Koivisto P, Miettinen T A
Gastroenterology. 1986 Apr;90(4):984-90. doi: 10.1016/0016-5085(86)90877-2.
Cholesterol and bile acid metabolism and vitamin B12 were studied in 19 patients with heterozygous familial hypercholesterolemia in an 8-yr follow-up (3-12 yr after ileal bypass operation), and in 11 unoperated controls. Absorption of cholesterol and vitamin B12 were decreased by the operation, but improved slowly, and at 8 yr cholesterol absorption was normal. Cholesterol excretion as fecal neutral steroids was not increased by the operation, and at 8 yr the flux of endogenous cholesterol to the gut was similar in the operated and control patients. Cholesterol absorption was positively correlated with mouth to anus transit time in the unoperated patients. Fecal bile acid excretion was increased immediately after the operation and continued to increase even after the second postoperative year. In the operated patients fecal excretion of fat, water, and dry matter were positively correlated with fecal bile acid excretion. Our study suggests that adaptive changes occur slowly after ileal bypass, resulting in gradual normalization of cholesterol absorption, despite continuing bile acid malabsorption, and that the intestinal transit time is related to steroid absorption even under physiologic conditions.
对19例杂合子家族性高胆固醇血症患者进行了为期8年的随访研究（回肠旁路手术后3 - 12年），并与11例未手术的对照者进行对比，观察胆固醇、胆汁酸代谢及维生素B12情况。手术使胆固醇和维生素B12的吸收减少，但随后缓慢改善，至8年时胆固醇吸收恢复正常。手术未增加粪便中性类固醇形式的胆固醇排泄，8年时手术患者和对照者内源性胆固醇向肠道的流量相似。在未手术患者中，胆固醇吸收与口腔至肛门的转运时间呈正相关。术后粪便胆汁酸排泄立即增加，甚至在术后第二年仍持续增加。手术患者粪便中脂肪、水分和干物质的排泄与粪便胆汁酸排泄呈正相关。我们的研究表明，回肠旁路术后适应性变化出现缓慢，尽管胆汁酸吸收持续不良，但胆固醇吸收仍逐渐恢复正常，且即使在生理条件下，肠道转运时间也与类固醇吸收有关。
