Alamuddin Naji, Vetter Marion L, Ahima Rexford S, Hesson Louise, Ritter Scott, Minnick Alyssa, Faulconbridge Lucy F, Allison Kelly C, Sarwer David B, Chittams Jesse, Williams Noel N, Hayes Matthew R, Loughead James W, Gur Ruben, Wadden Thomas A
Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, and the Institute for Diabetes, Obesity and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
Obes Surg. 2017 Jun;27(6):1563-1572. doi: 10.1007/s11695-016-2505-5.
Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) produce substantial weight loss, both primarily through gastric restriction but with potentially different hormonal signaling. This prospective, observational study compared changes in gut-derived hormones in VSG, RYGB, and weight-stable participants at 6 and 18 months post-surgery.
Sixty-four obese, non-diabetic women, including 18 VSG, 23 RYGB, and 23 weight-stable controls completed assessments at baseline and 6 months, before and after consuming a mixed-nutrient meal; blood sampling occurred for 180 min post-meal. Fifty-one participants completed the 18-month outcome. Change from baseline in post-prandial area under the curve (over 180 min) for GLP-1, PYY, ghrelin, and leptin was measured at 6 and 18 months post-surgery.
At 18 months, VSG and RYGB participants lost a mean (±SEM) of 25.5 ± 2.3% and 34.2 ± 4.2% of initial weight, respectively (p < 0.156), which both differed (p < 0.001) from the +1.7 ± 1.0% gain in the control group. Fasting ghrelin declined significantly more in VSG than RYGB participants at both months 6 (p = 0.0199) and 18 (p = 0.0003). In response to the mixed-nutrient meal, GLP-1 and PYY demonstrated an exaggerated post-prandial response that was significantly greater in RYGB than VSG at 6 months (p < 0.0001 and p = 0.0062, respectively) but not 18 months (p = 0.0296 and p = 0.1210).
VSG and RYGB both produced substantial weight losses at 18 months. The data suggest a role of gastrointestinal hormones as mediators of weight loss.
垂直袖状胃切除术（VSG）和Roux-en-Y胃旁路术（RYGB）均能显著减轻体重，两者主要通过胃限制起作用，但可能具有不同的激素信号传导。这项前瞻性观察性研究比较了VSG、RYGB患者以及体重稳定的参与者在术后6个月和18个月时肠道源性激素的变化。
64名肥胖非糖尿病女性，包括18名接受VSG手术者、23名接受RYGB手术者和23名体重稳定的对照者，在基线时以及进食混合营养餐前后6个月完成评估；进食后180分钟进行血样采集。51名参与者完成了18个月的结果评估。在术后6个月和18个月时，测量了胰高血糖素样肽-1（GLP-1）、肽YY（PYY）、胃饥饿素和瘦素餐后曲线下面积（180分钟内）相对于基线的变化。
在18个月时，VSG组和RYGB组参与者分别减轻了初始体重的平均（±标准误）25.5±2.3%和34.2±4.2%（p<0.156），这两组与对照组体重增加1.7±1.0%均存在差异（p<0.001）。在术后6个月（p=0.0199）和18个月（p=0.0003）时，VSG组空腹胃饥饿素的下降幅度均显著大于RYGB组。在进食混合营养餐时，GLP-1和PYY表现出餐后反应增强，在术后6个月时，RYGB组的这种反应显著大于VSG组（分别为p<0.0001和p=0.0062），但在18个月时无显著差异（p= .0296和p=0.1210）。
VSG和RYGB在18个月时均能显著减轻体重。数据表明胃肠激素在体重减轻过程中起到了介导作用。
