Frige' F, Laneri M, Veronelli A, Folli F, Paganelli M, Vedani P, Marchi M, Noe' D, Ventura P, Opocher E, Pontiroli A E
Università degli Studi di Milano, Milano, Italy.
Nutr Metab Cardiovasc Dis. 2009 Mar;19(3):198-204. doi: 10.1016/j.numecd.2008.04.005. Epub 2008 Aug 5.
Bariatric surgery induces significant weight loss and improves glucose metabolism in obese patients (BMI>35 kg/m(2)). Our aim was to compare restrictive (LAGB, laparoscopic gastric banding) and malabsorptive approaches (BIBP, biliary-intestinal bypass) on the loss of fat-free mass (FFM), fat mass (FM), and on changes of glucose and lipid metabolism.
Body composition (bio-impedance analysis, BIA), blood glucose (BG), insulin, triglycerides, total- and HDL-cholesterol, liver enzymes (AST and ALT) were measured at baseline and 1 year after surgery in patients undergoing LAGB, BIBP, and in diet-treated control patients. In the main study, with patients matched for initial BMI (43-55 kg/m(2), LAGB=24, BIBP=12, controls=6), decreases of BMI, FM, BG and cholesterol were greater in patients with BIBP than with LAGB (p<0.01), while decreases of FFM, insulin, HOMA-IR and triglycerides were similar. No effects on BMI, FM, FFM, BG, insulin, HOMA-IR or cholesterol were observed in the control patients. Decreases of BG, insulin, HOMA-IR, cholesterol and triglycerides correlated with FM but not with FFM decrease. Similar results were obtained in an additional study in patients with a different initial BMI (LAGB=25, BIBP=6, controls=24) and when considering all subjects together. A decrease of liver enzymes (ALT) was greater with LAGB than with BIBP, and HDL-cholesterol increased with LAGB and decreased with BIBP.
BMI, FM, BG and cholesterol decrease more with malabsorptive than with restrictive surgery, while FFM, insulin, HOMA-IR and triglycerides decrease in a similar way. FFM loss is of low entity. Changes of glucose and lipid metabolism are proportional to a decrease of fat mass but not of fat-free mass.
减肥手术可使肥胖患者（BMI>35 kg/m²）显著减重并改善糖代谢。我们的目的是比较限制性手术（腹腔镜胃束带术，LAGB）和吸收不良性手术（胆肠转流术，BIBP）对无脂肪组织（FFM）、脂肪组织（FM）丢失以及糖脂代谢变化的影响。
对接受LAGB、BIBP手术的患者以及接受饮食治疗的对照患者，在基线时和术后1年测量其身体成分（生物电阻抗分析，BIA）、血糖（BG）、胰岛素、甘油三酯、总胆固醇和高密度脂蛋白胆固醇、肝酶（AST和ALT）。在主要研究中，初始BMI匹配的患者（43 - 55 kg/m²，LAGB组24例，BIBP组12例，对照组6例），BIBP组患者的BMI、FM、BG和胆固醇下降幅度大于LAGB组（p<0.01），而FFM、胰岛素、HOMA-IR和甘油三酯的下降幅度相似。对照组患者的BMI、FM、FFM、BG、胰岛素、HOMA-IR或胆固醇未见变化。BG、胰岛素、HOMA-IR、胆固醇和甘油三酯的下降与FM相关，而与FFM下降无关。在另一项针对不同初始BMI患者的研究中（LAGB组25例，BIBP组6例，对照组24例）以及将所有受试者综合考虑时，得到了相似的结果。LAGB组肝酶（ALT）下降幅度大于BIBP组，LAGB组高密度脂蛋白胆固醇升高，BIBP组降低。
与限制性手术相比，吸收不良性手术使BMI、FM、BG和胆固醇下降更多，而FFM、胰岛素、HOMA-IR和甘油三酯下降方式相似。FFM丢失程度较低。糖脂代谢变化与脂肪组织减少成正比，而非与无脂肪组织减少成正比。
