Holdstock C, Lind L, Engstrom B Eden, Ohrvall M, Sundbom M, Larsson A, Karlsson F A
Department of Medical Sciences: Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
Int J Obes (Lond). 2005 Oct;29(10):1275-80. doi: 10.1038/sj.ijo.0803000.
Obesity is frequently associated with insulin resistance, dyslipidemia, hypertension and an increased risk of cardiovascular disease, reflected in elevated markers of inflammation, in particular C-reactive protein (CRP). To what extent the insulin resistance or the obesity per se contributes to increased CRP levels is unclear. In morbidly obese patients, gastric bypass surgery causes marked changes in body weight and improves metabolism, thereby providing informative material for studies on the regulation of inflammatory markers.
Prospective, surgical intervention study of inflammatory markers in morbidly obese subjects.
In total, 66 obese subjects with mean age 39 y and mean body mass index (BMI) 45 kg/m2 were studied prior to and 6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery.
Serum concentrations of high sensitivity CRP, serum amyloid A (SAA) and interleukin-6 (IL-6), as well as markers of glucose and lipid metabolism.
Prior to surgery, CRP levels were elevated compared to the reference range of healthy, normal-weight subjects. CRP correlated with insulin sensitivity, as reflected by the homeostatic model assessment (HOMA) index, but not BMI, when corrected for age and gender. Surgery reduced BMI from 45 to 31 kg/m2 and lowered CRP, SAA and IL-6 levels by 82, 57 and 50%, respectively, at 12 months. The reduction in CRP was inversely related to HOMA at baseline independently of the change in body weight (r=-0.36, P=0.005). At 12 months, 140 and 40% reductions in CRP were seen in subjects with HOMA < 4 (insulin sensitive) and HOMA>9 (insulin resistant) despite similar reductions in BMI. Reductions in SAA and IL-6 tended to parallel the changes in CRP, but were less informative.
In morbidly obese subjects, gastric bypass surgery lowers energy intake, reduces inflammatory markers and improves insulin sensitivity. Despite a marked reduction in body weight, only a small effect on CRP levels was seen in insulin-resistant patients, indicating that flexibility of circulating CRP levels is primarily dependent upon insulin sensitivity rather than energy supply.
肥胖常与胰岛素抵抗、血脂异常、高血压以及心血管疾病风险增加相关，这在炎症标志物升高，尤其是C反应蛋白（CRP）升高方面得以体现。胰岛素抵抗或肥胖本身在多大程度上导致CRP水平升高尚不清楚。在病态肥胖患者中，胃旁路手术会引起体重显著变化并改善代谢，从而为研究炎症标志物的调节提供了有益资料。
对病态肥胖受试者的炎症标志物进行前瞻性手术干预研究。
总共66名肥胖受试者，平均年龄39岁，平均体重指数（BMI）为45kg/m²，在接受Roux-en-Y胃旁路术（RYGBP）手术前、术后6个月和12个月进行研究。
高敏CRP、血清淀粉样蛋白A（SAA）和白细胞介素-6（IL-6）的血清浓度，以及葡萄糖和脂质代谢标志物。
手术前，与健康、体重正常受试者的参考范围相比，CRP水平升高。在校正年龄和性别后，CRP与胰岛素敏感性相关，这通过稳态模型评估（HOMA）指数得以体现，但与BMI无关。手术使BMI从45降至31kg/m²，并在12个月时分别使CRP、SAA和IL-6水平降低了82%、57%和50%。CRP的降低与基线时的HOMA呈负相关，与体重变化无关（r=-0.36，P=0.005）。在12个月时，尽管BMI降低程度相似，但HOMA<4（胰岛素敏感）和HOMA>9（胰岛素抵抗）的受试者中，CRP分别降低了140%和40%。SAA和IL-6的降低趋势与CRP的变化平行，但信息较少。
在病态肥胖受试者中，胃旁路手术降低能量摄入，降低炎症标志物并改善胰岛素敏感性。尽管体重显著降低，但胰岛素抵抗患者中CRP水平仅出现较小变化，表明循环CRP水平的灵活性主要取决于胰岛素敏感性而非能量供应。
