Merhi Zaher O, Durkin Helen G, Feldman Joseph, Macura Jerzy, Rodriguez Carlos, Minkoff Howard
Maimonides Medical Center, Brooklyn, New York, USA.
Surg Obes Relat Dis. 2009 Mar-Apr;5(2):165-71. doi: 10.1016/j.soard.2008.09.004. Epub 2008 Sep 10.
The use of bariatric surgery to treat refractory obesity is increasingly common. The great weight loss that can result from these procedures has been shown to ameliorate certain deleterious effects of obesity. However, the effect of surgery on immune status is unclear. We investigated the relationship between surgical weight loss and peripheral blood lymphocyte percentages in women.
Women (n=20, age range 25-59 years, body mass index [BMI] range 36.4-68.2 kg/m2) who had undergone either gastric banding (n=14) or gastric bypass (n=6) were enrolled in a prospective study to determine the percentages of their peripheral blood T cells (CD3+, CD4+, and CD8+), CD19+ B cells, and CD3-/CD16+CD56+ natural killer precursor cells before and 85+/-7 days (3 months) postoperatively using flow cytometry. The data are expressed as the percentage of total lymphocytes+/-the standard error of the mean.
A decrease in the BMI at 3 months postoperatively was 12% in the overall study population and 8% and 20% in the banding and bypass groups, respectively. No significant changes were found in the CD4+ or CD8+ T cells (P=.9 and P=.5, respectively), CD19+ B cells (P=.6), or natural killer precursor cells (P=.25) in the overall population or among the patients when stratified by surgical procedure (gastric banding or bypass). The change in CD3+ T cells approached significance (P=.06). A "same direction" (negative) correlation was found between the decrease in BMI and changes in the CD4+ T cell percentages between the pre- and postoperative levels in all the participants, and in the bypass and banding groups separately. However, it only reached statistical significance in the bypass group (r=-.96, P=.002). When studying the correlation between the decrease in BMI and the changes in CD3+ T cell percentages between the pre- and postoperative levels, a borderline significant negative correlation was found for all participants (r=-.44, P=.05) and in the bypass group (r=-.76, P=.08). The rate of change in the CD4+ and CD3+ T cells was greatest among those with the least weight loss and decreased with greater weight loss.
An inverse relationship exists between the change in certain T cells (CD4+ and CD3+) and the amount of weight lost after bariatric surgery, mainly gastric bypass surgery. The greater the decrease in BMI, the lower the change in these T cells.
使用减肥手术治疗难治性肥胖越来越普遍。这些手术带来的显著体重减轻已被证明可改善肥胖的某些有害影响。然而，手术对免疫状态的影响尚不清楚。我们调查了手术减肥与女性外周血淋巴细胞百分比之间的关系。
对接受胃束带术（n = 14）或胃旁路术（n = 6）的女性（n = 20，年龄范围25 - 59岁，体重指数[BMI]范围36.4 - 68.2 kg/m²）进行一项前瞻性研究，以使用流式细胞术测定她们术前及术后85±7天（3个月）外周血T细胞（CD3⁺、CD4⁺和CD8⁺）、CD19⁺ B细胞以及CD3⁻/CD16⁺CD56⁺自然杀伤前体细胞的百分比。数据表示为总淋巴细胞的百分比±均值的标准误差。
术后3个月时，总体研究人群的BMI下降了12%，胃束带术组和胃旁路术组分别下降了8%和20%。总体人群或按手术方式（胃束带术或胃旁路术）分层的患者中，CD4⁺或CD8⁺ T细胞（分别为P = 0.9和P = 0.5）、CD19⁺ B细胞（P = 0.6）或自然杀伤前体细胞（P = 0.25）均未发现显著变化。CD3⁺ T细胞的变化接近显著水平（P = 0.06）。在所有参与者以及分别在胃旁路术组和胃束带术组中，发现BMI的下降与术前和术后水平之间CD4⁺ T细胞百分比的变化呈“同向”（负向）相关。然而，仅在胃旁路术组达到统计学显著性（r = -0.96，P = 0.002）。在研究BMI的下降与术前和术后水平之间CD3⁺ T细胞百分比的变化之间的相关性时，在所有参与者（r = -0.44，P = 0.05）和胃旁路术组（r = -0.76，P = 0.08）中发现了临界显著的负相关。体重减轻最少的患者中CD4⁺和CD3⁺ T细胞的变化率最大，且随着体重减轻幅度的增大而降低。
某些T细胞（CD4⁺和CD3⁺）的变化与减肥手术后的体重减轻量之间存在反比关系，主要是胃旁路手术。BMI下降幅度越大，这些T细胞的变化越小。
