Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Laboratory of Endocrine and the Laboratory of Lipid & Glucose Metabolism, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Surg Obes Relat Dis. 2022 Oct;18(10):1209-1217. doi: 10.1016/j.soard.2022.05.013. Epub 2022 May 18.
Obesity has become a global problem that poses a serious threat to human health. Laparoscopic sleeve gastrectomy (LSG) is an effective long-term treatment. However, the weight loss of some patients after LSG is still insufficient. It is necessary to investigate the factors associated with inadequate weight loss after LSG.
The objective of this study was to explore whether preoperative insulin secretion could be associated with weight loss after LSG in patients with obesity.
This is a single-center prospective cohort study conducted in a university hospital.
Patients from a prospective database who underwent LSG were analyzed. All 178 participants underwent a 75-g oral glucose tolerance test (OGTT) to assess preoperative insulin and c-peptide secretion before LSG. The areas under the curve (AUCs) for glucose, insulin, and c-peptide were determined in the OGTT. The percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were used to estimate the effect of weight loss after LSG. Regression models were used to assess the correlation between preoperative insulin and c-peptide secretion with %EWL ≥75% and TWL ≥35% at 12 months after LSG.
The AUCs of insulin and c-peptide were significantly lower in the %EWL ≥75% and %TWL ≥35% groups at 0-30 minutes, 0-60 minutes, and 0-120 minutes during the OGTT. At 30, 60, and 120 minutes during the OGTT, c-peptide levels were significantly lower in the %EWL ≥75% group and %TWL ≥35% group. The preoperative c-peptide level at 30 minutes during the OGTT (C) was significantly negatively correlated with %EWL (β = -.37, P < .001) and %TWL (β = -.28, P = .011). Univariate logistic regression analysis showed that preoperative C was associated with %EWL ≥75% and %TWL ≥35% after LSG. According to multiple logistic regression analysis, patients with a low preoperative C had an 8-fold higher %TWL ≥35% after LSG than those with a high C (odds ratio: 8.41 [95% confidence interval: 1.46-48.58], P = .017). Similarly, patients with a low preoperative C had a 7-fold higher EWL% ≥75% after LSG than patients with a high C (odds ratio: 7.25 [95% confidence interval: 1.11-47.50], P = .039).
The rate of weight loss after LSG is low among patients with preoperative hyperinsulinemia. The preoperative c-peptide level at 30 minutes during the OGTT is associated with weight loss after LSG.
肥胖已成为全球问题，严重威胁人类健康。腹腔镜袖状胃切除术（LSG）是一种有效的长期治疗方法。然而，一些患者在 LSG 后的体重减轻仍然不足。有必要研究与 LSG 后体重减轻不足相关的因素。
本研究旨在探讨肥胖患者术前胰岛素分泌是否与 LSG 后的体重减轻有关。
这是在一所大学医院进行的单中心前瞻性队列研究。
对接受 LSG 的前瞻性数据库中的患者进行分析。所有 178 名参与者在 LSG 前均进行了 75g 口服葡萄糖耐量试验（OGTT），以评估术前胰岛素和 C 肽分泌情况。OGTT 中确定了葡萄糖、胰岛素和 C 肽的曲线下面积（AUC）。%EWL（ excess weight loss，超重减轻百分比）和 %TWL（total weight loss，总体重减轻百分比）用于估计 LSG 后体重减轻的效果。回归模型用于评估 OGTT 中 0-30 分钟、0-60 分钟和 0-120 分钟时胰岛素和 C 肽分泌与 LSG 后 12 个月时的 %EWL≥75%和 %TWL≥35%之间的相关性。
OGTT 中，胰岛素和 C 肽的 AUC 在 0-30 分钟、0-60 分钟和 0-120 分钟时，%EWL≥75%组和%TWL≥35%组均明显较低。OGTT 中 30、60 和 120 分钟时，%EWL≥75%组和%TWL≥35%组的 C 肽水平明显较低。OGTT 中 30 分钟时的术前 C 肽水平（C）与%EWL（β=-.37，P<.001）和%TWL（β=-.28，P=.011）呈显著负相关。单变量逻辑回归分析显示，术前 C 与 LSG 后%EWL≥75%和%TWL≥35%相关。根据多变量逻辑回归分析，术前 C 较低的患者 LSG 后%TWL≥35%的可能性是术前 C 较高的患者的 8 倍（比值比：8.41[95%置信区间：1.46-48.58]，P=.017）。同样，术前 C 较低的患者 LSG 后 EWL%≥75%的可能性是术前 C 较高的患者的 7 倍（比值比：7.25[95%置信区间：1.11-47.50]，P=.039）。
术前高胰岛素血症患者 LSG 后的体重减轻率较低。OGTT 中 30 分钟时的 C 肽水平与 LSG 后的体重减轻有关。
