Seyfried Florian, Bueter Marco, Spliethoff Kerstin, Miras Alexander D, Abegg Kathrin, Lutz Thomas A, le Roux Carel W
Department of Investigative Medicine, Imperial College London, London, UK.
Obes Surg. 2014 Nov;24(11):1888-95. doi: 10.1007/s11695-014-1301-3.
Whilst weight loss results in many beneficial metabolic consequences, the immediate improvement in glycaemia after Roux-en-Y Gastric bypass (RYGB) remains intriguing. Duodenal jejunal bypass (DJB) induces similar glycaemic effects, while not affecting calorie intake or weight loss. We studied diabetic ZDF(fa/fa) rats to compare the effects of DJB and RYGB operations on glycaemia.
Male ZDF(fa/fa) rats, aged 12 weeks underwent RYGB, DJB or sham operations. Unoperated ZDF(fa/fa) and ZDF(fa/+w)ere used as controls. Body weight, food intake, fasting glucose, insulin and gut hormones were measured at baseline and on postoperative days 2, 10 and 35. An oral glucose tolerance test (OGTT) was performed on days 12 and 26.
DJB had similar food intake and body weight to sham-operated and unoperated control ZDF(fa/fa) rats (p = NS), but had lower fasting glucose (p < 0.05). RYGB had lower food intake, body weight and fasting glucose compared to all groups (p < 0.001). DJB prevented the progressive decline in fasting insulin observed in the sham-operated or unoperated ZDF(fa/fa) rats, while RYGB with normalized glycaemia reduced the physiological requirement for raised fasting insulin.
Bypassing the proximal small bowel with the DJB has mild to moderate body weight independent effects on glucose homeostasis and preservation of fasting insulin levels in the medium term. These effects might be further amplified by the additional anatomical and physiological changes after RYGB.
虽然体重减轻会带来许多有益的代谢结果，但胃旁路术（RYGB）后血糖的立即改善仍然很有趣。十二指肠空肠旁路术（DJB）可产生类似的血糖效应，同时不影响热量摄入或体重减轻。我们研究了糖尿病ZDF（fa/fa）大鼠，以比较DJB和RYGB手术对血糖的影响。
12周龄的雄性ZDF（fa/fa）大鼠接受RYGB、DJB或假手术。未手术的ZDF（fa/fa）和ZDF（fa/+）大鼠用作对照。在基线以及术后第2、10和35天测量体重、食物摄入量、空腹血糖、胰岛素和肠道激素。在第12天和第26天进行口服葡萄糖耐量试验（OGTT）。
DJB的食物摄入量和体重与假手术和未手术的对照ZDF（fa/fa）大鼠相似（p=无显著性差异），但空腹血糖较低（p<0.05）。与所有组相比，RYGB的食物摄入量、体重和空腹血糖较低（p<0.001）。DJB阻止了假手术或未手术的ZDF（fa/fa）大鼠中观察到的空腹胰岛素的逐渐下降，而血糖正常化的RYGB降低了对升高的空腹胰岛素的生理需求。
通过DJB绕过近端小肠对葡萄糖稳态有轻度至中度的体重独立影响，并在中期维持空腹胰岛素水平。RYGB术后额外的解剖和生理变化可能会进一步放大这些影响。
