Clinical and Experimental Endocrinology, Department of Anatomy, Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.
Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
Int J Obes (Lond). 2019 May;43(5):1009-1018. doi: 10.1038/s41366-018-0117-y. Epub 2018 May 24.
BACKGROUND/OBJECTIVES: Changes in gut hormone secretion are important for the anti-diabetic effects of bariatric surgery. Roux-en-Y gastric bypass (RYGB) with extended biliopancreatic limb (BPL) length may improve the metabolic outcomes when compared to the classical procedure. The purpose of this study was to compare the gut hormone responses to a liquid mixed meal after RYGB with one of two different BPL lengths.
SUBJECTS/METHODS: Non-diabetic weight-stable individuals previously submitted to classical RYGB (n = 9; BPL length: 87.8 ± 20.5 cm) or long BPL RYGB (n = 11; BPL length: 200 cm) underwent a liquid mixed-meal tolerance test (MMTT). Blood was sampled at baseline and 15, 30, 45, 60, 90 and 120 min later for measurement of plasma glucose, enteropancreatic hormones and total bile acids (TBA).
Plasma glucose excursion curves were similar in the two groups. The long BPL RYGB group displayed significantly higher fasting and post-prandial GLP-1 (t = 0 min, p = 0.01 and t = 45 min, p < 0.05; tAUC: 11,205 ± 3399 vs 7889 ± 1686 pmol/L × min, p = 0.02) and neurotensin (t = 0 min, p = 0.02; t = 45 min, p < 0.05 and t = 60 min, p < 0.01; tAUC: 18,392 ± 7066 vs 11,437 ± 3658 pmol/L × min, p = 0.02) levels, while responses of GIP (t = 15 min, p < 0.01), insulin and C-peptide (t = 30 min, p < 0.001) were lower as compared to classical RYGB. There were no differences in glucagon, PP, PYY and TBA between the groups.
RYGB with a longer BPL results in a distinctive post-prandial hormone profile with augmented GLP-1 and neurotensin responses that could be beneficial for the metabolic outcomes of the surgery.
背景/目的：肠道激素分泌的变化对于减重手术的抗糖尿病作用很重要。与经典手术相比，延长胆胰支（BPL）长度的 Roux-en-Y 胃旁路术（RYGB）可能会改善代谢结果。本研究的目的是比较两种不同 BPL 长度的 RYGB 术后对混合液餐后肠道激素的反应。
受试者/方法：非糖尿病体重稳定的个体先前接受过经典 RYGB（n=9；BPL 长度：87.8±20.5cm）或长 BPL RYGB（n=11；BPL 长度：200cm），进行液体混合餐耐量试验（MMTT）。在基线和 15、30、45、60、90 和 120 分钟时采集血样，以测量血浆葡萄糖、肠胰激素和总胆汁酸（TBA）。
两组的血糖波动曲线相似。长 BPL RYGB 组空腹和餐后 GLP-1（t=0 分钟，p=0.01 和 t=45 分钟，p<0.05；tAUC：11205±3399 比 7889±1686pmol/L×min，p=0.02）和神经降压素（t=0 分钟，p=0.02；t=45 分钟，p<0.05 和 t=60 分钟，p<0.01；tAUC：18392±7066 比 11437±3658pmol/L×min，p=0.02）水平显著升高，而 GIP（t=15 分钟，p<0.01）、胰岛素和 C 肽（t=30 分钟，p<0.001）的反应则较低。两组间胰高血糖素、PP、PYY 和 TBA 无差异。
BPL 较长的 RYGB 术后会产生独特的餐后激素谱，GLP-1 和神经降压素反应增强，这可能对手术的代谢结果有益。
