Ram Edward, Vishne Tali, Maayan Rachel, Lerner Igor, Weizman Abraham, Dreznik Zeev, Konstantin Bloch, Seror D, Pnina Vardi
Division of General Surgery, Rabin Medical Center, Campus Golda, Petach Tikva, Sacklar School of Medicine, Tel Aviv University, Israel.
Obes Surg. 2005 Nov-Dec;15(10):1456-62. doi: 10.1381/096089205774859146.
Morbid obesity is associated with over-secretion of leptin and insulin, and predisposes to development of carbohydrate intolerance. In the current study, we explored the impact of BMI after laparoscopic adjustable gastric banding (LAGB) on leptin, insulin and proinsulin levels.
23 obese patients (8 males, 15 females) were included in the study. Their mean age was 36+/-6 yrs (range 21-56 yrs). Blood samples were collected for measurement of plasma leptin, insulin and proinsulin before and 6 and 14 months after LAGB.
Mean BMI before surgery was 46.04 +/- 4.44 kg/m2, with significant and equal reduction of 18% in each of the follow-up periods, with total BMI reduction of 33% (P <.0001). The levels of circulating leptin, insulin and proinsulin before intervention were 119.3 +/- 53.1 ng/ml, 159 +/- 13 pmol/l, and 36.36 +/- 23.06 pmol/l respectively. Despite an equal BMI reduction in the 2 follow-up periods, the most significant decrease in hormone levels was observed in the immediate postoperative period (54, 53, and 45%, respectively), when compared to the second follow-up period (15, 30, 10%, respectively). The highest total decline in hormone level of 70% was obtained with insulin, compared to 52% in leptin, and 50% in proinsulin. Despite the significant decrease in proinsulin and insulin levels, their ratio increased from 0.22, to 0.28 and 0.36 after LAGB. Unlike insulin and proinsulin, leptin levels strongly and persistently correlated with BMI during the study.
Following LAGB, weight loss was associated with decreased levels of circulating leptin, insulin and proinsulin, most prominent in the first follow-up period. Unlike insulin and proinsulin, leptin showed the most significant and persistent correlation with BMI, suggesting that morbid obesity acts through different feedback hormonal mechanisms which are probably not regulated only by absolute weight loss. Longer follow-up and larger numbers of patients are needed to clarify long-term hormonal profile, as well as the beneficial lasting effects of such interventions.
病态肥胖与瘦素和胰岛素分泌过多有关，且易导致碳水化合物不耐受的发生。在本研究中，我们探讨了腹腔镜可调节胃束带术（LAGB）后体重指数（BMI）对瘦素、胰岛素和胰岛素原水平的影响。
本研究纳入了23例肥胖患者（8例男性，15例女性）。他们的平均年龄为36±6岁（范围21 - 56岁）。在LAGB术前、术后6个月和14个月采集血样，用于检测血浆瘦素、胰岛素和胰岛素原水平。
手术前平均BMI为46.04±4.44kg/m²，在每个随访期均显著且同等程度地降低了18%，BMI总体降低了33%（P<.0001）。干预前循环瘦素、胰岛素和胰岛素原水平分别为119.3±53.1ng/ml、159±13pmol/l和36.36±23.06pmol/l。尽管在两个随访期内BMI降低程度相同，但与第二个随访期相比，术后即刻激素水平下降最为显著（分别为54%、53%和45%），第二个随访期分别为15%、30%和10%。激素水平总下降幅度最高的是胰岛素，为70%，瘦素为52%，胰岛素原为50%。尽管胰岛素原和胰岛素水平显著下降，但LAGB后它们的比值从0.22增加到了0.28和0.36。与胰岛素和胰岛素原不同，在研究期间瘦素水平与BMI呈强烈且持续的相关性。
LAGB术后，体重减轻与循环瘦素、胰岛素和胰岛素原水平降低有关，在首次随访期最为明显。与胰岛素和胰岛素原不同，瘦素与BMI的相关性最为显著且持续，这表明病态肥胖通过不同的反馈激素机制起作用，这些机制可能不仅仅受绝对体重减轻的调节。需要更长时间的随访和更多患者来阐明长期激素谱以及此类干预措施的有益持久效果。
