Kalinowski Piotr, Paluszkiewicz Rafał, Wróblewski Tadeusz, Remiszewski Piotr, Grodzicki Mariusz, Bartoszewicz Zbigniew, Krawczyk Marek
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Surg Obes Relat Dis. 2017 Feb;13(2):181-188. doi: 10.1016/j.soard.2016.08.025. Epub 2016 Aug 18.
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cause weight loss and metabolic improvement, but results of published studies are contradictory.
The aim of this study was to compare the effects of SG and RYGB on ghrelin, leptin, and glucose homeostasis in a randomized controlled trial.
University hospital, Poland.
Seventy-two morbidly obese patients were randomly selected to undergo either SG (n = 36) or RYGB (n = 36). Fasting ghrelin, leptin, glucose, insulin, C-peptide, glucagon, glycated hemoglobin, and homeostasis model assessment of insulin resistance were assessed preoperatively and at 1, 6, and 12 months postoperatively. No differences were found in anthropometric and biochemical parameters between the study groups at baseline.
Sixty-nine (95.8%) patients completed the study. Percentage of excess weight loss at 12 months was 67.6±19.3% after SG and 64.2±18.5% after RYGB (P>.05). Fasting ghrelin levels decreased 1 month after SG (from 76.8 pmol/L to 35.3 pmol/L; P<.05) and remained reduced until 12 months (41.6 pmol/L; P<.05) but increased 12 months after RYGB from 74.6 pmol/L to 130.2 pmol/L (P<.05). Leptin, glucose, insulin, and C-peptide concentrations and glycated hemoglobin and homeostasis model assessment of insulin resistance values decreased significantly in both groups during 12 months.
RYGB and SG induce comparable weight loss and improvement in metabolism of glucose. Ghrelin levels decrease after SG and increase after RYGB, but this difference does not affect similar outcomes of these procedures during 1-year follow-up. The contribution of ghrelin to weight loss or metabolic benefits after bariatric surgery is not straightforward, but rather influenced by multiple factors.
袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）可导致体重减轻和代谢改善，但已发表研究的结果相互矛盾。
本研究的目的是在一项随机对照试验中比较SG和RYGB对胃饥饿素、瘦素和葡萄糖稳态的影响。
波兰大学医院。
72例病态肥胖患者被随机选择接受SG（n = 36）或RYGB（n = 36）。术前及术后1、6和12个月评估空腹胃饥饿素、瘦素、葡萄糖、胰岛素、C肽、胰高血糖素、糖化血红蛋白和胰岛素抵抗的稳态模型评估。研究组在基线时的人体测量和生化参数无差异。
69例（95.8%）患者完成了研究。SG术后12个月的超重减轻百分比为67.6±19.3%，RYGB术后为64.2±18.5%（P>0.05）。SG术后1个月空腹胃饥饿素水平下降（从76.8 pmol/L降至35.3 pmol/L；P<0.05），并持续降低至12个月（41.6 pmol/L；P<0.05），但RYGB术后12个月从74.6 pmol/L升至130.2 pmol/L（P<0.05）。两组在12个月内瘦素、葡萄糖、胰岛素和C肽浓度以及糖化血红蛋白和胰岛素抵抗的稳态模型评估值均显著下降。
RYGB和SG导致相似的体重减轻和葡萄糖代谢改善。SG后胃饥饿素水平下降，RYGB后升高，但这种差异在1年随访期间不影响这些手术的相似结果。胃饥饿素对减肥手术术后体重减轻或代谢益处的贡献并不直接，而是受多种因素影响。
