Grup d'Estudi de Malalties Metabòliques Associades a Insulin Resistència (GEMMAIR), Departament de Medicina i Cirurgia, Universitat Rovira i Virgili (URV), Tarragona, Spain; Servei Medicina Interna, Hospital Universitari Joan XXIII Tarragona, Tarragona, Spain.
Obesity (Silver Spring). 2014 Jan;22(1):188-94. doi: 10.1002/oby.20470. Epub 2013 Jul 23.
Recent studies report the effect of bariatric surgery on glycaemia control and prevention of type-2-diabetes in obese patients. This study is about the pathophysiological mechanisms associated to these changes.
Circulating levels of receptors of tumor necrosis factor (TNF-RI, TNF-RII), visfatin, high molecular weight (HMW) adiponectin, and C reactive protein (CRP) in 30 morbidly obese women (body mass index, BMI>40 kg/m(2) ) and 60 normal-weight controls (BMI>25 kg/m(2) ) were analyzed. Morbidly obese were studied at three time-points: before surgery (baseline), and 6 and 12 months after.
After surgery, the levels of TNF-RI, TNF-RII, visfatin, and CRP were significantly lower than its baseline levels, whereas HMW adiponectin was higher. Fasting glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA2-IR) levels were markedly lower postoperatively. High density lipoproteins (HDL) moderately increased, and triglyceride levels had sharply decreased. The study of the predictive value of variables indicated that preoperative levels of TNF-RI and visfatin correlated positively with levels of glucose, insulin, glycosylated hemoglobin A1c, and HOMA2-IR postoperatively, whereas adiponectin levels correlated negatively. Baseline CRP levels negatively linked to HDL and TNF-RII positively to triglyceride.
The preoperative profile with high levels of proinflammatory adipocytokines is linked to smaller improvements in glucose homeostasis and lipid factors. The use of a range of biomarkers may predict the level of metabolic changes following bariatric surgery.
最近的研究报告了肥胖患者的减重手术对血糖控制和 2 型糖尿病预防的影响。本研究旨在探讨与这些变化相关的病理生理机制。
分析了 30 名病态肥胖女性（BMI>40 kg/m²）和 60 名正常体重对照组（BMI>25 kg/m²）的循环肿瘤坏死因子受体（TNF-RI、TNF-RII）、内脏脂肪素、高分子量（HMW）脂联素和 C 反应蛋白（CRP）水平。病态肥胖患者在三个时间点进行研究：手术前（基线），以及术后 6 个月和 12 个月。
手术后，TNF-RI、TNF-RII、内脏脂肪素和 CRP 水平明显低于基线水平，而 HMW 脂联素水平升高。术后空腹血糖、胰岛素和稳态模型评估的胰岛素抵抗（HOMA2-IR）水平显著降低。高密度脂蛋白（HDL）水平适度升高，甘油三酯水平急剧下降。对变量预测价值的研究表明，术前 TNF-RI 和内脏脂肪素水平与术后血糖、胰岛素、糖化血红蛋白 A1c 和 HOMA2-IR 水平呈正相关，而脂联素水平与上述指标呈负相关。基线 CRP 水平与 HDL 呈负相关，而 TNF-RII 与甘油三酯呈正相关。
术前高水平的促炎脂肪细胞因子与血糖稳态和脂质因素的改善较小相关。使用一系列生物标志物可能有助于预测减重手术后的代谢变化水平。
