Department of Basic Oncology, Cancer Institute, Hacettepe University.
Depatment of Surgery, Medical School, Hacettepe University.
Int J Surg. 2024 Sep 1;110(9):5434-5443. doi: 10.1097/JS9.0000000000001608.
Humoral factors and neural mechanisms play a central role in the pathogenesis of obesity and in weight loss following bariatric surgery. Although various hormones and adipokines, including ghrelin and resistin, are linked to obesity, studies analyzing the changes in fasting ghrelin and resistin levels in patients following one anastomosis gastric bypass (OAGB) are lacking.
The authors aimed to investigate resistin and ghrelin levels before and after two commonly used bariatric procedures with different mechanisms of action: sleeve gastrectomy (SG) and OAGB.
Fasting serum ghrelin and resistin levels were evaluated by using ELISA in a nonrandomized, prospective cohort study for the pattern of changes in the preoperative period and 1 week, 1 month, 3 months and, 12 months after surgery in age and sex-matched patients with BMI ≥40 kg/m 2 undergoing either SG ( n =40) or OAGB ( n =40). Their relationships with demographic parameters such as body weight, BMI, presence of T2DM, HbA 1 C, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index were also evaluated.
OAGB was superior in weight control compared to the SG group. There were significant differences in resistin and ghrelin levels between the OAGB and SG groups. Ghrelin decreased more in the SG group than the preoperative values. This change in ghrelin levels was more significant at 1 year after SG [preoperative mean (range) level of 334.2 (36.6-972.1) pg/ml decreased to 84 (9.1-227) pg/ml at 1 year] whereas in the OAGB group no significant change was observed [preoperative mean (range) level of 310 (146-548) pg/ml decreased to 264 (112-418) pg/ml at 1 year]. Resistin levels decreased in both groups, especially after 3 months and onward following both operations [the mean (range) resistin levels were 2.6 (0.87-5.4) ng/ml and decreased to 1.1 (0.5-2.4) ng/ml in the SG group vs 2.48 (0.89-6.43) ng/ml decreased to 0.72 (0.35-1.8) ng/ml in OAGB group at 1 year], which was in parallel with changes in HOMA-IR index, body weight, and BMI changes at 1st year. HOMA-IR index changes were similar, but more prominent after OAGB. OAGB was als3 three months and onward), and HOMA-IR changes.
This is the first study to compare fasting ghrelin and resistin levels after OAGB and SG. Although similar changes were observed, ghrelin changes were more prominent after SG, whereas resistin were observed after OAGB. OAGB was superior in T2DM control, which was in parallel with weight loss, fasting resistin levels, and HOMA-IR changes suggesting a possible effect of resistin after OAGB in glucose metabolism and insulin resistance.
体液因素和神经机制在肥胖的发病机制和减重手术后的体重减轻中起着核心作用。尽管各种激素和脂肪因子，包括胃饥饿素和抵抗素，与肥胖有关，但缺乏分析患者在接受一种吻合口胃旁路术（OAGB）后空腹胃饥饿素和抵抗素水平变化的研究。
作者旨在研究两种常用减重手术（袖状胃切除术[SG]和 OAGB）后抵抗素和胃饥饿素水平的变化，这两种手术具有不同的作用机制。
采用 ELISA 法检测空腹血清胃饥饿素和抵抗素水平，在一项非随机前瞻性队列研究中，对 BMI≥40kg/m2的患者进行评估，这些患者接受 SG（n=40）或 OAGB（n=40），年龄和性别匹配，评估术前、术后 1 周、1 个月、3 个月和 12 个月时体重、BMI、T2DM 存在、HbA1C 和稳态模型评估胰岛素抵抗指数（HOMA-IR）等与体重相关的参数的变化。
与 SG 组相比，OAGB 组在体重控制方面更具优势。OAGB 和 SG 组之间的抵抗素和胃饥饿素水平存在显著差异。SG 组的胃饥饿素水平下降较术前更为明显。SG 组这种胃饥饿素水平的变化在术后 1 年更为显著[术前（36.6-972.1）pg/ml 范围内的平均（中位）水平 334.2 pg/ml 下降至 1 年后的 84（9.1-227）pg/ml]，而在 OAGB 组则未观察到显著变化[术前（146-548）pg/ml 范围内的平均（中位）水平 310 pg/ml 下降至 1 年后的 264（112-418）pg/ml]。两组抵抗素水平均下降，尤其是在术后 3 个月后[平均（范围）抵抗素水平为 2.6（0.87-5.4）ng/ml，下降至 1.1（0.5-2.4）ng/ml，SG 组；2.48（0.89-6.43）ng/ml，下降至 OAGB 组 1 年后的 0.72（0.35-1.8）ng/ml]，与 HOMA-IR 指数、体重和 BMI 变化一致。HOMA-IR 指数变化相似，但 OAGB 术后更为明显。OAGB 还与空腹抵抗素水平、HOMA-IR 变化和体重减轻相关。
这是第一项比较 OAGB 和 SG 术后空腹胃饥饿素和抵抗素水平的研究。尽管观察到相似的变化，但 SG 后胃饥饿素变化更为明显，而 OAGB 后抵抗素变化更为明显。OAGB 在 T2DM 控制方面更具优势，这与体重减轻、空腹抵抗素水平和 HOMA-IR 变化一致，提示 OAGB 后抵抗素可能对葡萄糖代谢和胰岛素抵抗有影响。
