Bienias Piotr, Rymarczyk Zuzanna, Domienik-Karłowicz Justyna, Lisik Wojciech, Sobieraj Piotr, Pruszczyk Piotr, Ciurzyński Michał
Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland.
Department of General Surgery and Transplantology, Medical University of Warsaw, 02-005 Warsaw, Poland.
J Clin Med. 2021 May 15;10(10):2140. doi: 10.3390/jcm10102140.
The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m, aged 36.5 (18-56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, all subjects had 24-h Holter monitoring with heart rate variability (HRV) and heart rate turbulence (HRT) evaluation. After a median of 15 months, BMI decreased from 43.9 to 29.7 kg/m, the incidence of hypertension decreased from 54 to 32% ( = 0.04) and any carbohydrate disorders decreased from 24 to 6% ( = 0.02). Fasting insulin concentration and insulin resistance index improved significantly ( < 0.001). Improvements in HRV parameters related to the sympathetic autonomic division were also observed ( < 0.001), while HRT evaluation was not conclusive. The enhancement of autonomic tone indices was correlated with reduction of BMI (SDNN-I r = 0.281 = 0.04; SDNN r = 0.267 = 0.05), but not with reduction of waist circumference, and it was also associated with decrease of mean heart rate (OR 0.02, 95%CI 0.0-0.1, < 0.001). The incidence of arrhythmias was low and similar before and after follow-up. In conclusion, improvement of homeostasis of carbohydrate metabolism and autonomic function is observed in relatively young patients after weight loss due to laparoscopic sleeve gastrectomy.
减肥手术后体重减轻对自主神经平衡、心律失常和胰岛素抵抗的影响仍备受关注。我们前瞻性地研究了50例BMI>40kg/m²、年龄36.5（18 - 56）岁且接受腹腔镜袖状胃切除术的患者。在其他检查中，所有受试者均进行了24小时动态心电图监测，并评估心率变异性（HRV）和心率震荡（HRT）。中位随访15个月后，BMI从43.9降至29.7kg/m²，高血压发病率从54%降至32%（P = 0.04），任何碳水化合物紊乱从24%降至6%（P = 0.02）。空腹胰岛素浓度和胰岛素抵抗指数显著改善（P<0.001）。与交感自主神经分支相关的HRV参数也有改善（P<0.001），而HRT评估结果尚无定论。自主神经张力指数的增强与BMI的降低相关（SDNN - I r = 0.281，P = 0.04；SDNN r = 0.267，P = 0.05），但与腰围的降低无关，并且还与平均心率的降低有关（OR 0.02，95%CI 0.0 - 0.1，P<0.001）。心律失常的发生率较低，随访前后相似。总之，在因腹腔镜袖状胃切除术导致体重减轻的相对年轻患者中，观察到碳水化合物代谢和自主神经功能的内稳态得到改善。
