Roux-en-Y 胃旁路手术会降低大鼠的骨密度并导致代谢性酸中毒。

Roux-en-Y gastric bypass surgery reduces bone mineral density and induces metabolic acidosis in rats.

机构信息

Institute of Veterinary Physiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland;

出版信息

Am J Physiol Regul Integr Comp Physiol. 2013 Nov 1;305(9):R999-R1009. doi: 10.1152/ajpregu.00038.2013. Epub 2013 Sep 11.

Abstract

Roux-en-Y gastric bypass (RYGB) surgery leads to bone loss in humans, which may be caused by vitamin D and calcium malabsorption and subsequent secondary hyperparathyroidism. However, because these conditions occur frequently in obese people, it is unclear whether they are the primary causes of bone loss after RYGB. To determine the contribution of calcium and vitamin D malabsorption to bone loss in a rat RYGB model, adult male Wistar rats were randomized for RYGB surgery, sham-operation-ad libitum fed, or sham-operation-body weight-matched. Bone mineral density, calcium and phosphorus balance, acid-base status, and markers of bone turnover were assessed at different time points for 14 wk after surgery. Bone mineral density decreased for several weeks after RYGB. Intestinal calcium absorption was reduced early after surgery, but plasma calcium and parathyroid hormone levels were normal. 25-hydroxyvitamin D levels decreased, while levels of active 1,25-dihydroxyvitamin D increased after surgery. RYGB rats displayed metabolic acidosis due to increased plasma lactate levels and increased urinary calcium loss throughout the study. These results suggest that initial calcium malabsorption may play a key role in bone loss early after RYGB in rats, but other factors, including chronic metabolic acidosis, contribute to insufficient bone restoration after normalization of intestinal calcium absorption. Secondary hyperparathyroidism is not involved in postoperative bone loss. Upregulated vitamin D activation may compensate for any vitamin D malabsorption.

摘要

胃旁路术(RYGB)导致人体骨丢失,这可能是由于维生素 D 和钙吸收不良以及随后的继发性甲状旁腺功能亢进引起的。然而,由于这些情况在肥胖人群中经常发生,因此尚不清楚它们是否是 RYGB 后骨丢失的主要原因。为了确定钙和维生素 D 吸收不良对 RYGB 大鼠模型骨丢失的贡献,将成年雄性 Wistar 大鼠随机分为 RYGB 手术组、假手术随意喂养组和假手术体重匹配组。在手术后 14 周的不同时间点评估骨密度、钙磷平衡、酸碱状态和骨转换标志物。RYGB 后几周骨密度下降。手术后早期肠道钙吸收减少,但血浆钙和甲状旁腺激素水平正常。25-羟维生素 D 水平下降,而活性 1,25-二羟维生素 D 水平升高。RYGB 大鼠由于血浆乳酸水平升高和尿钙丢失增加而表现出代谢性酸中毒。这些结果表明,初始钙吸收不良可能在 RYGB 后大鼠早期骨丢失中起关键作用,但其他因素,包括慢性代谢性酸中毒,导致肠道钙吸收正常后骨恢复不足。继发性甲状旁腺功能亢进不参与术后骨丢失。上调的维生素 D 激活可能补偿任何维生素 D 吸收不良。

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