Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt.
Clinical Pathology, Alexandria University, Alexandria, Egypt.
Obes Surg. 2022 Dec;32(12):3942-3950. doi: 10.1007/s11695-022-06296-2. Epub 2022 Oct 6.
Obesity is associated with metabolic syndrome (MBS), a cluster of components including central obesity, insulin resistance (IR), dyslipidemia, and hypertension. IR is the major risk factor in the development and progression of type 2 diabetes mellitus in obesity and MBS. Predicting preoperatively whether a patient with obesity would have improved or non-improved IR after bariatric surgery would improve treatment decisions.
A prospective cohort study was conducted between August 2019 and September 2021. We identified pre- and postoperative metabolic biomarkers in patients who underwent laparoscopic sleeve gastrectomy. Patients were divided into two groups: group A (IR < 2.5), with improved IR, and group B (IR ≥ 2.5), with non-improved IR. A prediction model and receiver operating characteristics (ROC) were used to determine the effect of metabolic biomarkers on IR.
Seventy patients with obesity and MBS were enrolled. At 12-month postoperative a significant improvement in lipid profile, fasting blood glucose, and hormonal biomarkers and a significant reduction in the BMI in all patients (p = 0.008) were visible. HOMA-IR significantly decreased in 57.14% of the patients postoperatively. Significant effects on the change in HOMA-IR ≥ 2.5 were the variables; preoperative BMI, leptin, ghrelin, leptin/ghrelin ratio (LGr), insulin, and triglyceride with an OR of 1.6,1.82, 1.33, 1.69, 1.77, and 1.82, respectively (p = 0.009 towards p = 0.041). Leptin had the best predictive cutoff value on ROC (86% sensitivity and 92% specificity), whereas ghrelin had the lowest (70% sensitivity and 73% specificity).
Preoperative BMI, leptin, ghrelin, LGr, and increased triglycerides have a predictive value on higher postoperative, non-improved patients with HOMA-IR (≥ 2.5). Therefore, assessing metabolic biomarkers can help decide on treatment/extra therapy and outcome before surgery.
肥胖与代谢综合征（MBS）有关，MBS 是一组包括中心性肥胖、胰岛素抵抗（IR）、血脂异常和高血压的成分。IR 是肥胖和 MBS 中 2 型糖尿病发展和进展的主要危险因素。预测肥胖患者在接受减重手术后 IR 是否改善或未改善，将改善治疗决策。
这是一项于 2019 年 8 月至 2021 年 9 月进行的前瞻性队列研究。我们确定了接受腹腔镜袖状胃切除术的患者的术前和术后代谢生物标志物。患者分为两组：A 组（IR＜2.5），IR 改善，B 组（IR≥2.5），IR 未改善。使用预测模型和接收者操作特征（ROC）来确定代谢生物标志物对 IR 的影响。
共纳入 70 例肥胖合并 MBS 患者。在术后 12 个月，所有患者的血脂谱、空腹血糖和激素生物标志物均显著改善，BMI 显著降低（p=0.008）。术后 57.14%的患者 HOMA-IR 显著降低。对 HOMA-IR≥2.5 的变化有显著影响的变量是术前 BMI、瘦素、胃饥饿素、瘦素/胃饥饿素比值（LGr）、胰岛素和三酰甘油，其 OR 分别为 1.6、1.82、1.33、1.69、1.77 和 1.82（p=0.009 至 p=0.041）。瘦素在 ROC 上具有最佳预测截断值（86%的敏感性和 92%的特异性），而胃饥饿素的敏感性和特异性最低（70%的敏感性和 73%的特异性）。
术前 BMI、瘦素、胃饥饿素、LGr 和三酰甘油升高对术后 HOMA-IR（≥2.5）较高的非改善患者具有预测价值。因此，评估代谢生物标志物可以帮助术前决定治疗/额外治疗和结果。
