Wölnerhanssen Bettina K, Meyer-Gerspach Anne Christin, Peters Thomas, Beglinger Christoph, Peterli Ralph
Department of Biomedicine, University Hospital, CH-4031, Basel, Switzerland; Department of Research, St. Claraspital, CH-4016, Basel, Switzerland.
Department of Biomedicine, University Hospital, CH-4031, Basel, Switzerland.
Surg Obes Relat Dis. 2016 Aug;12(7):1320-1327. doi: 10.1016/j.soard.2015.11.022. Epub 2015 Nov 27.
After laparoscopic Roux-en-Y gastric bypass (LRYGB), many patients suffer from dumping syndrome. Oral glucose tolerance tests are usually carried out with 50-75 g of glucose. The aim of this study was to examine whether minimal glucose loads of 10 g and 25 g induce a reliable secretion of satiation peptides without dumping symptoms after LRYGB. In addition, lean and obese controls were examined.
The objective of this study was to determine the effects of low oral glucose loads on incretin release and gastric emptying.
All surgical procedures were performed by the same surgeon (RP) at the St. Claraspital Basel in Switzerland. Oral glucose challenges were carried out at the University Hospital of Basel (Phase 1 Research Unit).
Eight patients 10±.4 weeks after LRYGB (PostOP; body mass index [BMI]: 38.6 kg/m±1.7) as well as 12 lean controls (LC; BMI: 21.8 kg/m±.6) and 12 obese controls (OC; BMI 38.7 kg/m±1.3) received 10 g and 25 g of oral glucose. We examined clinical signs of dumping syndrome; plasma glucose, insulin, glucagon-like peptide 1, glucose-dependent insulinotropic peptide, and peptide tyrosine tyrosine concentrations; and gastric emptying with a C-sodium acetate breath test.
No signs of dumping were seen in PostOP. Compared with OC, LC showed lower fasting glucose, insulin, and C-peptide, and lower homeostasis model assessment (HOMA) and AUC-180 for insulin and C-peptide. In PostOP, fasting insulin, HOMA and AUC-180 for insulin was lower and no difference was found in fasting C-peptide or AUC-180 for C-peptide compared to OC. There was no significant difference in fasting glucose, insulin, C-peptide, HOMA and AUC-180 for insulin in PostOP compared to LC, but AUC-180 for C-peptide was higher in PostOP. AUC-60 for gut hormones was similar in OC and LC and higher in PostOP compared to OC or LC. gastric emptying was slower in LC and OC compared with PostOP.
After LRYGB, 25 g oral glucose is well tolerated and leads to reliable secretion of gut hormones. Fasting glucose, insulin and C-peptide are normalized, while glucagon-like peptide 1, glucose-dependent insulinotropic peptide and peptide tyrosine tyrosine are overcorrected. Pouch emptying is accelerated after LRYGB.
腹腔镜Roux-en-Y胃旁路术（LRYGB）后，许多患者会出现倾倒综合征。口服葡萄糖耐量试验通常采用50 - 75克葡萄糖进行。本研究的目的是检验10克和25克的最小葡萄糖负荷量是否能在LRYGB术后诱导饱腹感肽的可靠分泌且无倾倒症状。此外，还对体重正常者和肥胖者进行了对照研究。
本研究的目的是确定低口服葡萄糖负荷量对肠促胰岛素释放和胃排空的影响。
所有手术均由瑞士巴塞尔圣克拉拉医院的同一位外科医生（RP）进行。口服葡萄糖激发试验在巴塞尔大学医院（一期研究单元）进行。
8例LRYGB术后10±0.4周的患者（术后组；体重指数[BMI]：38.6 kg/m²±1.7）以及12例体重正常对照者（体重正常组；BMI：21.8 kg/m²±0.6）和12例肥胖对照者（肥胖组；BMI 38.7 kg/m²±1.3）接受了10克和25克的口服葡萄糖。我们检查了倾倒综合征的临床体征；血浆葡萄糖、胰岛素、胰高血糖素样肽1、葡萄糖依赖性促胰岛素多肽和肽YY浓度；并用¹⁴C - 醋酸钠呼气试验检测了胃排空情况。
术后组未出现倾倒迹象。与肥胖组相比，体重正常组空腹血糖、胰岛素和C肽水平较低，胰岛素和C肽的稳态模型评估（HOMA）及AUC - 180也较低。术后组与肥胖组相比，空腹胰岛素、HOMA及胰岛素的AUC - 180较低，空腹C肽或C肽的AUC - 180无差异。术后组与体重正常组相比，空腹血糖、胰岛素、C肽、HOMA及胰岛素的AUC - 180无显著差异，但术后组C肽的AUC - 180较高。肥胖组和体重正常组肠道激素的AUC - 60相似，术后组高于肥胖组或体重正常组。与术后组相比，体重正常组和肥胖组的胃排空较慢。
LRYGB术后，25克口服葡萄糖耐受性良好，可导致肠道激素的可靠分泌。空腹血糖、胰岛素和C肽恢复正常，而胰高血糖素样肽1、葡萄糖依赖性促胰岛素多肽和肽YY过度纠正。LRYGB术后胃囊排空加快。
