Departments of *Surgery and †Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
Ann Surg. 2014 Apr;259(4):694-9. doi: 10.1097/SLA.0b013e31829d6989.
To assess the effect of Roux-en-Y gastric bypass (RYGB) on high-density lipoprotein cholesterol (HDL-C) concentration and its apolipoprotein A4 (ApoA4) content at 1 year after bariatric surgery in comparison with a hypocaloric diet. Secondary aim was to measure total cholesterol and triglycerides levels and insulin sensitivity after interventions.
Very few prospective uncontrolled studies have investigated the effects of RYGB on cardiovascular risk factors. No controlled studies had as primary goal the changes in HDL-C after gastric bypass.
Forty subjects with a body mass index more than 40 or 35 kg/m or more in the presence of diabetes were enrolled. Twenty of them underwent RYGB, whereas 20 received lifestyle modification suggestions and medical therapy for obesity complications (diabetes, hypertension, and hyperlipidemia).
A significant (P < 0.0001) increase in HDL-C concentrations was observed only in the surgical arm (from 41.95 ± 7.24 to 56.55 ± 9.01 mg/dL). Mean systolic and diastolic blood pressures were significantly reduced (P < 0.0001) in both groups with no between-group differences, probably in relation to the optimization of the antihypertensive treatment. Plasma concentration of ApoA4, a major HDL-C protein fraction, significantly increased 1 year after RYGB (from 496.61 ± 400.41 to 987.88 ± 637.41μg/L, P < 0.01). Circulating triglycerides concentration significantly decreased after surgery, whereas both peripheral and hepatic insulin resistance increased significantly.
Our study shows that HDL-C and ApoA4 significantly increase after gastric bypass and that this increase is associated with a net improvement in hepatic insulin sensitivity. Furthermore, we speculate that ApoA4, which induces satiety in animals, can eventually play a role on the appetite reduction after RYGB because there is a strict and inverse relationship between weight and ApoA4 changes. (NCT01707771).
比较减肥手术后 1 年 Roux-en-Y 胃旁路术（RYGB）与低热量饮食对高密度脂蛋白胆固醇（HDL-C）浓度及其载脂蛋白 A4（ApoA4）含量的影响。次要目的是测量干预后总胆固醇和甘油三酯水平及胰岛素敏感性。
很少有前瞻性非对照研究调查 RYGB 对心血管危险因素的影响。没有对照研究将胃旁路术后 HDL-C 的变化作为主要目标。
共纳入 40 名体重指数（BMI）大于 40 或 35 kg/m2 或合并糖尿病的患者。其中 20 名接受 RYGB，20 名接受生活方式改变建议和肥胖并发症（糖尿病、高血压、高脂血症）的药物治疗。
仅手术组 HDL-C 浓度显著升高（P<0.0001，从 41.95±7.24 升至 56.55±9.01 mg/dL）。两组收缩压和舒张压均显著降低（P<0.0001），两组间无差异，可能与降压治疗的优化有关。载脂蛋白 A4 是 HDL-C 的主要蛋白部分，其血浆浓度在 RYGB 后 1 年显著升高（从 496.61±400.41 升至 987.88±637.41μg/L，P<0.01）。手术后循环甘油三酯浓度显著降低，而外周和肝胰岛素抵抗显著增加。
我们的研究表明，胃旁路术后 HDL-C 和 ApoA4 显著增加，这种增加与肝胰岛素敏感性的净改善相关。此外，我们推测 ApoA4 可以在动物中产生饱腹感，最终可能在 RYGB 后的食欲减少中发挥作用，因为体重与 ApoA4 变化之间存在严格的反比关系。（NCT01707771）
