Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.
Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Surg Endosc. 2018 Feb;32(2):805-812. doi: 10.1007/s00464-017-5747-y. Epub 2017 Aug 4.
Bile acids (BAs) are post-prandial hormones that play an important role in glucose and lipid homeostasis as well as energy expenditure. Total and glycine-amidated BAs increase after sleeve gastrectomy (SG) and correlate to improved metabolic disease. No specific bile acid subtype has been shown conclusively to mediate the weight loss effect. Therefore, the objective of this study was to prospectively evaluate the comprehensive changes in meal-stimulated BAs after SG and determine if a specific change in the BA profile correlates to the early weight loss response.
Patients were prospectively enrolled at the University of Nebraska Medical Center who were undergoing a SG for treatment of morbid obesity. Primary and secondary plasma bile acids and their amidated (glycine, G-, or taurine, T-) subtypes were measured at fasting, 30 and 60 min after a liquid meal performed pre-op, and at 6 and 12 weeks post-op. Area under the curve (AUC) was calculated for the hour meal test for each bile acid subtype. BAs that were significantly increased post-op were correlated to body mass index (BMI) loss.
Total BA AUC was significantly increased at 6 (p < 0.01) and 12 weeks post-op (p < 0.01) compared to pre-operative values. The increase in total BA AUC was due to a statistically significant increase in G-BAs. Nine different BA AUC subtypes were significantly increased at both 6 and 12 weeks post-op. Increased total and G-chenodeoxycholic acid AUC was significantly correlated to the 6 week BMI loss (p = 0.03). Increased G-hyocholic acid was significantly correlated to increased weight loss at both 6 (p = 0.05) and 12 weeks (p = 0.006).
SG induced an early and persistent post-prandial surge in multiple bile acid subtypes. Increased G-hyocholic consistently correlated with greater early BMI loss. This study provides evidence for a role of BAs in the surgical weight loss response after SG.
胆汁酸（BAs）是餐后激素，在葡萄糖和脂质稳态以及能量消耗中发挥重要作用。袖状胃切除术（SG）后总胆汁酸和甘氨酰化胆汁酸增加，并与改善代谢疾病相关。没有具体的胆汁酸亚型被证明可以介导减肥效果。因此，本研究旨在前瞻性评估 SG 后餐刺激胆汁酸的综合变化，并确定 BA 谱的特定变化是否与早期体重减轻反应相关。
内布拉斯加大学医学中心前瞻性招募接受 SG 治疗病态肥胖的患者。在术前、术后 6 和 12 周，分别在空腹、液体餐后 30 和 60 分钟时测量初级和次级血浆胆汁酸及其酰胺化（甘氨酸，G-，或牛磺酸，T-）亚型。计算每种胆汁酸亚型的小时餐测试曲线下面积（AUC）。与 BMI 损失相关的术后显著增加的 BA。
与术前值相比，术后 6 周（p < 0.01）和 12 周（p < 0.01）总 BA AUC 显著增加。总 BA AUC 的增加是由于 G-胆汁酸的统计学显著增加。9 种不同的 BA AUC 亚型在术后 6 周和 12 周均显著增加。总胆汁酸和 G-鹅脱氧胆酸 AUC 的增加与 6 周 BMI 损失显著相关（p = 0.03）。G-胆酸增加与 6 周（p = 0.05）和 12 周（p = 0.006）体重减轻增加显著相关。
SG 诱导餐后多种胆汁酸亚型的早期和持续激增。G-胆酸的增加与早期 BMI 损失增加一致。这项研究为 SG 后 BA 在手术减肥反应中的作用提供了证据。
