Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands.
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands.
Metabolism. 2016 Nov;65(11):1614-1620. doi: 10.1016/j.metabol.2016.07.013. Epub 2016 Aug 16.
Weight loss interventions such as Roux-en-Y gastric bypass (RYGB) and very low calorie diets (VLCD) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes. Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity. However, a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking.
Systemic inflammation was investigated in age- and BMI-matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry, in addition to measuring circulating levels of cytokines and CRP. Systemic inflammation was assessed one month before and three months after RYGB (n=15) or VLCD (n=12). An age matched group of lean women (n=12) was studied as control group.
Three months after the intervention, CRP and leptin levels were reduced whereas adiponectin levels were increased both by RYGB and VLCD. TNF-α levels were increased by RYGB, but reduced by VLCD. IL-2 and IL-6 levels were reduced and IL-4 levels were increased by VLCD but not affected by RYGB. The number of activated peripheral cytotoxic T (CD8+CD25+) and B (CD19+CD38+) cells was significantly higher after RYGB than after VLCD.
In conclusion, RYGB and VLCD have differential effects on the activation status of peripheral leukocytes and levels of cytokines in obese women with T2DM, despite comparable weight loss three months after the intervention. VLCD seems to have more favorable effects on the inflammatory profile as compared to RYGB.
减重干预措施，如 Roux-en-Y 胃旁路手术（RYGB）和极低热量饮食（VLCD）可改善 2 型糖尿病肥胖患者的葡萄糖代谢。体重减轻也可以积极影响与肥胖相关的不利炎症特征。然而，VLCD 和 RYGB 对全身炎症的影响缺乏直接比较。
通过流式细胞术测定外周血白细胞的数量和激活或记忆状态，以及测量循环细胞因子和 CRP 水平，在年龄和 BMI 匹配的患有 2 型糖尿病的病态肥胖女性中研究全身炎症。在 RYGB（n=15）或 VLCD（n=12）前一个月和后三个月评估全身炎症。年龄匹配的瘦女性组（n=12）作为对照组进行研究。
干预后 3 个月，RYGB 和 VLCD 均可降低 CRP 和瘦素水平，增加脂联素水平。RYGB 增加 TNF-α 水平，而 VLCD 降低 TNF-α 水平。VLCD 降低 IL-2 和 IL-6 水平，增加 IL-4 水平，但 RYGB 不受影响。RYGB 后外周细胞毒性 T（CD8+CD25+）和 B（CD19+CD38+）细胞的激活数量明显高于 VLCD。
总之，RYGB 和 VLCD 对 2 型糖尿病肥胖女性外周白细胞的激活状态和细胞因子水平有不同的影响，尽管干预后 3 个月体重减轻相当。与 RYGB 相比，VLCD 似乎对炎症特征有更有利的影响。
