未酰化胃饥饿素与肥胖 2 型糖尿病患者 Roux-en-Y 胃旁路术后骨密度下降相关。

Unacylated ghrelin is correlated with the decline of bone mineral density after Roux-en-Y gastric bypass in obese Chinese with type 2 diabetes.

机构信息

Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, China.

Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.

出版信息

Surg Obes Relat Dis. 2019 Sep;15(9):1473-1480. doi: 10.1016/j.soard.2019.04.011. Epub 2019 Apr 16.

DOI:10.1016/j.soard.2019.04.011

PMID:31548003

Abstract

BACKGROUND

Bariatric surgery is an effective and therapeutic way for different metabolic diseases. It has become a focus of attention about the effects and molecular mechanisms to bone metabolism.

OBJECTIVE

We aim to assess the changes of bone mineral density (BMD) among Chinese obese individuals with type 2 diabetes who have undergone Roux-en-Y gastric bypass surgery (RYGB). Two ghrelin gene products, namely unacylated ghrelin (UAG) and obestatin, were evaluated the roles in this pathologic process.

SETTING

University-affiliated hospital, China.

METHODS

Thirty patients who had received RYGB were enrolled in the study. Changes in anthropometric parameters, metabolic indexes, and serum UAG and obestatin were assessed preoperatively, 6, 12, and 24 months postoperatively. BMD at lumbar spine (LS), femoral neck (FN), and total hip (TH) were identified.

RESULTS

RYGB resulted in statistical reductions of BMD in 3 different skeletal parts. After the first 6 months, BMD began to reduce and maintained a declining trend until 24 months postoperatively. Comparing to baseline, the maximal reduction of BMD was as high as 10.28% in total hip. The plasma concentration of UAG increased after 6 months (51.61 ± 55.21 versus 71.95 ± 64.91 pg/mL; P < .01), as well as the serum obestatin level (1.65 ± 0.88 versus 1.71 ± 0.99 ng/mL; P > .05). Although there was a slight drop of both peptides in the first year, they were still above the baseline. Notably, in the second year, UAG and obestatin rose to their peak values, respectively (91.90 ± 77.11 pg/mL and 1.74 ± 1.09 ng/mL). There was a negative correlation between UAG and BMD in all sites. Multiple linear regression analysis showed that the UAG level was the independent parameter associated with BMD at baseline (FN: β = -.407, P = .012 and TH: β = -0.396, P = .030 respectively), as well as the changes of UAG that were independently related with reduction percentage of LS BMD after 24 months (β = - .379, P = .046).

CONCLUSION

The reduction of BMD in obese Chinese with type 2 diabetes was observed after RYGB. The pronounced increase of serum UAG acts as an independent risk factor for the decrease of BMD.

摘要

背景

减重手术是治疗多种代谢性疾病的有效方法。它已成为研究骨代谢相关作用和分子机制的焦点。

目的

评估中国肥胖 2 型糖尿病患者行 Roux-en-Y 胃旁路手术后（RYGB）骨密度（BMD）的变化。评估两种胃饥饿素基因产物，即未酰化胃饥饿素（UAG）和肥胖抑制素，在这一病理过程中的作用。

设置

中国大学附属医院。

方法

共纳入 30 例行 RYGB 的患者。术前、术后 6、12 和 24 个月评估人体测量参数、代谢指标及血清 UAG 和肥胖抑制素变化。检测腰椎（LS）、股骨颈（FN）和全髋（TH）的 BMD。

结果

RYGB 导致 3 个不同骨骼部位的 BMD 出现统计学上的降低。术后第 1 个月，BMD 开始下降，并保持下降趋势至术后 24 个月。与基线相比，全髋关节的最大 BMD 降低率高达 10.28%。术后 6 个月 UAG 水平升高（51.61±55.21 比 71.95±64.91 pg/mL；P<.01），血清肥胖抑制素水平升高（1.65±0.88 比 1.71±0.99 ng/mL；P>.05）。尽管在第 1 年内两种肽略有下降，但仍高于基线。值得注意的是，在第 2 年，UAG 和肥胖抑制素分别上升至峰值（91.90±77.11 pg/mL 和 1.74±1.09 ng/mL）。UAG 与所有部位的 BMD 均呈负相关。多元线性回归分析显示，UAG 水平是与基线 FN（β=-.407，P=0.012）和 TH（β= -0.396，P=0.030）BMD 相关的独立参数，以及与术后 24 个月 LS BMD 降低百分比相关的独立变量（β= -0.379，P=0.046）。