Davidson W S, Inge T H, Sexmith H, Heink A, Elder D, Hui D Y, Melchior J T, Kelesidis T, Shah A S
Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH, USA.
Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Int J Obes (Lond). 2017 Jan;41(1):83-89. doi: 10.1038/ijo.2016.190. Epub 2016 Oct 26.
BACKGROUND/OBJECTIVE: Youth with obesity have an altered high-density lipoprotein (HDL) subspecies profile characterized by depletion of large apoE-rich HDL particles and an enrichment of small HDL particles. The goal of this study was to test the hypothesis that this atherogenic HDL profile is reversible and that HDL function would improve with metabolic surgery.
Serum samples from adolescent males with severe obesity mean±s.d. age of 17.4±1.6 years were studied at baseline and 1 year following vertical sleeve gastrectomy (VSG). HDL subspecies and HDL function were evaluated pre and post VSG using paired t-tests. A lean group of adolescents was included as a reference group.
After VSG, body mass index decreased by 32% and insulin resistance as estimated by homeostatic model assessment of insulin resistance decreased by 75% (both P<0.01). Large apoE-rich HDL subspecies increased following VSG (P<0.01) and approached that of lean adolescents despite participants with considerable residual obesity. In addition, HDL function improved compared with baseline (cholesterol efflux capacity increased by 12%, HDL lipid peroxidation potential decreased by 30% and HDL anti-oxidative capacity improved by 25%, all P<0.01).
Metabolic surgery results in a significant improvement in the quantity of large HDL subspecies and HDL function. Our data suggest metabolic surgery may improve cardiovascular risk in adolescents and young adults.
背景/目的：肥胖青少年的高密度脂蛋白（HDL）亚类分布发生改变，其特征是富含载脂蛋白E（apoE）的大颗粒HDL减少，小颗粒HDL增多。本研究的目的是检验以下假设：这种致动脉粥样硬化的HDL分布是可逆的，并且代谢手术后HDL功能会改善。
对平均年龄为17.4±1.6岁的重度肥胖青少年男性的血清样本在基线时以及垂直袖状胃切除术（VSG）后1年进行研究。使用配对t检验评估VSG前后的HDL亚类和HDL功能。纳入一组瘦的青少年作为参照组。
VSG后，体重指数下降了32%，根据胰岛素抵抗稳态模型评估得出的胰岛素抵抗下降了75%（两者P<0.01）。VSG后，富含apoE的大颗粒HDL亚类增加（P<0.01），尽管仍有相当程度残余肥胖的参与者，但其已接近瘦青少年的水平。此外，与基线相比，HDL功能有所改善（胆固醇流出能力增加了12%，HDL脂质过氧化潜能下降了30%，HDL抗氧化能力提高了25%，均P<0.01）。
代谢手术可使大颗粒HDL亚类的数量和HDL功能显著改善。我们的数据表明，代谢手术可能改善青少年和年轻成年人的心血管风险。
