Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
Obes Surg. 2018 Dec;28(12):3969-3975. doi: 10.1007/s11695-018-3447-x.
Different bariatric procedures have been associated with variable weight loss and decrease in serum levels of lipids and lipoproteins. This variation could be partly related to the length of the small intestinal bypass. We evaluated the association of the small intestinal length with the non-alcoholic fatty liver disease (NAFLD) at baseline and with lipid metabolism before and after laparoscopic Roux-en-Y gastric bypass (LRYGB).
Seventy consecutive morbidly obese patients were recruited to this prospective study. A standard 60-cm biliopancreatic limb (BPL) and 120-cm alimentary limb (AL) was performed, and thereafter, the common channel (CC) length was measured during elective LRYGB. Histological analysis of liver biopsy to diagnose NAFLD was performed. The mRNA expression of genes participating in the cholesterol and fatty acid metabolism in the liver was analyzed.
Female sex (p = 0.006), serum triglycerides (TG, p = 0.016), serum alanine aminotransferase (ALT, p = 0.007), and liver steatosis (p = 0.001) associated with the small intestinal length (BPL + AL + CC) at baseline. Association remained significant between levels of serum TG and CC length (p = 0.048) at 1-year follow-up. Liver mRNA expression of genes regulating cholesterol synthesis and bile metabolism did not associate with the baseline small intestinal length.
Our findings support the suggestions that small intestinal length regulates TG metabolism before and after LRYGB. Therefore, modification of the length of bypassed small intestine based on measured total small intestinal length could optimize the outcomes of the elective LRYGB.
不同的减重手术与体重减轻和血清脂质及脂蛋白水平降低有关。这种差异可能部分与小肠旁路的长度有关。我们评估了小肠长度与基线时非酒精性脂肪性肝病（NAFLD）的相关性，以及与腹腔镜 Roux-en-Y 胃旁路术（LRYGB）前后脂质代谢的相关性。
连续招募了 70 例病态肥胖患者进行这项前瞻性研究。我们进行了标准的 60cm 胆胰支（BPL）和 120cm 营养支（AL），然后在选择性 LRYGB 期间测量共同通道（CC）的长度。对肝活检进行组织学分析以诊断 NAFLD。分析参与肝脏胆固醇和脂肪酸代谢的基因的 mRNA 表达。
女性（p=0.006）、血清三酰甘油（TG，p=0.016）、血清丙氨酸氨基转移酶（ALT，p=0.007）和肝脂肪变性（p=0.001）与基线时的小肠长度（BPL+AL+CC）相关。在 1 年随访时，血清 TG 水平与 CC 长度之间仍存在显著相关性（p=0.048）。调节胆固醇合成和胆汁代谢的肝脏基因的 mRNA 表达与基线小肠长度无关。
我们的研究结果支持这样的观点，即小肠长度在 LRYGB 前后调节 TG 代谢。因此，基于测量的总小肠长度来调整旁路小肠的长度可以优化选择性 LRYGB 的结果。
