Illán Gómez Fátima, Gonzálvez Ortega Manuel, Aragón Alonso Aurora, Orea Soler Sabel, Alcaraz Tafalla M ª Soledad, Pérez Paredes Matías, Lozano Almela M ª Luisa
Department of Endocrinology and Nutrition. Hospital Universitario Morales Meseguer. Murcia.
Nutr Hosp. 2016 Nov 29;33(6):1340-1346. doi: 10.20960/nh.793.
Obesity is associated with a high risk for atherosclerotic cardiovascular disease. There is a causal association between obesity, inflammation, insulin resistance (IR) and endothelial dysfunction. The aim of this study was to evaluate changes in IR, proinflammatory state and markers of endothelial dysfunction in morbidly obese patients after weight loss following bariatric surgery.
In this study, we measured the levels of soluble intracellular adhesion molecule-1 (sICAM1), plasminogen activator inhibitor 1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) in 79 morbidly obese patients at baseline and 3, 6 and 12 months after gastric bypass. Also, we evaluated changes in IR.
Twelve months after surgery, there was a significant decrease in plasma levels of sICAM1 (p < 0.001), PAI-1 (p < 0.05), hs-CRP (p < 0.001), IL-6 (p < 0.001) and homeostasis model assessment (HOMA) (p < 0.001) and a significant increase of McAuley index (McAuley) (p < 0.001). Baseline levels of hs-PCR were positively correlated with sICAM-1 (r = 0.450, p < 0.01) and IL-6 (r = 0.451, p < 0.01). Significant correlations were also found between the decrease of PAI-1 and the decrease of hs-PCR (r = 0.425, p < 0.01) and tryglicerides (r = 0.351, p < 0.01).
In patients with morbid obesity, substantial surgically induced weight loss is followed by a significant improvement in the endothelial function, inflammatory state and insulin sensitivity, that may reduce their cardiovascular risk. A relationship exists between improved inflammatory profile and endothelial function.
肥胖与动脉粥样硬化性心血管疾病的高风险相关。肥胖、炎症、胰岛素抵抗（IR）和内皮功能障碍之间存在因果关系。本研究的目的是评估病态肥胖患者在接受减肥手术后体重减轻后IR、促炎状态和内皮功能障碍标志物的变化。
在本研究中，我们测量了79例病态肥胖患者在基线时以及胃旁路手术后3、6和12个月时可溶性细胞间黏附分子-1（sICAM1）、纤溶酶原激活物抑制剂1（PAI-1）、高敏C反应蛋白（hs-CRP）和白细胞介素-6（IL-6）的水平。此外，我们评估了IR的变化。
手术后12个月，血浆sICAM1（p < 0.001）、PAI-1（p < 0.05）、hs-CRP（p < 0.001）、IL-6（p < 0.001）和稳态模型评估（HOMA）（p < 0.001）水平显著降低，麦考利指数（McAuley）显著升高（p < 0.001）。hs-PCR的基线水平与sICAM-1（r = 0.450，p < 0.01）和IL-6（r = 0.451，p < 0.01）呈正相关。PAI-1的降低与hs-PCR的降低（r = 0.425，p < 0.01）和甘油三酯的降低（r = 0.351，p < 0.01）之间也存在显著相关性。
在病态肥胖患者中，手术引起的大量体重减轻后，内皮功能、炎症状态和胰岛素敏感性显著改善，这可能降低他们的心血管风险。炎症指标改善与内皮功能之间存在关联。
