Department of Medicine (H7), Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Ersta Hospital, Stockholm, Sweden.
J Intern Med. 2019 Jan;285(1):92-101. doi: 10.1111/joim.12824. Epub 2018 Sep 25.
The cardiometabolic risk profile improves following bariatric surgery. However, the degree of improvement in relation to weight-stable control subjects is unknown.
To study the differences in cardiometabolic risk profile between formerly obese patients following Roux-en-Y gastric bypass (RYGB) surgery and control subjects.
Subjects undergoing RYGB and reaching a BMI <30 kg m 2 years postsurgery were matched with control subjects regarding age, sex and BMI. The following examinations were performed: insulin sensitivity measured by hyperinsulinaemic-euglycaemic clamp, insulin clearance, homeostatic model assessment of insulin resistance (HOMA-IR), lipid profile, inflammatory marker levels, dual-energy X-ray absorptiometry and subcutaneous adipose tissue cellularity (fat cell size and number).
Sixty-nine subjects undergoing RYGB were matched to a control subject. Insulin sensitivity measured by hyperinsulinaemic-euglycaemic clamp, blood pressure, inflammatory status and glucose, triglyceride and HDL cholesterol levels were comparable to values of control subjects. However, HOMA-IR (1.0 ± 0.5 vs. 1.3 ± 0.7, P = 0.005), insulin clearance (0.38 ± 0.08 vs. 0.34 ± 0.08 μL m min , P < 0.0001) and circulating levels of insulin (31 ± 15 vs. 37 ± 17 pmol L , P = 0.008), total cholesterol (4.1 ± 0.7 vs. 4.8 ± 0.9 mmol L , P < 0.0001) and LDL cholesterol (2.1 ± 0.6 vs. 2.9 ± 0.8 mmol L , P < 0.0001) were improved beyond the levels in matched control subjects. Furthermore, formerly obese subjects had higher lean and lower fat mass as well as a more benign type of adipose cellularity (hyperplasia with many small fat cells) compared to control subjects.
Subjects who underwent RYGB and reached a postobese state demonstrated a beneficial body composition, slightly increased insulin sensitivity as indirectly measured by HOMA-IR and higher insulin clearance, lower atherogenic lipid/lipoprotein levels and benign adipocyte morphology compared with control subjects who had never been obese. In line with previous results, our findings may in part explain why RYGB confers long-term protection against metabolic complications.
减重手术后，心脏代谢风险状况会得到改善。然而，与体重稳定的对照组相比，改善的程度尚不清楚。
研究肥胖症患者在接受 Roux-en-Y 胃旁路手术后（RYGB）与对照组之间心脏代谢风险状况的差异。
对 RYGB 术后 BMI<30kg/m2 且达到稳定体重的患者进行研究，并与对照组进行年龄、性别和 BMI 匹配。进行以下检查：高胰岛素-正葡萄糖钳夹法测量胰岛素敏感性、胰岛素清除率、稳态模型评估的胰岛素抵抗（HOMA-IR）、血脂谱、炎症标志物水平、双能 X 射线吸收法和皮下脂肪组织细胞数（脂肪细胞大小和数量）。
69 例 RYGB 患者与对照组进行匹配。高胰岛素-正葡萄糖钳夹法测量的胰岛素敏感性、血压、炎症状态以及血糖、甘油三酯和 HDL 胆固醇水平与对照组相当。然而，HOMA-IR（1.0±0.5 与 1.3±0.7，P=0.005）、胰岛素清除率（0.38±0.08 与 0.34±0.08μL/min，P<0.0001）和循环胰岛素水平（31±15 与 37±17 pmol/L，P=0.008）、总胆固醇（4.1±0.7 与 4.8±0.9mmol/L，P<0.0001）和 LDL 胆固醇（2.1±0.6 与 2.9±0.8mmol/L，P<0.0001）均优于匹配对照组。此外，与对照组相比，肥胖症患者具有更高的瘦体重和更低的脂肪量，以及良性的脂肪细胞形态（增生且有许多小脂肪细胞）。
与从未肥胖的对照组相比，接受 RYGB 并达到肥胖后状态的患者具有有益的身体组成，HOMA-IR 间接测量的胰岛素敏感性略有增加，胰岛素清除率更高，致动脉粥样硬化的血脂/脂蛋白水平更低，脂肪细胞形态良性。与先前的结果一致，我们的发现部分解释了 RYGB 为何能长期预防代谢并发症。
