血清 FABP4 浓度在 Roux-en-Y 胃旁路手术后降低，但在强化药物治疗后不会降低。
Serum FABP4 concentrations decrease after Roux-en-Y gastric bypass but not after intensive medical management.
机构信息
Department of Surgery, University of Minnesota, Minneapolis, MN.
Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN.
出版信息
Surgery. 2019 Mar;165(3):571-578. doi: 10.1016/j.surg.2018.08.007. Epub 2018 Oct 1.
BACKGROUND
Serum concentrations of fatty acid binding protein 4, an adipose tissue fatty acid chaperone, have been correlated with insulin resistance and cardiovascular risk factors. The objective of this study were to assess relationships among Roux-en-Y gastric bypass, intensive lifestyle modification and medical management protocol, fatty acid binding protein 4, and metabolic parameters in obese patients with severe type 2 diabetes mellitus; and to evaluate the relative contribution of abdominal subcutaneous adipose and visceral adipose to the secretion of fatty acid binding protein 4.
METHODS
Participants were randomly assigned to intensive lifestyle modification and medical management protocol (n = 29) or to intensive lifestyle modification and medical management protocol augmented with Roux-en-Y gastric bypass (n = 34). Relationships among fatty acid binding protein 4 and demographic characteristics, metabolic parameters, and 12-month changes in these values were examined. Visceral and subcutaneous adipose tissue explants from obese nondiabetic patients (n = 5) were obtained and treated with forskolin to evaluate relative secretion of fatty acid binding protein 4 in the different adipose tissue depots.
RESULTS
The intensive lifestyle modification and medical management protocol and Roux-en-Y gastric bypass cohorts had similar fasting serum fatty acid binding protein 4 concentrations at baseline. At 1 year, mean serum fatty acid binding protein 4 decreased by 42% in Roux-en-Y gastric bypass participants (P = .002) but did not change significantly in the intensive lifestyle modification and medical management protocol cohort. Percentage of weight change was not a significant predictor of 12-month fatty acid binding protein 4 within treatment arm or in multivariate models adjusted for treatment arm. In adipose tissue explants, fatty acid binding protein 4 was secreted similarly between visceral and subcutaneous adipose tissue.
CONCLUSION
After Roux-en-Y gastric bypass, fatty acid binding protein 4 is reduced 12 months after surgery but not after intensive lifestyle modification and medical management protocol in patients with type 2 diabetes mellitus. Fatty acid binding protein 4 was secreted similarly between subcutaneous and visceral adipose tissue explants.
背景
血清脂肪酸结合蛋白 4（一种脂肪组织脂肪酸伴侣）的浓度与胰岛素抵抗和心血管危险因素相关。本研究旨在评估 Roux-en-Y 胃旁路术、强化生活方式改变和医学管理方案、脂肪酸结合蛋白 4 与代谢参数之间的关系，以及评估内脏和皮下脂肪组织对脂肪酸结合蛋白 4 分泌的相对贡献，对象为患有 2 型糖尿病的肥胖患者；并评估内脏和皮下脂肪组织对脂肪酸结合蛋白 4 分泌的相对贡献。
方法
参与者被随机分配到强化生活方式改变和医学管理方案组（n=29）或强化生活方式改变和医学管理方案联合 Roux-en-Y 胃旁路术组（n=34）。研究了脂肪酸结合蛋白 4 与人口统计学特征、代谢参数以及这些值在 12 个月内的变化之间的关系。从肥胖非糖尿病患者（n=5）获得内脏和皮下脂肪组织标本，并使用 forskolin 处理以评估不同脂肪组织库中脂肪酸结合蛋白 4 的相对分泌情况。
结果
强化生活方式改变和医学管理方案组和 Roux-en-Y 胃旁路术组的空腹血清脂肪酸结合蛋白 4 浓度在基线时相似。在 1 年时，Roux-en-Y 胃旁路术组的血清脂肪酸结合蛋白 4 平均下降 42%（P=0.002），但强化生活方式改变和医学管理方案组无明显变化。在治疗组内或调整治疗组后的多变量模型中，体重变化百分比不是 12 个月脂肪酸结合蛋白 4 的显著预测因子。在脂肪组织标本中，内脏和皮下脂肪组织中脂肪酸结合蛋白 4 的分泌情况相似。
结论
在 Roux-en-Y 胃旁路术后，2 型糖尿病患者手术后 12 个月内脂肪酸结合蛋白 4 降低，但强化生活方式改变和医学管理方案后则不会。皮下和内脏脂肪组织的脂肪酸结合蛋白 4 分泌情况相似。
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