Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan 48109-0008, USA.
Nutr Clin Pract. 2011 Oct;26(5):583-92. doi: 10.1177/0884533611416127.
The duodenal switch (DS) procedure is a type of restrictive-malabsorptive bariatric surgery that is typically reserved for severe morbidly obese people (body mass index >50 kg/m(2)) with obesity-related comorbidities, when diet, lifestyle changes, and pharmacologic therapy fail to achieve adequate weight loss. Patients who undergo the DS procedure are at risk for malabsorption, malnutrition, and nutrient deficiencies. Copper deficiency is a commonly reported long-term complication of Roux-en-Y gastric bypass (RYGB) surgery. However, data are limited on copper deficiency-associated complications and their treatment in DS patients. This article presents a case of a patient who developed hypocupremia with associated pancytopenia, myeloneuropathy, and leukoencephalopathy following DS and reviews the literature related to the pathophysiology of copper deficiency and copper replacement in bariatric surgery patients. When severe diarrhea was present, intravenous elemental copper 4 mg (as cupric chloride)/d in addition to daily oral copper gluconate was necessary to correct the hypocupremia and improve the hematologic indices and neurologic symptoms of copper deficiency. When diarrhea subsided, oral elemental copper 4 mg (as copper gluconate) 3 times daily maintained normal serum copper concentrations and avoided the relapse of severe neurologic dysfunction. Regular monitoring of serum copper and ceruloplasmin concentrations is recommended following DS surgery to detect any copper deficiency before irreversible neurologic damage occurs. Long-term copper supplementation is likely necessary to maintain normal copper status in DS patients.
十二指肠转流术（DS）是一种限制型吸收不良型减肥手术，通常保留给严重病态肥胖患者（体重指数>50 kg/m2），这些患者存在与肥胖相关的合并症，并且在饮食、生活方式改变和药物治疗后无法达到足够的减重效果。接受 DS 手术的患者存在吸收不良、营养不良和营养缺乏的风险。铜缺乏是 Roux-en-Y 胃旁路术（RYGB）手术后常见的长期并发症。然而，关于 DS 患者中铜缺乏相关并发症及其治疗的数据有限。本文报告了一例患者在接受 DS 手术后出现低铜血症，伴有全血细胞减少、骨髓神经病和白质脑病，并复习了与铜缺乏症的病理生理学以及减肥手术患者中铜替代相关的文献。当存在严重腹泻时，除了每天口服葡萄糖酸铜外，还需要静脉内给予元素铜 4 mg（以氯化铜形式）/d，以纠正低铜血症并改善铜缺乏的血液学指标和神经症状。当腹泻缓解后，每日口服元素铜 4 mg（以葡萄糖酸铜形式）3 次可维持正常的血清铜浓度，并避免严重神经功能障碍的复发。建议在 DS 手术后定期监测血清铜和铜蓝蛋白浓度，以在不可逆的神经损伤发生之前发现任何铜缺乏症。DS 患者可能需要长期铜补充，以维持正常的铜状态。
