Bobbioni-Harsch E, Sztajzel J, Barthassat V, Lehmann T N O, Sievert K, Chassot G, Huber O, Morel P, Golay A, Assimacopoulos-Jeannet F
Service of Therapeutic Education for Chronic Disease, Geneva University Hospital, 1211, Geneva, Switzerland.
Diabetologia. 2005 Jul;48(7):1258-63. doi: 10.1007/s00125-005-1792-5. Epub 2005 Jun 4.
AIMS/HYPOTHESIS: The aim of this study was to assess the predictive role of autonomic reactivity in body weight loss induced by gastric bypass.
A group of 22 morbidly obese subjects, who were due to undergo a gastric bypass, were submitted, before surgery, to a euglycaemic-hyperinsulinaemic clamp, during which a continuous recording of the ECG was performed. The effect of insulin on cardiac autonomic balance was evaluated by performing power spectral analysis of heart rate variability. The low-to-high frequency ratio was calculated before and during the clamp and its modifications were expressed as % delta low-to-high frequency ratio (%Delta L: H).
Preoperative %Delta L: H showed a significant (p=0.0009, r2=0.43), positive relationship to the reduction of body weight, measured 1 year after surgery and expressed as % excess weight loss (% EWL). Preoperative BMI was also significantly (p=0.0009, r2=0.43) negatively related to the 12-month % EWL. In a multiple regression analysis, %Delta L: H remained a significant (p=0.003), independent predictor of body weight loss, even when preoperative BMI or age, % fat mass, insulinaemia and glucose disposal were taken into account.
CONCLUSIONS/INTERPRETATION: The best correction of excess body weight was achieved by those obese subjects who had a preserved capacity to shift their cardiac autonomic balance towards a sympathetic prevalence in response to an euglycaemic-hyperinsulinaemic clamp. Further studies are needed to elucidate the mechanisms through which the autonomic nervous system influences weight reduction.
目的/假设：本研究旨在评估自主神经反应性在胃旁路手术所致体重减轻中的预测作用。
一组22名病态肥胖受试者，即将接受胃旁路手术，在手术前进行了正常血糖-高胰岛素钳夹试验，期间连续记录心电图。通过对心率变异性进行功率谱分析，评估胰岛素对心脏自主神经平衡的影响。在钳夹试验前和试验期间计算低频与高频比值，其变化以低频与高频比值变化百分比（%Delta L:H）表示。
术前%Delta L:H与术后1年测量的体重减轻呈显著正相关（p = 0.0009，r2 = 0.43），体重减轻以超重减轻百分比（%EWL）表示。术前体重指数（BMI）也与12个月的%EWL呈显著负相关（p = 0.0009，r2 = 0.43）。在多元回归分析中，即使考虑了术前BMI或年龄、体脂百分比、胰岛素血症和葡萄糖处置情况，%Delta L:H仍然是体重减轻的显著独立预测因素（p = 0.003）。
结论/解读：那些在正常血糖-高胰岛素钳夹试验中能够保持将心脏自主神经平衡转向交感神经占优势状态的肥胖受试者，实现了对超重的最佳矫正。需要进一步研究以阐明自主神经系统影响体重减轻的机制。
