Zhang Xiong, Yu Bo, Yang Dan, Qiao Zhengdong, Cao Ting, Zhang Peng
Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
Surg Obes Relat Dis. 2016 Sep-Oct;12(8):1569-1576. doi: 10.1016/j.soard.2016.04.018. Epub 2016 Apr 20.
Roux-en-Y gastric bypass (RYGB) has shown positive outcomes in the remission of type 2 diabetes (T2D) and weight loss in obese patients by inhibiting food intake and nutrient absorption as well as inducing favorable hormonal changes. The purpose of the present study was to investigate whether gastric volume reduction is still required in addition to intestinal bypass for the purpose of T2D remission in nonobese patients.
University Medical Center.
Nonobese T2D Goto-Kakizaki rats were employed in the study. All rats were randomized into 3 groups according to the surgical procedure performed, including (1) RYGB, (2) duodeno-jejunal bypass (DJB) without gastric volume reduction, and (3) sham surgery (control). In addition, age-matched Wistar rats were adopted as normal nondiabetic controls. Weight, food intake, fasting plasma glucose, and intraperitoneal glucose tolerance test were measured in vivo before and 2, 4, and 8 weeks after the treatment. Whole body metabolic parameters including respiratory exchange ratio, energy expenditure, and activities were also recorded in all animals at the third week postoperatively.
Compared with DJB and sham animals, the RYGB group had lower weight, less food intake, lower fasting plasma glucose, and improved glucose tolerance at all measuring time points postoperatively. By measuring whole body metabolic parameters, we found that RYGB, but not DJB, increased metabolic rate manifested by increased energy expenditure but less activity at night. In the meantime, respiratory exchange ratio was lower in RYGB group than in the other 3 groups at daytime, meaning adipose tissue became the main source of internal energy production during the resting phase in the group.
For nonobese T2D patients, adding gastric volume reduction to intestine bypass gave better efficacy in remission of T2D by increasing metabolic rate and adipolysis, especially during the resting period.
Roux-en-Y胃旁路术（RYGB）通过抑制食物摄入和营养吸收以及诱导有利的激素变化，在肥胖患者的2型糖尿病（T2D）缓解和体重减轻方面显示出积极效果。本研究的目的是调查对于非肥胖患者，除了肠道旁路术之外，为了实现T2D缓解是否仍然需要减少胃容量。
大学医学中心。
本研究采用非肥胖T2D Goto-Kakizaki大鼠。根据所进行的手术程序，将所有大鼠随机分为3组，包括（1）RYGB组，（2）不减少胃容量的十二指肠-空肠旁路术（DJB）组，以及（3）假手术组（对照组）。此外，采用年龄匹配的Wistar大鼠作为正常非糖尿病对照。在治疗前以及治疗后2、4和8周，在体内测量体重、食物摄入量、空腹血糖和腹腔内葡萄糖耐量试验。在术后第三周，还记录了所有动物的全身代谢参数，包括呼吸交换率、能量消耗和活动情况。
与DJB组和假手术组动物相比，RYGB组在术后所有测量时间点的体重更低、食物摄入量更少、空腹血糖更低，且葡萄糖耐量得到改善。通过测量全身代谢参数，我们发现RYGB组增加了代谢率，表现为能量消耗增加但夜间活动减少，而DJB组则没有。同时，RYGB组白天的呼吸交换率低于其他3组，这意味着在该组的静息期，脂肪组织成为体内能量产生的主要来源。
对于非肥胖T2D患者，在肠道旁路术的基础上减少胃容量，通过提高代谢率和脂肪分解，尤其是在静息期，在T2D缓解方面具有更好的疗效。
