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美国华盛顿大学医学院Samuel Klein课题组的一项最新研究发现，胆胰分流术比Roux-en-Y胃旁路术更能改善代谢。2019年10月3日，《细胞—代谢》在线发表了这一成果。

胆胰分流术（BPD）后的糖尿病缓解率比Roux-en-Y胃旁路术（RYGB）手术更大。研究人员使用摄入和注入的葡萄糖示踪剂的混合膳食测试以及葡萄糖示踪剂输注的高胰岛素-正常血糖钳夹程序评估了RYGB或BPD引起的20％体重减轻对肥胖症患者糖调节的影响（ClinicalTrials.gov编号：NCT03111953）。与RYGB后相比，BPD后餐后血糖和胰岛素浓度的升高明显减慢了摄取葡萄糖进入循环系统的速度。BPD后的胰岛素敏感性（以胰岛素输注期间的葡萄糖处置率评估）比RYGB高约45％，而两组之间的β细胞功能无差异。

这些结果表明，与RYGB引起的匹配百分比的体重减轻相比，BPD对血糖控制具有独特的有益作用，表现为餐后葡萄糖吸收较慢，餐后血浆葡萄糖和胰岛素改变减少以及胰岛素敏感性改善增加。

附：英文原文

Title: Biliopancreatic Diversion Induces Greater Metabolic Improvement Than Roux-en-Y Gastric Bypass

Author: Lydia-Ann Harris, Brandon D. Kayser, Consuelo Cefalo, Luca Marini, Jeramie D. Watrous, Jeffrey Ding, Mohit Jain, Jeffrey G. McDonald, Bonne M. Thompson, Elisa Fabbrini, J. Christopher Eagon, Bruce W. Patterson, Bettina Mittendorfer, Geltrude Mingrone, Samuel Klein

Issue&Volume: 3 October 2019

Abstract: Diabetes remission is greater after biliopancreatic diversion (BPD) than Roux-en-Y gastric bypass (RYGB) surgery. We used a mixed-meal test with ingested and infused glucose tracers and the hyperinsulinemic-euglycemic clamp procedure with glucose tracer infusion to assess the effect of 20% weight loss induced by either RYGB or BPD on glucoregulation in people with obesity (ClinicalTrials.gov number: NCT03111953). The rate of appearance of ingested glucose into the circulation was much slower, and the postprandial increases in plasma glucose and insulin concentrations were markedly blunted after BPD compared to after RYGB. Insulin sensitivity, assessed as glucose disposal rate during insulin infusion, was ～45% greater after BPD than RYGB, whereas β cell function was not different between groups. These results demonstrate that compared with matched-percentage weight loss induced by RYGB, BPD has unique beneficial effects on glycemic control, manifested by slower postprandial glucose absorption, blunted postprandial plasma glucose and insulin excursions, and greater improvement in insulin sensitivity.

DOI: 10.1016/j.cmet.2019.09.002

Source: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30503-0

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