the upper limit of the reference range, an indicator of small intestinal bacterial overgrowth. In 41 patients with normal thiamine levels, only 14 (34%) had folate levels higher than the upper limit of the reference range (chi(2) test, P < .01). In the second study, 21 patients (17 women and 4 men) had thiamine diphosphate levels less than the lower limit of the reference range and abnormal glucose-hydrogen breath tests, consistent with small intestinal bacterial overgrowth. Fifteen patients received oral thiamine supplements, but repeated thiamine levels remained low in all 15. Nine of these patients then received oral antibiotic therapy; repeated thiamine levels were found to be normal in all 9 patients. These results support the hypothesis that small intestinal bacterial overgrowth results from altered gut ecology and induces thiamine deficiency after gastric bypass surgery in obese patients.
有人提出，肥胖患者胃旁路手术后硫胺素缺乏是由长期恶心和呕吐引起的。我们推测硫胺素缺乏是由肠道生态改变所致。本报告包括两项对1999年至2005年在我院接受Roux-en-Y胃旁路手术的肥胖患者的回顾性研究。在第一项研究中，80名患者（52名女性和28名男性）检测了全血硫胺二磷酸水平和血清叶酸水平。在这80名患者中，39名（49%）的硫胺二磷酸水平低于参考范围下限，其中39名中的28名（72%）叶酸水平高于参考范围上限，这是小肠细菌过度生长的一个指标。在41名硫胺素水平正常的患者中，只有14名（34%）的叶酸水平高于参考范围上限（卡方检验，P <.01）。在第二项研究中，21名患者（17名女性和4名男性）的硫胺二磷酸水平低于参考范围下限，且葡萄糖-氢气呼气试验异常，符合小肠细菌过度生长。15名患者接受了口服硫胺素补充剂，但所有15名患者的硫胺素水平反复检测仍较低。其中9名患者随后接受了口服抗生素治疗；所有9名患者的硫胺素水平反复检测均正常。这些结果支持了以下假设：肠道生态改变导致小肠细菌过度生长，并在肥胖患者胃旁路手术后诱发硫胺素缺乏。
