Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Int J Obes (Lond). 2016 Feb;40(2):275-80. doi: 10.1038/ijo.2015.174. Epub 2015 Aug 28.
BACKGROUND/OBJECTIVES: Inflammation, oxidative stress and dysregulation of adipokines are thought to be pathophysiological mechanisms linking obesity to the development of insulin resistance and atherosclerosis. In adults, bariatric surgery reduces inflammation and oxidative stress, and beneficially changes the levels of several adipokines, but little is known about the postsurgical changes among adolescents.
SUBJECTS/METHODS: In two separate longitudinal cohorts we evaluated change from baseline of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), monocyte chemo-attractant protein-1 (MCP-1), oxidized low-density lipoprotein cholesterol (oxLDL), adiponectin, leptin and resistin up to 12 months following elective laparoscopic Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG) surgery in adolescents with severe obesity.
In cohort 1, which consisted of 39 adolescents (mean age 16.5±1.6 years; 29 females) undergoing either RYGB or VSG, IL-6 (baseline: 2.3±3.4 pg ml(-1) vs 12 months: 0.8±0.6 pg ml(-1), P<0.01), leptin (baseline: 178±224 ng ml(-1) vs 12 months: 41.4±31.9 ng ml(-1), P<0.001) and oxLDL (baseline: 41.6±11.6 U l(-1) vs 12 months: 35.5±11.1 U l(-1), P=0.001) significantly decreased and adiponectin significantly increased (baseline: 5.4±2.4 μg ml(-1) vs 12 months: 13.5±8.9 μg ml(-1), P<0.001). In cohort 2, which consisted of 13 adolescents (mean age 16.5±1.6 years; 10 females) undergoing RYGB, results were similar: IL-6 (baseline: 1.7±0.9 pg ml(-1) vs 12 months: 0.4±0.9 pg ml(-1), P<0.05) and leptin (baseline: 92.9±31.3 ng ml(-1) vs 12 months: 37.3±33.4 ng ml(-1), P<0.001) significantly decreased and adiponectin significantly increased (baseline: 6.1±2.9 μg ml(-1) vs 12 months: 15.4±8.0 μg ml(-1), P<0.001). When the cohorts were combined to evaluate changes at 12 months, oxLDL also significantly decreased (baseline: 39.8±16.7 U l(-1) vs 12 months: 32.7±11.9 U l(-1), P=0.03).
Bariatric surgery produced robust improvements in markers of inflammation, oxidative stress and several adipokines among adolescents with severe obesity, suggesting potential reductions in risk for type 2 diabetes and cardiovascular disease.
背景/目的：炎症、氧化应激和脂肪因子失调被认为是将肥胖与胰岛素抵抗和动脉粥样硬化的发展联系起来的病理生理机制。在成年人中，减肥手术可降低炎症和氧化应激水平，并有益地改变几种脂肪因子的水平，但青少年术后的变化知之甚少。
我们在两个独立的纵向队列中评估了 39 名（平均年龄 16.5±1.6 岁；29 名女性）严重肥胖青少年在接受腹腔镜 Roux-en-Y 胃旁路术（RYGB）或垂直袖状胃切除术（VSG）后的 12 个月内，从基线开始白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、单核细胞趋化蛋白-1（MCP-1）、氧化低密度脂蛋白胆固醇（oxLDL）、脂联素、瘦素和抵抗素的变化。
在队列 1 中，由 39 名青少年（平均年龄 16.5±1.6 岁；29 名女性）组成，其中接受 RYGB 或 VSG 手术，IL-6（基线：2.3±3.4 pg/ml vs 12 个月：0.8±0.6 pg/ml，P<0.01）、瘦素（基线：178±224 ng/ml vs 12 个月：41.4±31.9 ng/ml，P<0.001）和 oxLDL（基线：41.6±11.6 U/l vs 12 个月：35.5±11.1 U/l，P=0.001）显著降低，脂联素显著升高（基线：5.4±2.4 μg/ml vs 12 个月：13.5±8.9 μg/ml，P<0.001）。在队列 2 中，由 13 名青少年（平均年龄 16.5±1.6 岁；10 名女性）接受 RYGB 手术组成，结果相似：IL-6（基线：1.7±0.9 pg/ml vs 12 个月：0.4±0.9 pg/ml，P<0.05）和瘦素（基线：92.9±31.3 ng/ml vs 12 个月：37.3±33.4 ng/ml，P<0.001）显著降低，脂联素显著升高（基线：6.1±2.9 μg/ml vs 12 个月：15.4±8.0 μg/ml，P<0.001）。当将两个队列合并以评估 12 个月的变化时，oxLDL 也显著降低（基线：39.8±16.7 U/l vs 12 个月：32.7±11.9 U/l，P=0.03）。
减肥手术可显著改善严重肥胖青少年的炎症、氧化应激和几种脂肪因子标志物，表明其可能降低 2 型糖尿病和心血管疾病的风险。
