Mumphrey Michael B, Hao Zheng, Townsend R Leigh, Patterson Laurel M, Berthoud Hans-Rudolf
Neurobiology of Nutrition Laboratory, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
Obes Surg. 2015 Aug;25(8):1468-73. doi: 10.1007/s11695-014-1547-9.
Clinical studies have shown similar rapid improvements in body mass and glycemic control after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). Evidence suggests that adaptive intestinal tissue growth and reprogramming of intestinal glucose disposal play a key role in the beneficial effects on glucose homeostasis after RYGB, but it is not known whether such adaptive changes also occur after sleeve gastrectomy.
High-fat diet-induced obese rats were subjected to either VSG or RYGB, and intestinal growth and functional adaptations were assessed by using morphometric, immunohistochemical, and immuno-blot techniques, 3 months after surgery or sham surgery.
The cross-sectional areas of the Roux and common limbs are significantly increased after RYGB compared with sham surgery (Roux limb: 17.1 ± 4.0 vs. 5.5 ± 0.1 mm(2); common limb: 11.7 ± 0.6 vs. 5.1 ± 0.5 mm(2); p < 0.01), but the cross-sectional area of the corresponding jejunum is not different from controls after VSG. Similarly, mucosal thickness and the number of GLP-1 cells are not increased after VSG. Protein expression of hexokinase II is increased fourfold (p < 0.01) in the Roux limb after RYGB, but not in the jejunum after VSG.
Adaptive hypertrophy and reprogramming of glucose metabolism in the small intestine are not necessary for VSG to improve body composition and glycemic control. The similar beneficial effects of VSG and RYGB on glucose homeostasis might be mediated by different mechanisms.
临床研究表明，Roux-en-Y胃旁路术（RYGB）和垂直袖状胃切除术（VSG）后，体重和血糖控制方面均有相似的快速改善。有证据表明，适应性肠道组织生长和肠道葡萄糖代谢重编程在RYGB术后对葡萄糖稳态的有益影响中起关键作用，但尚不清楚袖状胃切除术后是否也会发生这种适应性变化。
对高脂饮食诱导的肥胖大鼠进行VSG或RYGB手术，并在手术或假手术后3个月，使用形态计量学、免疫组织化学和免疫印迹技术评估肠道生长和功能适应性。
与假手术相比，RYGB术后Roux袢和共同袢的横截面积显著增加（Roux袢：17.1±4.0 vs. 5.5±0.1mm²；共同袢：11.7±0.6 vs. 5.1±0.5mm²；p<0.01），但VSG术后相应空肠的横截面积与对照组无差异。同样，VSG术后黏膜厚度和GLP-1细胞数量未增加。RYGB术后Roux袢中己糖激酶II的蛋白表达增加了四倍（p<0.01），但VSG术后空肠中未增加。
VSG改善身体成分和血糖控制并不需要小肠的适应性肥大和葡萄糖代谢重编程。VSG和RYGB对葡萄糖稳态的相似有益作用可能由不同机制介导。
