Wang Yong, Yu Zong-Fan, Cheng Yun-Sheng, Jia Ben-Li, Yu Gang, Yin Xiao-Qiang, Wang Yang
Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.
Medicine (Baltimore). 2017 Jul;96(30):e7498. doi: 10.1097/MD.0000000000007498.
This study is all about predicting the value of serum vaspin level in the amelioration of fatty liver and metabolic disturbance in patients with severe obesity after laparoscopic vertical banded gastroplasty (LVBG).
A total of 164 patients (from January 2012 to May 2015) with severe obesity were chosen and performed LVBG. Enzyme-linked immunosorbent assay was performed to detect the serum vaspin level. The patients were given a biochemical automatic analyzer to measure the biochemical indicators. Homeostasis model assessment (HOMA) helps in the calculation of fasting insulin level (FINS) and insulin resistance (IR). The changes in fatty liver were examined by computed tomography (CT). Receiver operating characteristic curve is used to increase the predictive value of serum vaspin level in the amelioration of liver function and disturbances in the metabolism.
Weight, BMI, waist circumference, serum vaspin level, and triglyceride (TG) decreased, but CT value of liver increased at 4th, 7th, and 12th month after surgery. After the 7th and 12th month period of surgery, the alanine aminotransferase, aspartate aminotransferase, FINS, and HOMA-IR reduced in the patients (P <.005). The area under ROC curve (AUC) is about 0.871 ± 0.031 with 95%CI of 0.810-0.931 (P <.001). The sensitivity, specificity, and accuracy of serum vaspin level ≤0.9 were 87.80%, 78.05%, and 83.28%, respectively. BMI, FINS, and serum vaspin level ≤0.9 were the influencing factors of the amelioration of fatty liver and metabolic disturbance.
This study proves that the serum vaspin level serves as a predictive indicator in the amelioration of fatty liver and metabolic disturbance in patients with severe obesity after LVBG.
本研究旨在预测血清内脏脂肪素水平在腹腔镜垂直束带胃成形术（LVBG）后重度肥胖患者脂肪肝改善及代谢紊乱方面的价值。
选取2012年1月至2015年5月期间共164例重度肥胖患者，为其实施LVBG。采用酶联免疫吸附测定法检测血清内脏脂肪素水平。使用生化自动分析仪测量患者的生化指标。稳态模型评估（HOMA）用于计算空腹胰岛素水平（FINS）和胰岛素抵抗（IR）。通过计算机断层扫描（CT）检查脂肪肝的变化情况。采用受试者工作特征曲线提高血清内脏脂肪素水平在肝功能改善及代谢紊乱方面的预测价值。
术后第4、7和12个月时，患者体重、体重指数（BMI）、腰围、血清内脏脂肪素水平及甘油三酯（TG）下降，但肝脏CT值升高。术后第7和12个月时，患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶、FINS及HOMA-IR降低（P<0.005）。ROC曲线下面积（AUC）约为0.871±0.031，95%置信区间为0.810 - 0.931（P<0.001）。血清内脏脂肪素水平≤0.9时的敏感度、特异度和准确度分别为87.80%、78.05%和83.28%。BMI、FINS及血清内脏脂肪素水平≤0.9是脂肪肝改善及代谢紊乱的影响因素。
本研究证明血清内脏脂肪素水平可作为LVBG后重度肥胖患者脂肪肝改善及代谢紊乱的预测指标。
