Doyle S L, Mongan A M, Donohoe C L, Pidgeon G P, Sherlock M, Reynolds J V, Lysaght J
Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital and Trinity College Dublin, Dublin, Ireland.
School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland.
Dis Esophagus. 2017 Jun 1;30(6):1-11. doi: 10.1093/dote/dox008.
Visceral obesity and metabolic syndrome (MetSyn) represent a constellation of inflammation, insulin resistance, and hyperglycemia and are established risk factors for gastrointestinal cancer. However, their impact on the immune and inflammatory response after major upper gastrointestinal oncologic surgery is unknown. In 125 consecutive patients who underwent esophagectomy, C-reactive protein (CRP) and CRP:albumin levels were recorded preoperatively and on days 1, 3, 7, and 14 postoperatively. In a subset of 30 patients, circulating levels of IL-6, IL-8, IL-10, IL-12p70, IFN-γ, TNF-α, TGF-β, and cortisol were measured. Incidences of postoperative complications were prospectively recorded. In the study cohort, 51% of patients were viscerally obese, 40.7% had MetSyn, and 33.6% were hyperglycemic. Viscerally obese and MetSyn-positive patients demonstrated greater postoperative CRP levels and CRP:albumin levels on day 7 and day 14 compared with nonobese and MetSyn-negative patients (P < 0.05). Higher postoperative circulating levels of cortisol were observed in the viscerally obese and hyperglycemic patients compared to nonobese and normoglycemic patients. No association was observed between visceral obesity, MetSyn or hyperglycemia, and postoperative cytokine profile. Viscerally obese patients had an increased overall incidence of postoperative complications compared to nonobese patients (67.2% vs. 47.5%, P = 0.031) on univariate but not multivariate analysis (P = 0.078) and visceral obesity was not associated with an increased incidence of specific complications. Visceral obesity, MetSyn, and hyperglycemia are prevalent in patients undergoing major upper gastrointestinal resection and are associated with an exaggerated acute-phase inflammatory response postoperatively. Further research is warranted to determine whether this association is directly causal.
内脏肥胖和代谢综合征（MetSyn）表现为炎症、胰岛素抵抗和高血糖的集合，是胃肠道癌症已确定的危险因素。然而，它们对主要上消化道肿瘤手术术后免疫和炎症反应的影响尚不清楚。在连续125例行食管切除术的患者中，记录术前及术后第1、3、7和14天的C反应蛋白（CRP）和CRP：白蛋白水平。在30例患者的亚组中，测量循环中白细胞介素-6、白细胞介素-8、白细胞介素-10、白细胞介素-12p70、干扰素-γ、肿瘤坏死因子-α、转化生长因子-β和皮质醇的水平。前瞻性记录术后并发症的发生率。在研究队列中，51%的患者为内脏肥胖，40.7%患有MetSyn，33.6%患有高血糖。与非肥胖和MetSyn阴性患者相比，内脏肥胖和MetSyn阳性患者在术后第7天和第14天的CRP水平和CRP：白蛋白水平更高（P<0.05）。与非肥胖和血糖正常的患者相比，在内脏肥胖和高血糖患者中观察到术后循环皮质醇水平更高。在内脏肥胖、MetSyn或高血糖与术后细胞因子谱之间未观察到关联。在单因素分析中，与非肥胖患者相比，内脏肥胖患者术后并发症的总体发生率增加（67.2%对47.5%，P=0.031），但在多因素分析中未增加（P=0.078），且内脏肥胖与特定并发症的发生率增加无关。内脏肥胖、MetSyn和高血糖在接受主要上消化道切除术的患者中普遍存在，并与术后过度的急性期炎症反应相关。有必要进行进一步研究以确定这种关联是否直接具有因果关系。
