Felipe Lucenda A, Bachi André L L, Oliveira Miriã C, Moreira Sandra M B P, Afonso João Pedro R, Lino Maria E M, Paixão Vitória, Silva Carlos H M, Vieira Rodolfo P, Vencio Sergio, Jirjos Elias I, Malheiros Carlos A, Insalaco Giuseppe, Júnior Wilson R Freitas, Oliveira Luis V F
Post-Graduation Program in Health Sciences, Santa Casa of Sao Paulo Medical School, Sao Paulo, SP, 01221-010, Brazil.
Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, SP, Brazil.
Diabetol Metab Syndr. 2023 Feb 14;15(1):19. doi: 10.1186/s13098-023-00986-2.
Obesity remains a public health problem worldwide. The high prevalence of this condition in the population raises further concerns, considering that comorbidities are often associated with obesity. Among the comorbidities closely associated with obesity, metabolic syndrome (MS) is particularly important, which potentially increases the risk of manifestation of other disorders, such as the prothrombotic and systemic pro-inflammatory states.
A randomized, controlled clinical trial was performed involving female patients (n = 32) aged between 18 and 65 years, with a clinical diagnosis of MS, with severe obesity undergoing Roux-en-Y gastric bypass (RYGB). The study design followed the Consolidated Standards of Reporting Trials statement (CONSORT). Lipid profile, blood glucose and adipokines (adiponectin, leptin, and resistin) and (cytokines IL-1β, IL-6, IL-17, IL-23, and TNF-α) in blood plasma samples were evaluated before and six months after RYGB.
Patients undergoing RYGB (BSG) showed a significant improvement from preoperative grade III obesity to postoperative grade I obesity. The results showed that while HDL levels increased, the other parameters showed a significant reduction in their postoperative values when compared not only to the values observed before surgery in the BSG group, but also to the values obtained in the control group (CG). As for systemic inflammatory markers adiponectin, leptin, resistin, IL-1β, IL-6, IL-17, IL-23 and TNF- α it was observed that the levels of resistin and IL-17 in the second evaluation increased significantly when compared to the levels observed in the first evaluation in the CG. In the BSG group, while the levels of adiponectin increased, the levels of the other markers showed significant reductions in the postoperative period, in relation to the respective preoperative levels. The analysis of Spearman's correlation coefficient showed a significant positive correlation between IL-17 and IL-23 in the preoperative period, significant positive correlations between TNF-α and IL-6, TNF-α and IL-17, IL-6 and IL-17, and IL-17 and IL-23 were observed postoperatively.
According to our results, the reduction of anthropometric measurements induced by RYGB, significantly improves not only the plasma biochemical parameters (lipid profile and glycemia), but also the systemic inflammatory status of severely obese patients with MS. Trials registration NCT02409160.
肥胖仍然是一个全球性的公共卫生问题。鉴于肥胖症常伴有合并症，该病症在人群中的高发病率引发了更多关注。在与肥胖密切相关的合并症中，代谢综合征（MS）尤为重要，它可能会增加其他疾病发生的风险，如血栓前状态和全身性炎症状态。
进行了一项随机对照临床试验，纳入年龄在18至65岁之间、临床诊断为MS且患有重度肥胖症并接受Roux-en-Y胃旁路术（RYGB）的女性患者（n = 32）。研究设计遵循了《报告试验的统一标准》（CONSORT）声明。在RYGB术前和术后六个月评估血浆样本中的血脂谱、血糖以及脂肪因子（脂联素、瘦素和抵抗素）和（细胞因子IL-1β、IL-6、IL-17、IL-23和TNF-α）。
接受RYGB（BSG）手术的患者从术前的III级肥胖显著改善为术后的I级肥胖。结果表明，虽然高密度脂蛋白（HDL）水平升高，但与BSG组术前观察值以及对照组（CG）获得的值相比，其他参数的术后值均显著降低。至于全身性炎症标志物脂联素、瘦素、抵抗素、IL-1β、IL-6、IL-17、IL-23和TNF-α，观察到与CG组第一次评估时观察到的水平相比，第二次评估时抵抗素和IL-17的水平显著升高。在BSG组中，虽然脂联素水平升高，但与各自术前水平相比，其他标志物的水平在术后显著降低。Spearman相关系数分析显示，术前IL-17与IL-23之间存在显著正相关，术后观察到TNF-α与IL-6、TNF-α与IL-17、IL-6与IL-17以及IL-17与IL-23之间存在显著正相关。
根据我们的结果，RYGB引起的人体测量指标的降低，不仅显著改善了血浆生化参数（血脂谱和血糖），还改善了重度肥胖MS患者的全身性炎症状态。试验注册号：NCT02409160。
