Cardiovascular Division, Internal Medicine Department, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC; Department of Nutrition and Health Sciences, School of Healthcare Management, Kai-Nan University, Taoyuan, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC.
Metabolic & Bariatric Surgical Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
Asian J Surg. 2022 Nov;45(11):2253-2258. doi: 10.1016/j.asjsur.2021.12.064. Epub 2022 Jan 7.
While clinical findings demonstrate a superior benefit of cardiovascular (CV) risk reduction in obese patients with type 2 diabetes mellitus (T2D) receiving bariatric surgery over non-T2D patients, the mechanism is unclear. This study aimed to investigate the changes in the CV risk score and five CV-associated biomarkers after gastric bypass surgery.
We enrolled 80 obese subjects who underwent gastric bypass (40 T2D and 40 non-T2D). CV risks were assessed using the United Kingdom Prospective Diabetes Study (UKPDS) engine before and after surgery. Levels of five biomarkers -fasting serum fibroblast growth factor (FGF)-19, FGF-21, corin, oxidized low-density lipoprotein (ox-LDL), and soluble receptor for advanced glycation end-products (sRAGE)-were measured before surgery and one year after surgery.
The T2D group was significantly older and had a higher CV risk score than the non-T2D group, but body mass index (BMI) was similar between the groups. Preoperative biomarker levels were similar in both the T2D and the non-T2D groups. One year after surgery, the percentage of total weight loss (%TWL) was similar between the two groups (32.2 ± 19.5% versus 34.1% ± 8.8%, p = 0.611). Complete T2D remission (hemoglobin A1c (HbA1c) < 6.0%) was achieved in 29 patients (72.5%). The 10-year CV risk scores by the UKPDS risk engine reduced significantly in both the T2D and the non-T2D groups, but more in the T2D group. Three of five biomarkers changed significantly after surgery: the FGF-19 increased from 195.6 ± 249.1 pg/mL to 283.2 ± 211.8 pg/mL, corin increased from 3.3 ± 2.3 ng/mL to 4.6 ± 3.7 ng/mL, and ox-LDL decreased from 148.5 ± 71.7-107.9 U/L; the P values were 0.002, 0.002 and < 0.001, respectively. The T2D group showed a significantly different change in FGF-19 increase and FGF-21 decrease compared to the non-T2D group. The changes in corin and ox-LDL levels were not different between the T2D and non-T2D groups.
Gastric bypass surgery resulted in a higher UKPDS CV risk score reduction in obese T2D Asians than in those without. FGF-19 and FGF-21 may be associated with the underlying mechanism of this difference.
尽管临床研究表明，与非 2 型糖尿病（T2D）患者相比，接受减重手术的肥胖 T2D 患者在心血管（CV）风险降低方面具有优势，但具体机制尚不清楚。本研究旨在探讨胃旁路手术后 CV 风险评分和五种与 CV 相关生物标志物的变化。
我们纳入了 80 名接受胃旁路手术的肥胖患者（40 名 T2D 和 40 名非 T2D）。使用英国前瞻性糖尿病研究（UKPDS）引擎在手术前后评估 CV 风险。在手术前和手术后一年测量了五种生物标志物-空腹血清成纤维细胞生长因子（FGF）-19、FGF-21、心钠肽、氧化型低密度脂蛋白（ox-LDL）和晚期糖基化终产物可溶性受体（sRAGE）的水平。
T2D 组的年龄明显大于非 T2D 组，CV 风险评分也高于非 T2D 组，但两组的体重指数（BMI）相似。两组的术前生物标志物水平相似。手术后一年，两组的总体重减轻百分比（%TWL）相似（32.2±19.5%与 34.1%±8.8%，p=0.611）。29 名患者（72.5%）实现了完全 T2D 缓解（糖化血红蛋白（HbA1c）<6.0%）。UKPDS 风险引擎的 10 年 CV 风险评分在 T2D 和非 T2D 组均显著降低，但 T2D 组降低更明显。手术后有三种生物标志物发生了显著变化：FGF-19 从 195.6±249.1 pg/mL 增加到 283.2±211.8 pg/mL，心钠肽从 3.3±2.3 ng/mL 增加到 4.6±3.7 ng/mL，ox-LDL 从 148.5±71.7-107.9 U/L；P 值分别为 0.002、0.002 和<0.001。与非 T2D 组相比，T2D 组的 FGF-19 增加和 FGF-21 减少有显著差异。T2D 和非 T2D 组的 corin 和 ox-LDL 水平变化无差异。
与非 T2D 患者相比，胃旁路手术可使亚洲肥胖 T2D 患者的 UKPDS CV 风险评分降低幅度更大。FGF-19 和 FGF-21 可能与这种差异的潜在机制有关。
