Roux-en-Y胃旁路手术后空腹及餐后血浆胆汁酸反应增强。
Enhanced fasting and post-prandial plasma bile acid responses after Roux-en-Y gastric bypass surgery.
作者信息
Werling Malin, Vincent Royce P, Cross Gemma F, Marschall Hanns-Ulrich, Fändriks Lars, Lönroth Hans, Taylor David R, Alaghband-Zadeh Jamshid, Olbers Torsten, Le Roux Carel W
机构信息
Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital , Sweden.
出版信息
Scand J Gastroenterol. 2013 Nov;48(11):1257-64. doi: 10.3109/00365521.2013.833647. Epub 2013 Sep 18.
OBJECTIVE
Exogenous bile acid (BA) administration is associated with beneficial metabolic effects very similar to those seen after Roux-en-Y gastric bypass (RYGB) surgery. Re-routing of bile into a biliopancreatic limb with simultaneous exclusion of food occurs after RYGB, with subsequent increased fasting plasma BAs. The study assessed fasting and post-prandial plasma BA response before and 15 months after RYGB.
MATERIAL AND METHODS
The prospective study recruited 63 obese individuals (43 females), aged 43 (36-56) [median (IQR)] years. Blood samples were collected before and every 30 min for 120 min after a standard 400 kcal meal. Fasting and post-prandial plasma BAs, glucagons like peptide-1 (GLP-1), -tyrosine (PYY), fasting C-reactive protein (CRP), glucose and insulin were measured and homeostasis model assessment-insulin resistance (HOMA-IR) was calculated.
RESULTS
Following RYGB, body mass index, CRP, fasting glucose and HOMA-IR decreased; 43.7 (39.3-49.2) kg/m(2) to 29.2 (25.1-35.0) kg/m(2), 7.9 (4.1-11.9) mg/L to 0.4 (0.2-1.0) mg/L, 5.5 (5.0-6.0) mmol/L to 4.6 (4.3-4.9) mmol/L and 5.9 (3.5-9.2) to 1.7 (1.1-2.2), respectively, all P < 0.001. Fasting total BAs, GLP-1 and PYY increased after RYGB; 1.69 (0.70-2.56) µmol/L to 2.43 (1.23-3.82) µmol/L (P = 0.02), 6.8 (1.5-15.3) pmol/L to 17.1 (12.6-23.9) pmol/L (P < 0.001) and 4.0 (1.0-7.1) pmol/L to 15.2 (10.0-28.3) pmol/L (P < 0.001), respectively. The area under the curve for post-prandial total BAs, total glycine-conjugated BAs, GLP-1 and PYY were greater after RYGB; 486 (312-732) µmol/L/min versus 1012 (684-1921) µmol/L/min, 315 (221-466) µmol/L/min versus 686 (424-877) µmol/L/min, 3679 (3162-4537) pmol/L/min versus 5347 (4727-5781) pmol/L/min and 1887 (1423-2092) pmol/L/min versus 3296 (2534-3834) pmol/L/min, respectively, all P < 0.0001.
CONCLUSION
Weight loss following RYGB is associated with an increase in post-prandial plasma BA response due to larger amounts of glycine-conjugated BAs. This suggests up regulation of BA production and conjugation after RYGB.
目的
外源性胆汁酸（BA）给药与有益的代谢效应相关，这与Roux-en-Y胃旁路术（RYGB）手术后所见的效应非常相似。RYGB手术后，胆汁被重新引流到胆胰肢，同时食物被排除在外，随后空腹血浆BA增加。本研究评估了RYGB术前和术后15个月空腹和餐后血浆BA的反应。
材料与方法
这项前瞻性研究招募了63名肥胖个体（43名女性），年龄为43（36 - 56）[中位数（四分位间距）]岁。在摄入标准400千卡餐后，术前以及术后每30分钟采集一次血样，共采集120分钟。测量空腹和餐后血浆BA、胰高血糖素样肽-1（GLP-1）、酪酪肽（PYY）、空腹C反应蛋白（CRP）、血糖和胰岛素，并计算稳态模型评估胰岛素抵抗（HOMA-IR）。
结果
RYGB术后，体重指数、CRP、空腹血糖和HOMA-IR降低；分别从43.7（39.3 - 49.2）kg/m²降至29.2（25.1 - 35.0）kg/m²，7.9（4.1 - 11.9）mg/L降至0.4（0.2 - 1.0）mg/L，5.5（5.0 - 6.0）mmol/L降至4.6（4.3 - 4.9）mmol/L，以及5.9（3.5 - 9.2）降至1.7（1.1 - 2.2），所有P < 0.001。RYGB术后空腹总BA、GLP-1和PYY增加；分别从1.69（0.70 - 2.56）µmol/L增至2.43（1.23 - 3.82）µmol/L（P = 0.02），6.8（1.5 - 15.3）pmol/L增至17.1（12.6 - 23.9）pmol/L（P < 0.001），以及4.0（1.0 - 7.1）pmol/L增至15.2（10.0 - 28.3）pmol/L（P < 0.001）。RYGB术后餐后总BA、总甘氨酸结合型BA、GLP-1和PYY的曲线下面积更大；分别为486（312 - 732）µmol/L/分钟对1012（684 - 1921）µmol/L/分钟，315（221 - 466）µmol/L/分钟对686（424 - 877）µmol/L/分钟，3679（3162 - 4537）pmol/L/分钟对5347（4727 - 5781）pmol/L/分钟，以及1887（1423 - 2092）pmol/L/分钟对3296（2534 - 3834）pmol/L/分钟，所有P < 0.0001。
结论
RYGB术后体重减轻与餐后血浆BA反应增加有关，这是由于甘氨酸结合型BA含量增加。这表明RYGB术后BA生成和结合上调。
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