Sailon Alexander M, Wasserburg J Roscoe, Kling Rochelle R, Pasick Christina M, Taub Peter J
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
Ann Plast Surg. 2017 Dec;79(6):623-630. doi: 10.1097/SAP.0000000000001195.
Evidence suggesting that adipose tissue is a metabolically active tissue has generated debate on the effects of large-volume liposuction (LVL) on metabolic and cardiovascular health. Given the inconsistency in the literature, the authors performed a systematic review to identify available evidence in order to elucidate the potential impact of LVL on metabolic markers and cardiovascular risk factors.
A PubMed search using relevant keywords was conducted. Articles were screened using predetermined inclusion and exclusion criteria. Large-volume liposuction was defined as greater than 3.5 L of lipoaspirate. All studies included evaluation of patients' preoperative and postoperative cardiovascular risk factors, inflammatory cytokines, and/or insulin resistance/sensitivity. Relevant studies were evaluated and assigned a level of evidence.
A total of 12 studies that met the inclusion criteria were reviewed, of which 1 was a continuation of a previous study. All reports were prospective studies, 2 were randomized control trials, and 3 included a control group. A total of 364 patients were pooled for analysis. The mean volume of lipoaspirate was 7440 ± 1934.9 mL. The mean body mass index at baseline and postliposuction was 30.7 and 28.4, respectively. Seven studies reported a trend toward decrease in total cholesterol levels with an overall mean reduction of 0.21 ± 0.05 mmol/L from 4.6 ± 0.79 mmol/L to 4.4 ± 0.74 mmol/L. After LVL, leptin was reported to significantly decrease in 4 studies, and TNF-α was reported to significantly decrease in 2. Adiponectin was reported to significantly increase in 2 studies. IL-6 decreased significantly in 2 studies. Two studies included participants with type II diabetes mellitus, whereas 10 studies evaluated insulin sensitivity. Of these, 6 studies reported improvement in insulin sensitivity. Six studies represented level IV and 6 represented level II evidence.
Liposuction is among the most common aesthetic procedures performed with advances that make it possible to remove considerable amount of adipose tissue within a short period. Current data, although conflicting, appear to support the notion that LVL can affect cardiovascular risk factors, metabolic balance, and insulin resistance in positive ways. Future research with prospective studies is needed to clarify the role of LVL in improving overall health.
有证据表明脂肪组织是一种具有代谢活性的组织,这引发了关于大容量抽脂术(LVL)对代谢和心血管健康影响的争论。鉴于文献中的不一致性,作者进行了一项系统综述,以确定现有证据,从而阐明LVL对代谢标志物和心血管危险因素的潜在影响。
使用相关关键词在PubMed上进行检索。根据预先设定的纳入和排除标准筛选文章。大容量抽脂术被定义为抽脂量大于3.5升。所有研究均包括对患者术前和术后心血管危险因素、炎性细胞因子和/或胰岛素抵抗/敏感性的评估。对相关研究进行评估并赋予证据等级。
共审查了12项符合纳入标准的研究,其中1项是先前研究的延续。所有报告均为前瞻性研究,2项为随机对照试验,3项包括对照组。总共纳入364例患者进行分析。抽脂的平均量为7440±1934.9毫升。抽脂术前和术后的平均体重指数分别为30.7和28.4。7项研究报告总胆固醇水平有下降趋势,总体平均降低0.21±0.05毫摩尔/升,从4.6±0.79毫摩尔/升降至4.4±0.74毫摩尔/升。抽脂术后,4项研究报告瘦素显著降低,2项研究报告肿瘤坏死因子-α显著降低。2项研究报告脂联素显著升高。2项研究中白细胞介素-6显著降低。2项研究纳入了2型糖尿病患者,10项研究评估了胰岛素敏感性。其中,6项研究报告胰岛素敏感性有所改善。6项研究为IV级证据,6项为II级证据。
抽脂术是最常见的美容手术之一,随着技术进步,现在有可能在短时间内去除大量脂肪组织。目前的数据虽然相互矛盾,但似乎支持大容量抽脂术可以对心血管危险因素、代谢平衡和胰岛素抵抗产生积极影响这一观点。需要通过前瞻性研究进一步明确大容量抽脂术在改善整体健康方面的作用。