Kruljac Ivan, Mirošević Gorana, Kirigin Lora S, Nikolić Marko, Ljubičić Neven, Budimir Ivan, Bekavac Bešlin Miroslav, Vrkljan Milan
Department of Endocrinology, Diabetology and Metabolic diseases "Mladen Sekso", University Hospital Center "Sestre milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia.
Department of Gastroenterology and Hepatology, University Hospital Center "Sestre milosrdnice", University of Zagreb School of Medicine, University of Zagreb School of Dental Medicine, Zagreb, Croatia.
Clin Endocrinol (Oxf). 2016 Dec;85(6):852-860. doi: 10.1111/cen.13160. Epub 2016 Aug 19.
Although various metabolic hormones have been implicated in bariatric-related weight loss, their use as predictors of weight loss is unknown. Our study evaluates changes in metabolic hormones after bariatric surgery, and their role as predictors of weight loss.
This nonrandomized study included 51 patients, 21 underwent laporascopic adjustable gastric banding (LAGB), 15 laparoscopic sleeve gastrectomy (LSG) and 15 Roux-en Y gastric bypass (RYGB). Serum ghrelin, leptin, insulin, growth hormone, HOMA-IR and HOMA-β was recorded at baseline and 1, 3, 6 and 12 months, and correlated with weight loss. Successful weight loss was defined as excess weight loss >50% at 12 months for all groups.
Weight loss pattern was similar in all groups. Ghrelin increased only in the LAGB group (P = 0·016). However, baseline ghrelin concentrations >664·6 pg/mL in the LSG group predicted successful weight loss with 81·8% sensitivity and 100·0% specificity, and ghrelin >969·8 pg/mL in the 1st postoperative month predicted success with 83·3% sensitivity and 83·3% specificity in the LAGB group. Insulin and HOMA-IR decreased significantly in the LSG and RYGB group, HOMA-β increased in the LAGB and LSG group. Serum leptin decreased and GH increased in all groups (P < 0·001 for all changes). Changes in insulin, leptin and growth hormone were not predictors, but a consequence of weight loss.
LSG is the most effective procedure for improvement of beta-cell function. High baseline ghrelin in the LSG group and an adequate 1st month increase in the LAGB group are associated with greater weight loss. Validation studies are required to confirm the role of ghrelin in predicting weight loss after bariatric surgery, but also in selecting candidates for specific bariatric procedures.
尽管多种代谢激素与减重手术相关的体重减轻有关，但其作为体重减轻预测指标的作用尚不清楚。我们的研究评估了减重手术后代谢激素的变化及其作为体重减轻预测指标的作用。
这项非随机研究纳入了51例患者，其中21例行腹腔镜可调节胃束带术（LAGB），15例行腹腔镜袖状胃切除术（LSG），15例行Roux-en Y胃旁路术（RYGB）。在基线以及术后1、3、6和12个月记录血清胃饥饿素、瘦素、胰岛素、生长激素、胰岛素抵抗指数（HOMA-IR）和胰岛素β细胞功能指数（HOMA-β），并将其与体重减轻情况进行关联分析。所有组成功减重的定义为12个月时超重减轻>50%。
所有组的体重减轻模式相似。胃饥饿素仅在LAGB组中升高（P = 0.016）。然而，LSG组基线胃饥饿素浓度>664.6 pg/mL时预测成功减重的敏感性为81.8%，特异性为100.0%；LAGB组术后第1个月胃饥饿素>969.8 pg/mL时预测成功减重的敏感性为83.3%，特异性为83.3%。胰岛素和HOMA-IR在LSG组和RYGB组中显著降低，HOMA-β在LAGB组和LSG组中升高。所有组血清瘦素降低，生长激素升高（所有变化P < 0.001）。胰岛素、瘦素和生长激素的变化不是预测指标，而是体重减轻的结果。
LSG是改善β细胞功能最有效的手术方式。LSG组高基线胃饥饿素水平以及LAGB组术后第1个月的适当升高与更大程度的体重减轻相关。需要进行验证研究以证实胃饥饿素在预测减重手术后体重减轻方面的作用，以及在选择特定减重手术候选者方面的作用。
