Walicka Magdalena, Czerwińska Ewa, Tałałaj Marek, Marcinowska-Suchowierska Ewa
Klinika Medycyny Rodzinnej i Chorób Wewnetrznych, Centrum Medyczne Kształcenia Podyplomowego, Warszawa.
Endokrynol Pol. 2009 Mar-Apr;60(2):97-102.
Leptin is considered to exert dual effect on bone metabolism: anabolic (through peripheral pathways) and antiosteogenic (through central nervous system). The total leptin's effect on bone is not known. The aim of the study was to examine bone metabolism and leptin concentration in patients with morbid obesity before and after bariatric surgery (BS).
Forty one patients with morbid obesity selected for BS were included in the prospective study. Body mass index (BMI), serum leptin, parathyroid hormone (PTH), 25-hydroxy vitamin D (25(OH)D) concentrations and bone mineral density (BMD) in the lumbar spine (LS) and proximal femur (PF) were examined before and 6 months after BS.
Before operation (mean BMI 44.0 kg/m(2)) mean leptin and PTH concentration was increased (accordingly 37.1 ng/ml and 82.7 pg/ml), mean 25OHD concentration was decreased to 4.3 ng/ml. Mean BMD was within the upper limit of the population reference range. Leptin concentration was positively correlated with BMI. There was no correlation of leptin with BMD (in LS and PF), PTH and 25(OH)D. Following the operation (mean BMI 31.8 kg/m(2)) mean leptin concentration decreased by 30.6 ng/ml (p < 0.001), PTH decreased by 38.9 pg/ml (p < 0.001), 25(OH)D increased by 2.1 ng/ml (NS). Mean BMD in LS increased by 0.067 g/cm(2) (p < 0.005), in PF decreased by 0.044 g/cm(2) (p < 0.02). Leptin was positively correlated with BMI but not with BMD (in both sites), PTH, 25(OH)D.
Weight loss in patients with morbid obesity after BS leads to decrease in serum leptin, increase in BMD in LS and decrease in PF. These changes are accompanied by regression of hyperparathyroidism, which is probably secondary to vitamin D deficiency.
瘦素被认为对骨代谢具有双重作用：合成代谢作用（通过外周途径）和抗成骨作用（通过中枢神经系统）。瘦素对骨骼的总体影响尚不清楚。本研究的目的是检查肥胖症患者在减肥手术（BS）前后的骨代谢和瘦素浓度。
41例因减肥手术而入选的肥胖症患者纳入前瞻性研究。在减肥手术前和术后6个月，检测患者的体重指数（BMI）、血清瘦素、甲状旁腺激素（PTH）、25-羟基维生素D（25(OH)D）浓度以及腰椎（LS）和股骨近端（PF）的骨密度（BMD）。
术前（平均BMI为44.0kg/m²），平均瘦素和PTH浓度升高（分别为37.1ng/ml和82.7pg/ml），平均25OHD浓度降至4.3ng/ml。平均骨密度在人群参考范围的上限内。瘦素浓度与BMI呈正相关。瘦素与骨密度（在腰椎和股骨近端）、PTH和25(OH)D均无相关性。术后（平均BMI为31.8kg/m²），平均瘦素浓度降低30.6ng/ml（p<0.001），PTH降低38.9pg/ml（p<0.001），25(OH)D升高2.1ng/ml（无统计学意义）。腰椎的平均骨密度增加0.067g/cm²（p<0.005），股骨近端的平均骨密度降低0.044g/cm²（p<0.02）。瘦素与BMI呈正相关，但与骨密度（在两个部位）、PTH、25(OH)D均无相关性。
肥胖症患者在减肥手术后体重减轻导致血清瘦素降低，腰椎骨密度增加，股骨近端骨密度降低。这些变化伴随着甲状旁腺功能亢进的消退，这可能继发于维生素D缺乏。
