Division of General Surgery, Department of Surgery, Vanderbilt University, Nashville, TN, USA.
J Am Coll Surg. 2011 Apr;212(4):617-25; discussion 625-7. doi: 10.1016/j.jamcollsurg.2010.12.040.
Protein supplements are routinely used after a laparoscopic gastric bypass (LGB). The aim of this study was to evaluate the impact of an amino acid supplement on glucose homeostasis and hormonal and inflammatory markers after LGB.
Thirty patients undergoing LGB were randomized to receive or not 24 g of an oral supplement containing a leucine metabolite, glutamine, and arginine twice daily. Changes in weight, glucose, insulin, C-peptide, insulin sensitivity, interleukin (IL) 6, C-reactive protein (CRP), leptin, insulin-like growth factor (IGF) 1, ghrelin, and incretins were assessed preoperatively and 2 weeks and 8 weeks postoperatively.
Thirty patients (96.7% female, age 46.9 ± 8.4 years, body mass index 43.3 ± 4.1 kg/m(2)) were randomized. The experimental (n = 14) and control (n = 16) groups were not significantly different at baseline. Weight loss was similar for the 2 groups. Fasting glucose decreased significantly at 2 and 8 weeks compared with base line (p < 0.0001) with no difference between the experimental and control groups (p = 0.8), but insulin and calculated insulin sensitivity, which were similar at baseline, became significantly worse in the experimental group 8 weeks after surgery (p = 0.02 for insulin; p = 0.04 for the homeostasis model assessment of insulin resistance). CRP and IL-6, which were similar at baseline, were found to be significantly higher at 8 weeks in the experimental group (p = 0.018 and p = 0.05, respectively). Leptin and IGF-1 levels decreased significantly from baseline at 2 and 8 weeks (p < 0.0001), but there was no difference between the 2 groups. No significant changes in GLP-1, ghrelin, or gastric inhibitory polypeptide were noticed after 8 weeks.
An amino acid supplement had no effect on the early postoperative incretins after LGB. It may have a negative influence on glucose kinetics and degree of inflammation. Future studies are needed to clarify these effects.
蛋白补充剂在腹腔镜胃旁路手术后（LGB）通常被使用。本研究的目的是评估一种氨基酸补充剂对 LGB 后葡萄糖稳态及激素和炎症标志物的影响。
30 例接受 LGB 的患者随机分为接受或不接受每天两次、每次 24g 的含有亮氨酸代谢物、谷氨酰胺和精氨酸的口服补充剂。术前及术后 2 周和 8 周评估体重、葡萄糖、胰岛素、C 肽、胰岛素敏感性、白细胞介素（IL）6、C 反应蛋白（CRP）、瘦素、胰岛素样生长因子（IGF）1、胃饥饿素和肠促胰岛素的变化。
30 例患者（96.7%女性，年龄 46.9 ± 8.4 岁，体重指数 43.3 ± 4.1kg/m2）被随机分为实验组（n = 14）和对照组（n = 16）。两组基线时无显著差异。两组体重减轻相似。与基线相比，术后 2 周和 8 周时空腹血糖明显下降（p<0.0001），但实验组与对照组之间无差异（p = 0.8），但在术后 8 周时，实验组胰岛素和计算的胰岛素敏感性变得明显更差（胰岛素：p = 0.02；胰岛素抵抗的稳态模型评估：p = 0.04）。基线时相似的 CRP 和 IL-6，在实验组 8 周时明显升高（p = 0.018 和 p = 0.05）。瘦素和 IGF-1 水平在术后 2 周和 8 周时均明显下降（p<0.0001），但两组之间无差异。术后 8 周时 GLP-1、胃饥饿素或生长抑素无明显变化。
氨基酸补充剂对 LGB 后早期肠促胰岛素无影响。它可能对葡萄糖动力学和炎症程度有负面影响。需要进一步研究来阐明这些影响。
