腹腔镜胃旁路术后血清瘦素、脂联素变化与胰岛素抵抗的关系

 目的 观察腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y,LRYGB)前后肥胖症伴2型糖尿病(type 2 diabetes,T2DM)患者的血清瘦素和脂联素表达变化,并探讨该变化与胰岛素抵抗的关系。方法 回顾性分析2011-03至2012-02武警总医院普通外科行腹腔镜胃旁路手术的52例肥胖症伴T2DM患者的临床资料,BMI为28~35 kg/m2,术后随访期12个月。术前和术后1、3、6、12个月分别检测血清瘦素、脂联素、糖化血红蛋白(glycated hemoglobin,HbA1c)、三酰甘油(triglyceride, TG)和胆固醇(cholesterol, CH)、BMI,并行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)和胰岛素释放试验。结果 (1)12个月随访期间,T2DM显效率为86.5%(45/52),肥胖症治愈率为67.3%(35/52),无失访病例;(2)与术前空腹脂联素水平(4.36±2.63 μg/ml)]相比,术后空腹脂联素水平呈下降趋势至术后3个月(2.93±1.37)μg/ml],而升高至术后12个月(7.36±3.70 )μg/ml,P=0.028];(3)与术前空腹瘦素值(20.79±8.75) ng/ml相比,术后空腹瘦素值明显下降直至术后12个月(5.06±2.46 )ng/ml,P=0.005] ;(4)术后12个月空腹血糖水平较术前明显下降(P=0.003);术后12个月空腹胰岛素水平较术前明显下降(P=0.03);术后12个月HbA1c水平较术前明显下降(P=0.002);术后12个月HOMA-IR水平明显较术前明显下降(P=0.003);(5)术后12个月TG水平较术前明显下降(P=0.03),术后12个月CH较术前明显下降(P=0.04)。结论 LRYGB后脂联素表达上调和瘦素抵抗改善是胰岛素抵抗改善的机制之一。

Relationships between expressions of serum adiponectin,leptin, and insulin resistance in type 2 diabetes patients with obesity following laparoscopic gastric bypass

Objective To investigate the relationships between expressions of serumadiponectin,leptin, and insulin resistance in T2DM patients with obesity following laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods The clinical data on 52 cases of T2DM patients (BMI 28-35 kg/m2) treated with LRYGB between March 2011 and February 2012 was retrospectively analyzed. Levels of adiponectin, letptin, OGTT, HbA1c, triglycerides and cholesterol were detected before surgery and at 1, 3, 6, 12 months postoperatively during one year follow-up. Oral glucose tolerance test and insulin release test were also conducted.Results (1) During the follow-up, the cure rate of T2DM and obesity was 86.5% (45/52) and 67.3% (35/52)respectively. (2)Compared with the preoperative mean level(4.36±2.16) μg/ml, adiponectin decreased to(2.93±1.37) μg/ml within 3 months of follow-up, but increased gradually to(7.36±3.70) μg/ml,P=0.028]till postoperative 12 months. (3) Leptin decreased gradually from base line(20.79±8.75 ng/ml) until 12 months after surgery (5.06±2.46) ng/ml,P=0.005]. (4)Fasting blood glucose decreased gradually from base line(10.00±3.5) mmol/L until 12 months after surgery (6.48±0.5) mmol/L,P=0.003]. Compared with the preoperative fasting insulin level (24.8±9.8) pmol/L, the level decreased to (6.9±2.0) pmol/L,P=0.03] after 12 months. Compared with the preoperative HbA1c level (8.0%±1.5%), the level decreased to (6.5%±0.9%, P=0.002) after 12 months. Compared with the preoperative HOMA-IR level (10.25±5.01), there was a significant decrease after 12 months (2.64±0.98, P=0.003) (5)Preoperative TG was (3.50±1.46) mmol/L and decreased to (1.14±0.38) mmol/L, P=0.03] in 12 months. Preoperative CH was (5.14±1.18) mmol/L and decreased to (4.01±0.49) mmol/L, P=0.04] after 12 months.Conclusions The improvement of the pattern of cytokine production, as evidenced by postoperative rise in serum adiponectin and drop in leptin concentration, plays an important role in enhanced insulin resistance after LRYGB.