Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Fondazione Policlinico Universitario A. Gemelli Instituto di Ricovero e Cura a Carattere Scientifico and Università Cattolica del Sacro Cuore, Rome, Italy.
Br J Surg. 2019 Aug;106(9):1178-1186. doi: 10.1002/bjs.11208. Epub 2019 Jun 19.
Metabolic surgery is associated with a prompt improvement in insulin resistance, although the mechanism of action remains unknown. The literature on bile acid changes after metabolic surgery is conflicting, and insulin sensitivity is generally assessed by indirect methods. The aim of this study was to investigate the relationship between improvement in insulin sensitivity and concentration of circulating bile acids after biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB).
This was a prospective observational study of nine patients who underwent BPD and six who had RYGB. Inclusion criteria for participation were a BMI in excess of 40 kg/m , no previous diagnosis of type 2 diabetes and willingness to participate. Exclusion criteria were major endocrine diseases, malignancies and liver cirrhosis. Follow-up visits were carried out after a mean(s.d.) of 185·3(72·9) days. Fasting plasma bile acids were assessed by ultra-high-performance liquid chromatography coupled with a triple quadrupole mass spectrometer, and insulin sensitivity was measured by means of a hyperinsulinaemic-euglycaemic clamp.
A significant increase in all bile acids, as well as an amelioration of insulin sensitivity, was observed after metabolic surgery. An increase in conjugated secondary bile acids was significantly associated with an increase in insulin sensitivity. Only the increase in glycodeoxycholic acid was significantly associated with an increase in insulin sensitivity in analysis of individual conjugated secondary bile acids.
Glycodeoxycholic acid might drive the improved insulin sensitivity after metabolic surgery.
代谢手术可迅速改善胰岛素抵抗，但其作用机制尚不清楚。关于代谢手术后胆汁酸变化的文献存在争议，而胰岛素敏感性通常通过间接方法进行评估。本研究旨在探讨胆胰分流术（BPD）和 Roux-en-Y 胃旁路术（RYGB）后胰岛素敏感性改善与循环胆汁酸浓度之间的关系。
这是一项前瞻性观察研究，共纳入 9 例接受 BPD 手术的患者和 6 例接受 RYGB 手术的患者。参与研究的标准为 BMI 超过 40kg/m²，无 2 型糖尿病既往诊断且愿意参与。排除标准为主要内分泌疾病、恶性肿瘤和肝硬化。平均（标准差）185.3（72.9）天后进行随访。采用超高效液相色谱-三重四极杆质谱联用仪检测空腹血浆胆汁酸，通过高胰岛素-正常血糖钳夹技术测量胰岛素敏感性。
代谢手术后所有胆汁酸水平均显著升高，胰岛素敏感性也得到改善。结合型次级胆汁酸增加与胰岛素敏感性改善显著相关。在分析个体结合型次级胆汁酸时，仅甘脱氧胆酸的增加与胰岛素敏感性的增加显著相关。
甘脱氧胆酸可能是代谢手术后胰岛素敏感性改善的驱动因素。
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