Department of Endocrinology, Copenhagen University Hospital Hvidovre, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark.
Department of Clinical Physiology and Nuclear Medicine, Centre for Functional Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
Gastroenterology. 2019 May;156(6):1627-1641.e1. doi: 10.1053/j.gastro.2019.01.262. Epub 2019 Feb 8.
BACKGROUND & AIMS: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) induce substantial weight loss and improve glycemic control in patients with type 2 diabetes, but it is not clear whether these occur via the same mechanisms. We compared absorption rates of glucose and protein, as well as profiles of gastro-entero-pancreatic hormones, in patients who had undergone SG or RYGB vs controls.
We performed a cross-sectional study of 12 patients who had undergone sleeve gastrectomy, 12 patients who had undergone RYGB, and 12 individuals who had undergone neither surgery (controls), all in Denmark. Study participants were matched for body mass index, age, sex, and postoperative weight loss, and all had stable weights. They received continuous infusions of stable isotopes of glucose, glycerol, phenylalanine, tyrosine, and urea before and during a mixed meal containing labeled glucose and intrinsically phenylalanine-labeled caseinate. Blood samples were collected for 6 hours, at 10- to 60-minute intervals, and analyzed.
The systemic appearance of ingested glucose was faster after RYGB and SG vs controls; the peak glucose appearance rate was 64% higher after RYGB, and 23% higher after SG (both P < .05); the peak phenylalanine appearance rate from ingested casein was 118% higher after RYGB (P < .01), but similar between patients who had undergone SG and controls. Larger, but more transient increases in levels of plasma glucose and amino acids were accompanied by higher secretion of insulin, glucagon-like peptide 1, peptide YY, and cholecystokinin after RYGB, whereas levels of ghrelin were lower after SG, compared with RYGB and controls. Total 6-hour oral recovery of ingested glucose and protein was comparable among groups.
Postprandial glucose and protein absorption and gastro-entero-pancreatic hormone secretions differ after SG and RYGB. RYGB was characterized by accelerated absorption of glucose and amino acids, whereas protein metabolism after SG did not differ significantly from controls, suggesting that different mechanisms explain improved glycemic control and weight loss after these surgical procedures. ClinicalTrials.gov ID NCT03046186.
袖状胃切除术（SG）和 Roux-en-Y 胃旁路术（RYGB）可使 2 型糖尿病患者体重显著减轻并改善血糖控制，但尚不清楚这两种手术是否通过相同的机制来实现。我们比较了 SG 或 RYGB 患者与对照组患者的葡萄糖和蛋白质吸收率以及胃肠胰激素谱。
我们在丹麦进行了一项横断面研究，纳入了 12 例接受袖状胃切除术、12 例接受 Roux-en-Y 胃旁路术和 12 例未接受手术的个体（对照组）。所有研究参与者的体重指数、年龄、性别和术后体重减轻均匹配，且所有参与者的体重均稳定。他们在接受含有标记葡萄糖和内源性苯丙氨酸标记酪蛋白的混合餐之前和期间接受了稳定同位素葡萄糖、甘油、苯丙氨酸、酪氨酸和尿素的连续输注。在 6 小时内，每隔 10-60 分钟采集一次血样进行分析。
与对照组相比，RYGB 和 SG 术后摄入的葡萄糖全身表现更快；RYGB 后葡萄糖峰值出现率高 64%，SG 后高 23%（均 P <.05）；RYGB 后摄入酪蛋白的苯丙氨酸峰值出现率高 118%（P <.01），但 SG 患者与对照组之间相似。RYGB 后，血糖和氨基酸水平出现更大但更短暂的升高，伴随着胰岛素、胰高血糖素样肽 1、肽 YY 和胆囊收缩素的分泌增加，而 SG 后胃饥饿素水平较低，与 RYGB 和对照组相比。各组间 6 小时内口服摄入的葡萄糖和蛋白质的总回收率无差异。
SG 和 RYGB 术后的餐后葡萄糖和蛋白质吸收以及胃肠胰激素分泌不同。RYGB 的特点是葡萄糖和氨基酸吸收加速，而 SG 后的蛋白质代谢与对照组无显著差异，提示这两种手术改善血糖控制和减轻体重的机制不同。临床试验注册号 NCT03046186。
