Department of Integration of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan.
Oral Medicine Research Centre, Fukuoka, Japan.
Br J Surg. 2020 Nov;107(12):1673-1685. doi: 10.1002/bjs.11654. Epub 2020 May 20.
Laparoscopic sleeve gastrectomy (LSG) is a well established treatment for severe obesity and type 2 diabetes. Although the gut microbiota is linked to the efficacy of LSG, the underlying mechanisms remain elusive. The effect of LSG for morbid obesity on the gut microbiota and bile acids was assessed here.
Severely obese subjects who were candidates for LSG were included and followed until 6 months after surgery. The composition and abundance of the microbiota and bile acids in faeces were assessed by 16S ribosomal RNA sequencing, quantitative PCR and liquid chromatography-mass spectrometry.
In total, 28 patients with a mean(s.d.) BMI of 44·2(6·6) kg/m were enrolled. These patients had achieved excess weight loss of 53·2(19·0) per cent and showed improvement in metabolic diseases by 6 months after LSG, accompanied by an alteration in the faecal microbial community. The increase in α-diversity and abundance of specific taxa, such as Rikenellaceae and Christensenellaceae, was strongly associated with reduced faecal bile acid levels. These changes had a significant positive association with excess weight loss and metabolic alterations. However, the total number of faecal bacteria was lower in patients before (mean(s.d.) 10·26(0·36) log cells per g faeces) and after (10·39(0·29) log cells per g faeces) operation than in healthy subjects (10·83(0·27) log cells per g faeces).
LSG is associated with a reduction in faecal bile acids and greater abundance of specific bacterial taxa and α-diversity that may contribute to the metabolic changes.
腹腔镜袖状胃切除术（LSG）是治疗严重肥胖和 2 型糖尿病的成熟方法。尽管肠道微生物群与 LSG 的疗效有关，但潜在机制仍难以捉摸。本研究评估了 LSG 治疗病态肥胖对肠道微生物群和胆汁酸的影响。
纳入了符合 LSG 适应证的严重肥胖患者，并随访至手术 6 个月后。通过 16S 核糖体 RNA 测序、定量 PCR 和液相色谱-质谱法评估粪便中微生物群和胆汁酸的组成和丰度。
共纳入 28 例平均（标准差）BMI 为 44.2（6.6）kg/m 的患者。这些患者的超重体重减轻了 53.2（19.0）%，并在 LSG 后 6 个月内改善了代谢疾病，同时粪便微生物群落发生了改变。α-多样性的增加和特定分类群（如 Rikenellaceae 和 Christensenellaceae）的丰度增加与粪便胆汁酸水平降低密切相关。这些变化与超重体重减轻和代谢改变具有显著的正相关。然而，手术前后患者粪便中细菌总数（分别为 10.26（0.36）log 细胞/g 粪便和 10.39（0.29）log 细胞/g 粪便）低于健康受试者（10.83（0.27）log 细胞/g 粪便）。
LSG 与粪便胆汁酸减少以及特定细菌分类群丰度增加和 α-多样性增加有关，这可能有助于代谢变化。
