Paepegaey Anne-Cécile, Genser Laurent, Bouillot Jean-Luc, Oppert Jean-Michel, Clément Karine, Poitou Christine
Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Nutrition Department, Heart and Metabolism Division, Paris, France.
Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Bariatric and Digestive Surgery Department, Paris, France.
Surg Obes Relat Dis. 2015 Jan-Feb;11(1):148-54. doi: 10.1016/j.soard.2014.06.010. Epub 2014 Jun 18.
Obesity, characterized by low-grade inflammation both in blood and white adipose tissue (WAT) is associated with increased C-reactive protein (CRP), a well-known acute phase protein. The aim of this study was to determine factors associated with high levels of CRP in obesity.
In 674 obese patients candidates to bariatric surgery (mean body mass index [BMI]=47.4±7.4 kg/m²), we examined the relationships between CRP and a series of bioclinical markers and histologic features of subcutaneous and omental WAT (scWAT) and liver. We also compared the same parameters after separating patients with "high" inflammation (HI, CRP≥20 mg/L, n=52) and with "low" inflammation (LI, CRP<20 mg/L, n=622).
Mean CRP was 8.9±6.9 mg/L and positively correlated with fat mass (P<10(-4)). The HI group included predominantly women (92% versus 79%), of a younger age, with higher BMI (50.9±8.8 versus 47.1±7.2 kg/m2, P=.003), and fat mass (51.6 versus 48.8%, P<.001), higher prevalence of obstructive sleep apnea (OSA) (73% versus 57%, P=.02), and had increased number of HAM56+ immune cells in scWAT (20.8 versus 14.5%, P=.05). There was no difference in metabolic status, WAT fibrosis or liver histology findings between the groups. After 1 year of surgery-induced weight loss, 48 out of 52 patients with HI returned to CRP levels<20 mg/L.
Our results suggest that WAT inflammation is a major contributor to increased CRP in obesity. In obese patients presenting high CRP levels with no obvious explanation, age, gender, BMI, fat mass proportion, OSA, and WAT inflammation should be taken into account to decide to perform further additional medical investigations.
肥胖以血液和白色脂肪组织（WAT）中的低度炎症为特征，与C反应蛋白（CRP）升高有关，CRP是一种众所周知的急性期蛋白。本研究的目的是确定肥胖中与高水平CRP相关的因素。
在674例接受减肥手术的肥胖患者（平均体重指数[BMI]=47.4±7.4kg/m²）中，我们研究了CRP与一系列生物临床标志物以及皮下和网膜WAT（scWAT）和肝脏的组织学特征之间的关系。我们还在将患者分为“高”炎症（HI，CRP≥20mg/L，n=52）和“低”炎症（LI，CRP<20mg/L，n=622）后比较了相同的参数。
平均CRP为8.9±6.9mg/L，与脂肪量呈正相关（P<10⁻⁴）。HI组主要为女性（92%对79%），年龄较轻，BMI较高（50.9±8.8对47.1±7.2kg/m²，P=0.003），脂肪量较高（51.6%对48.8%，P<0.001），阻塞性睡眠呼吸暂停（OSA）患病率较高（73%对57%，P=0.02），scWAT中HAM56+免疫细胞数量增加（20.8%对14.5%，P=0.05）。两组之间的代谢状态、WAT纤维化或肝脏组织学结果无差异。手术诱导体重减轻1年后，52例HI患者中有48例的CRP水平恢复到<20mg/L。
我们的结果表明，WAT炎症是肥胖中CRP升高的主要原因。在CRP水平高且无明显解释的肥胖患者中，应考虑年龄、性别、BMI、脂肪量比例、OSA和WAT炎症，以决定是否进行进一步的额外医学检查。
