Zhang Xiang, Liu Teng, Wang Yanmin, Zhong Mingwei, Zhang Guangyong, Liu Shaozhuang, Wu Tongzhi, Rayner Christopher K, Hu Sanyuan
Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China.
Discipline of Medicine, The University of Adelaide, Level 6 Eleanor Harrald Building, Royal Adelaide Hospital, Frome Road, Adelaide, SA, Australia.
Obes Surg. 2016 Jul;26(7):1565-75. doi: 10.1007/s11695-015-1925-y.
Duodenal-jejunal bypass (DJB) induces rapid and durable improvement in glucose and lipid metabolism. Besides bypassing the proximal gut, DJB also diverts bile acids (BAs) into the distal gut, increasing luminal and systemic BAs that are essential to metabolic homeostasis. The aim of this study is to evaluate whether bile diversion (BD) alone can recapitulate the effects of DJB on glucose and lipid metabolism.
BD, DJB and SHAM procedures were performed in a diabetic rat model induced by high-fat diet (HFD)/streptozotocin (STZ). Body weight, energy intake, blood glucose, serum hormones, insulin sensitivity, lipid profiles, and luminal and systemic BAs were measured postsurgery.
BD reduced body weight, independently of energy intake, whereas DJB had no effects. Luminal and serum BAs were increased after both DJB and BD, and were higher after BD than DJB. During glucose tolerance test, both fasting and postprandial blood glucose concentrations were reduced with DJB and BD, and were lower after DJB than BD. Insulin sensitivity was improved after DJB, but remained unchanged after BD. Fasting and postprandial GLP-1 were equally increased after DJB and BD. Serum triglyceride and free fatty acids were decreased more after BD than DJB, while hepatic triglyceride storage was reduced more after DJB.
These observations indicate that BD, which increases luminal and systemic BAs and postprandial GLP-1, represents an important component of DJB in restoring glucose and lipid homeostasis in diabetic state. However, other mechanisms associated with DJB also appear to make complementary contributions to metabolic regulation.
十二指肠-空肠旁路术（DJB）能迅速且持久地改善糖脂代谢。除了绕过近端肠道外，DJB还将胆汁酸（BAs）引流至远端肠道，增加了对代谢稳态至关重要的肠腔和全身胆汁酸水平。本研究旨在评估单纯胆汁引流（BD）是否能重现DJB对糖脂代谢的影响。
在高脂饮食（HFD）/链脲佐菌素（STZ）诱导的糖尿病大鼠模型中进行BD、DJB和假手术。术后测量体重、能量摄入、血糖、血清激素、胰岛素敏感性、血脂谱以及肠腔和全身胆汁酸水平。
BD可降低体重，与能量摄入无关，而DJB无此作用。DJB和BD术后肠腔和血清胆汁酸均增加，且BD术后高于DJB。葡萄糖耐量试验期间，DJB和BD均降低了空腹和餐后血糖浓度，且DJB术后低于BD。DJB术后胰岛素敏感性提高，但BD术后无变化。DJB和BD术后空腹和餐后胰高血糖素样肽-1（GLP-1）均同样增加。BD术后血清甘油三酯和游离脂肪酸降低幅度大于DJB，而DJB术后肝脏甘油三酯储存减少幅度更大。
这些观察结果表明，BD增加了肠腔和全身胆汁酸以及餐后GLP-1水平，是DJB在糖尿病状态下恢复糖脂稳态的重要组成部分。然而，与DJB相关的其他机制似乎也对代谢调节起到了补充作用。
