Foschi Diego, Corsi Fabio, Pisoni Laura, Vago Tarcisio, Bevilacqua Maurizio, Trabucchi Andrea, Asti Emanuele, Trabucchi Emilio
Department of Clinical Science L. Sacco, San Siro Institute, Milan, Italy.
Obes Surg. 2003 Dec;13(6):874-8. doi: 10.1381/096089203322618696.
Leptin is considered one of the anorectic messengers to the central nervous system in lean subjects. Although it is secreted by the gastric mucosa, there are contradictory evidences of its involvement in mediating the acute satiety effect of the meal in obese patients. The effects of restrictive operations on meal-stimulated leptin secretion are unknown.
The effects of a standard acidified (pH 3) meal on leptin release were investigated in obese patients, before and after vertical banded gastroplasty (VBG). 8 morbidly obese patients (BMI 49.1+/-6.5) had serum leptin determination after an overnight fast. Samples were taken basally and every 30 minutes after the meal for 3 hours. The test was repeated after 20% BMI reduction. 5 lean volunteers (BMI 22.5+/-1.7) served as the control group.
In obese patients, basal serum leptin fell from 62+/-20.4 to 23.8+/-15.7 ng/ml after the operation (P <0.01) but still with significant differences vs the control group (5.6+/-3 ng/ml). The meal was associated with a significant decrease of serum leptin (ANOVA test, P <0.01), and significant differences between obese patients after surgery and lean subjects were found.
Serum leptin was reduced by the meal in obese patients and VBG did not attain satiety through serum leptin changes.
瘦素被认为是瘦人向中枢神经系统传递的食欲抑制信号之一。尽管它由胃黏膜分泌，但关于其在肥胖患者进餐时介导急性饱腹感效应方面的证据存在矛盾。限制性手术对进餐刺激的瘦素分泌的影响尚不清楚。
在垂直束带胃成形术（VBG）前后，研究了标准酸化（pH 3）餐对肥胖患者瘦素释放的影响。8例病态肥胖患者（BMI 49.1±6.5）在禁食过夜后测定血清瘦素。在进餐前及进餐后每30分钟采集样本，共采集3小时。在体重指数（BMI）降低20%后重复该试验。5名瘦志愿者（BMI 22.5±1.7）作为对照组。
肥胖患者术后基础血清瘦素从62±20.4降至23.8±15.7 ng/ml（P<0.01），但与对照组（5.6±3 ng/ml）相比仍有显著差异。进餐导致血清瘦素显著降低（方差分析，P<0.01），且发现术后肥胖患者与瘦人之间存在显著差异。
肥胖患者进餐可降低血清瘦素水平，垂直束带胃成形术并非通过血清瘦素变化实现饱腹感。
