Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Laparoendosc Adv Surg Tech A. 2022 Aug;32(8):817-822. doi: 10.1089/lap.2021.0558. Epub 2022 Feb 11.
Irisin has been recently reported to provide beneficial effects in obesity and diabetes. Elevation of high-sensitivity C-reactive protein (hs-CRP) reflects the inflammatory state that has been shown to play a key role in obesity and its comorbidities. Our study aimed to compare the changes of circulating irisin levels in an obese diabetic population who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) versus a control-matched population who underwent usual medical care plus diabetes support education (DSE) program. In addition, we aimed to explore the association between circulating irisin and hs-CRP levels after the interventions. In a prospective controlled trial, we studied 58 obese individuals with type 2 diabetes before and 12 months after intervention. Twenty-nine subjects underwent LRYGB and 29 subjects received DSE. At 12-month follow-up, compared with the DSE group, patients who underwent LRYGB lost more weight (LRYGB; -33.4 ± 11.2, and DSE; 0.2 ± 4.9 kg; < .001), fat mass ( < .001), and fat-free mass ( < .05). Circulating irisin ( < .05) and hs-CRP level ( < .05) were also significantly lower. Within the LRYGB group, the reduction of irisin level was positively associated with the changes of hs-CRP levels ( = 0.39, < .05). To the best of our knowledge, this is the first study showing that LRYGB significantly reduces circulating irisin levels compared with usual medical care and DSE, in an obese diabetic population. After LRYGB, the irisin reduction significantly correlates with the reduction of hs-CRP. The elevation of circulating irisin levels suggests irisin resistance in the obese state and its decrease after LRYGB might reflect the resolution of irisin resistance. Future investigations are needed to confirm and explore the mechanisms of irisin resistance in obesity, its resolution after LRYGB, and the pathophysiological significance.
鸢尾素最近被报道在肥胖和糖尿病中具有有益作用。高敏 C 反应蛋白（hs-CRP）的升高反映了炎症状态，已证明炎症状态在肥胖及其合并症中起关键作用。我们的研究旨在比较接受腹腔镜 Roux-en-Y 胃旁路术（LRYGB）的肥胖糖尿病患者与接受常规医疗加糖尿病支持教育（DSE）方案的对照组患者循环鸢尾素水平的变化。此外，我们旨在探讨干预后循环鸢尾素与 hs-CRP 水平之间的关联。在一项前瞻性对照试验中，我们在干预前和干预后 12 个月研究了 58 例肥胖 2 型糖尿病患者。29 例患者接受 LRYGB，29 例患者接受 DSE。在 12 个月随访时，与 DSE 组相比，接受 LRYGB 的患者体重减轻更多（LRYGB：-33.4±11.2，DSE：0.2±4.9kg；<.001），体脂（<.001）和去脂体重（<.05）。循环鸢尾素（<.05）和 hs-CRP 水平（<.05）也显著降低。在 LRYGB 组中，鸢尾素水平的降低与 hs-CRP 水平的变化呈正相关（ =0.39，<.05）。据我们所知，这是第一项研究表明，与常规医疗和 DSE 相比，LRYGB 可显著降低肥胖糖尿病患者的循环鸢尾素水平。LRYGB 后，鸢尾素的减少与 hs-CRP 的减少显著相关。循环鸢尾素水平的升高提示肥胖状态下的鸢尾素抵抗，LRYGB 后其减少可能反映了鸢尾素抵抗的消除。需要进一步的研究来证实和探讨肥胖时鸢尾素抵抗的机制、LRYGB 后的消除以及病理生理学意义。
