Impact of laparoscopic adjustable gastric banding on plasma ghrelin, eating behaviour and body weight

BACKGROUND: Plasma ghrelin, an orexigenic peptide derived from the stomach and duodenum, increases following weight loss and might contribute to weight regain. The aim of the present study was to evaluate the effect of laparoscopic adjustable gastric banding (LAGB) on body weight and body composition as well as plasma ghrelin in relation to eating behaviour in morbidly obese patients. MATERIALS AND METHODS: This study was performed in 23 morbidly obese subjects who underwent standardized LAGB. Fasting plasma ghrelin was measured before and 6 months after surgery and was correlated with body weight, body composition, and eating behaviour. RESULTS: Six months after LAGB, body weight decreased significantly by -15.7 +/- 1.4 kg (mean +/- SEM, P = 0.0001) which was accompanied by an increased cognitive restraint of eating (P = 0.001), and by a decreased disinhibition of eating and susceptibility to hunger (P = 0.0001). Plasma ghrelin increased (P = 0.016) by 27.2% from 100.39 +/- 12.90 to 127.22 +/- 13.15 fmol mL(-1). The change in plasma ghrelin correlated with changes in body weight (r = -0.49, P = 0.02), BMI (r = -0.42, P = 0.048) and fat mass (r = -0.519, P = 0.013), but not with changes of fat-free mass and of the three dimensions of eating behaviour. CONCLUSION: Weight loss following LAGB leads to an increase in fasting plasma ghrelin and is accompanied by a decrease in hunger, disinhibition of eating and an increase in cognitive restraint. Thus, changes in eating behaviour, which promote reduction of food intake and not fasting ghrelin, determines weight loss achieved by LAGB.     

Circulating ghrelin levels in obese women: a possible association with hypertension

Objective. The orexigenic hormone ghrelin induces weight gain by stimulating food intake. Ghrelin has been shown to modulate sympathetic activity, to exert vasodilative effects and to counterreact with leptin on both food intake and blood pressure. Of these two hormones, ghrelin levels are decreased in obesity, whereas leptin levels are increased. In this cross‐sectional study, differences in serum ghrelin and leptin levels were examined in normotensive and hypertensive obese women. Material and methods. Sixty‐one normotensive and hypertensive women were classified according to the body mass indices as follows: (a) 18 healthy subjects with BMI 21.5–27.5?kg/m²; (b) 22 normotensive subjects with BMI 30–47?kg/m²; (c) 21 hypertensive obese subjects (BMI 30–48?kg/m²) with systolic blood pressure ?140?mmHg or diastolic blood pressure ?90?mmHg. Anthropometric measurements including height, weight, BMI, waist and hip circumferences and blood pressure were recorded. The levels of ghrelin and leptin were determined in sera using the commercial ELISA kits. Results. In normotensive obese subjects, ghrelin levels were significantly lower than in controls (0.21±0.13 vs 0.60±0.3?ng/mL), whereas hypertensive obese women had elevated ghrelin levels (0.64±0.36?ng/mL). Ghrelin concentration was decreased despite the presence of hypertension in the patients who had BMIs above 35?kg/m². Leptin levels were significantly higher in both normotensive and hypertensive obese groups (19.54±11.19 and 21.61±12.7?ng/mL, respectively) than in controls (7.61±3.3?ng/mL), and were not affected by the presence of hypertension in obese subjects. Conclusion. Ghrelin was positively associated with hypertension in obese women and this association was inversely influenced by the increase of BMI.     

腹腔镜可调节胃束带术治疗病态肥胖症的麻醉管理

目的 总结腹腔镜可调节胃束带术(LAGB)治疗病态肥胖症(MO)围手术期麻醉管理经验.方法 21例MO患者在静脉吸入复合麻醉下行LAGB术,监潮心率、血压、心电图、经皮脉搏血氧饱和度(SpO2)、呼气期末二氧化碳分压(PETCO3)和动脉血气分析.结果 21例患者均麻醉满意,顺利完成手术.结论 适当插管方法 的选择、低呼气末正压(PEEP)呼吸的管理、掌握安全的拔管时机是MO患者麻醉的关键.     

The use of superelastic suture clips in laparoscopic gastric banding

Nickel‐Titanium suture clips have been developed to enhance suturing in cardiovascular surgery (U‐CLIP^TM, Medtronic, Minneapolis, MN, USA). The first applications of superelastic suture clips in bariatric surgery were reported by Barba and Kane in 2004. No other experiences in this field have been reported or published. Our experience with this newly developed suture clip, used for suturing the anterior wrap in laparoscopic gastric banding, started in 2007. The U‐Clip^TM technology and the surgical technique are described and discussed in this article.     

In vivo and in vitro evidence for a hepatic modulation of the leptin signal in rats

BACKGROUND: Leptin is primarily secreted by the adipose tissue. It binds not only to hypothalamic structures involved in energy regulation but also to many peripheral tissues including the liver. Leptin circulates in free and receptor-bound forms. Both components are differentially regulated under various pathophysiological conditions and serve different physiological functions. They are released from adipose tissue but previous data suggest an additional formation outside the fat compartment. Here we tested the contribution of the liver in binding and modulating leptin in the circulation. MATERIALS AND METHODS: In vivo experiments were performed with radioactive labelled leptin with and without pretreatment with unlabelled leptin in freely moving, chronic intravenously cannulated male rats. Livers were investigated by immunohistochemistry and in situ hybridization and immunoblotting was performed, followed by ex vivo liver perfusion studies with human recombinant leptin. RESULTS: In in vivo experiments radioactively labelled leptin (at low concentrations) is avidly bound to rat liver (greater than 80% of basal serum values 90 min following i.v. infusion). Pre-treatment with excess of unlabelled leptin in vivo revealed a rapid hepatic down-regulation of leptin receptor isoforms when tested by in situ hybridization, immunoblotting or immunohistochemistry. Ex vivo perfusion of rat liver with human recombinant leptin induced a dose- and time-dependent formation of receptor-bound leptin in the perfusate. CONCLUSIONS: The present data support an active role of the liver in the modulation of the leptin signal through different regulation of the soluble leptin receptor, the bound and free forms of the hormone, which may have important implications for leptin's central efficacy and the development of 'leptin resistance'.     

Regional variation in adipose tissue lipoprotein lipase activity: association with plasma high density lipoprotein levels

The associations of adipose tissue lipoprotien lipase (AT-LPL) activity with body fatness and plasma lipoprotein levels were studied in the light of the recently described regional differences in AT-LPL activity. In this regard, heparin-releasable LPL activity was measured in abdominal and femoral adipose tissues of 29 pre-menopausal women. Body fatness variables were all positively correlated with abdominal and femoral AT-LPL activities expressed per 10(6) cells. However, abdominal and femoral AT-LPL activities expressed per unit of cell surface displayed divergent association patterns with body fatness and plasma lipoprotein levels. Indeed, only abdominal AT-LPL activity remained significantly correlated with body fatness variables after adjustment for fat cell surface. Furthermore, whereas abdominal AT-LPL activity tended to be negatively correlated with plasma HDL-cholesterol levels, femoral AT-LPL activity was positively correlated with plasma HDL2-cholesterol (r = 0.40, P less than 0.05) concentration and with the HDL2-cholesterol/HDL3-cholesterol ratio (r = 0.49, P less than 0.01). These results demonstrate the importance of taking into account the regional variation in metabolic activity of adipose tissue when studying its associations with body fatness, and with plasma lipoprotein levels. The lack of association between abdominal AT-LPL activity and plasma HDL2-cholesterol levels lead us to suggest that AT-LPL activity may not be causally related with plasma HDL levels.     

肥胖与高血压患者血清瘦素水平与胰岛素抵抗的相关性研究

目的探讨肥胖和高血压患者血清瘦素水平与胰岛素抵抗(IR)的关系及在肥胖和高血压发病机制中的作用。方法选择男性合并肥胖或非肥胖的高血压患者和正常血压者,测定血糖、胰岛素、血脂、尿酸(Ur)、胰岛素敏感性指数(ISI)、24h尿蛋白定量和血清瘦素浓度,分析瘦素水平与IR的相关性及与体重指数(BMI)、血压和其它各项指标的关系。结果血清瘦素水平在高血压组高于正常血压组,肥胖者高于非肥胖者。ISI则为正常血压组的非肥胖者高于肥胖者,而无论肥胖与否,正常血压组均高于高血压组。在高血压组中,ISI降低程度肥胖与非肥胖者无显著差异。在合并肥胖的高血压和正常血压组中,血清瘦素水平与ISI呈显著负相关(r=－0.51,P<0.01)和(r="－"0.38,P<0.05)。BMI、腰臀比、ISI是影响两组瘦素水平的最显著因素,影响ISI的因素依次为BMI、SBP、DBP、TG、Ur和瘦素。BMI是影响瘦素水平和ISI的共同因素。多元逐步回归分析发现,BMI与瘦素、ISI、TG密切相关。结论肥胖者血清瘦素水平升高与IR高度相关,并与脂代谢有关。瘦素抵抗在高血压的发生中可能起间接促进作用,但与IR的关联尚待探讨。     

老年代谢综合征患者血清胃饥饿素、抵抗素水平与轻度认知功能障碍的相关性

目的探讨老年代谢综合征(MS)患者血清胃饥饿素、抵抗素水平与轻度认知功能障碍(MCI)的相关性。方法选取2016年6月至2018年10月该院诊治的老年MS患者108例作为研究对象。MS患者根据是否合并MCI分为MS组(n=63)和MS+MCI组(n=45)。选取同期体检健康者50例作为对照组。比较各组间基本资料、胃饥饿素、抵抗素及简易智力状态检查量表(MMSE)评分,并进行Pearson相关性分析和Logistic多元逐步回归分析。结果三组间的性别比例、年龄、受教育年限、吸烟、舒张压、高密度脂蛋白胆固醇(HDL-C)差异均无统计学意义(P>0.05),相较于对照组,MS+MCI组与MS组体质量指数(BMI)、收缩压、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(LDL-C)、空腹血糖、抵抗素均显著增高,胃饥饿素降低(P<0.05);MS+MCI组BMI、TG、LDL-C、抵抗素均显著高于MS组,胃饥饿素低于MS组(P<0.05)。MS+MCI组MMSE评分显著高于MS组和对照组(P<0.05)。经过Pearson相关性分析,BMI、TG、LDL-C、抵抗素与MS+MCI组患者MMSE呈负相关(P<0.05),胃饥饿素与MS+MCI组患者MMSE呈正相关(P<0.05)。经Logistic多元逐步回归分析,BMI、TG、LDL-C、抵抗素、胃饥饿素是MS患者发生MCI的预警因素。结论血清胃饥饿素、抵抗素与MS患者的MCI密切相关,可能成为早期MCI的生物学标志物。     

Visfatin expression in subcutaneous adipose tissue of pre-menopausal women: relation to hormones and weight reduction

Background A novel adipokine, visfatin, was found to be related to adiposity in humans and regulated by a number of hormonal signals. The aim of this study was to investigate the relationships of visfatin expression in adipose tissue with potential regulatory factors such as insulin, testosterone and tumor necrosis factor‐α (TNF‐α) and to elucidate the effect of a diet induced weight reduction on adipose tissue mRNA expression and plasma levels of visfatin. Materials and methods Biopsies of subcutaneous abdominal adipose tissue (SCAAT) and plasma samples were obtained at the beginning of the study from 47 pre‐menopausal women (age 38·7 ± 1·7 years, body mass index (BMI) 27·9 ± 1·4 kg m^?2), consisting of 15 lean, 16 overweight and 16 obese subjects. The subgroup of 32 overweight/obese women (age 42·1 ± 1·9 years, BMI 31·2 ± 0·9 kg m^?2) underwent a 12 week hypocaloric weight reducing diet and samples were obtained at the end of the diet. Biopsy samples were analysed for visfatin and TNF‐α mRNA levels and plasma was analysed for relevant metabolites and hormones. Results In the group of 47 subjects visfatin mRNA expression in SCAAT was negatively correlated with plasma free testosterone (r = –0. 363, P < 0·05) and BMI (r = –0·558, P < 0·01) and positively associated with adipose tissue TNF‐α mRNA expression (r = 0·688, P < 0·01). The diet resulted in the reduction of body weight and in the decrease of plasma insulin, free testosterone and TNF‐α levels. In the group of overweight/obese subjects visfatin mRNA in SCAAT increased after the diet and the diet induced increase was positively correlated with the magnitude of body weight loss. Conclusion Visfatin mRNA expression in SCAAT is associated with TNF‐α expression, plasma free testosterone and BMI in pre‐menopausal women. A weight reducing hypocaloric diet results in the increase of visfatin mRNA in SCAAT.     

Leptin induces tissue factor expression in human peripheral blood mononuclear cells: a possible link between obesity and cardiovascular risk?

BACKGROUND: Obesity is a major modifiable risk factor for cardiovascular disease. Leptin, the hormone synthesized and released primarily by adipose tissue and found increased in obese individuals, has been implicated in the regulation of inflammation and arterial and venous thrombosis. OBJECTIVE: To investigate the role of tissue factor (TF), the pivotal agonist of the clotting cascade, as a link between obesity and cardiovascular disease. METHODS AND RESULTS: In 15 obese patients, plasma levels of leptin and TF as well as TF expression in resting and endotoxin-stimulated mononuclear leukocytes (MN) were increased when compared with healthy donors. In a selected sample of obese patients, loss of body weight led to decreased circulating leptin levels, accompanied by a reduction in plasma TF as well as in TF expression, both in resting and endotoxin-stimulated MN. In subsequent in vitro experiments, leptin was incubated with MN from healthy subjects. Leptin induced TF activity and antigen in a dose-dependent fashion, as assessed by clotting assay and ELISA, respectively. Increased migration of c-Rel/p65 into the nucleus, as determined by EMSA, and development of TF mRNA in monocytes, as assessed by RT-PCR, were observed. Experiments with mitogen-activated protein kinase (MAPK) inhibitors, indicated the involvement of p38 and ERK1/2 pathways. CONCLUSIONS: The presence of TF-expressing MN in blood from obese subjects and the in vitro induction of TF by pharmacologic concentrations of leptin in MN from healthy subjects suggest that TF expression by leptin-stimulated monocytes may contribute to the cardiovascular risk associated with obesity.     

Gene expression in visceral and subcutaneous adipose tissues

A large body of evidence demonstrates depot-specific differences in the expression of genes coding important functional proteins in adipocytes. This may contribute to the well-known specific functional properties of the adipocytes from intra-abdominal and subcutaneous regions. This review will focus on the main findings regarding the regional differences in adipocyte gene expression in humans. These genes encode proteins belonging to three different functional groups: the metabolic enzyme and related signalling proteins, the adipogenic factors, and, finally, the products of adipocytes.     

运动对胰岛素抵抗大鼠脂肪组织中糖原合成酶激酶3β表达的影响

目的 探讨运动对高脂饮食诱导的胰岛素抵抗大鼠脂肪组织中糖原合成酶激酶3B（GSK-3β）表达的影响。方法 将30只SPF级雄性Wistar大鼠随机分为2组，其中正常对照组10只，给予常规饲料喂养，模型组20只，给予高脂饲料喂养。模型组大鼠经喂养4周后制成胰岛素抵抗模型，将其随机分为2个亚组（即胰岛素抵抗组和运动干预组），2个亚组继续给予高脂饲料喂养，同时运动干预组大鼠每周进行5d游泳运动，持续6周。采用Western—blot方法检测各组大鼠附睾脂肪组织中GSK-3β的表达；定期检测大鼠体重（BW）、空腹血糖（FPG）、血浆胰岛素（FINS）、血甘油三酯（TG）及胆固醇（TC）水平，并计算胰岛素敏感指数（ISI）。结果 各组大鼠经高脂饲料喂养4周后，与正常对照组比较，模型组大鼠BW、FPG、FINS、TC、TG均显著升高（P〈0．05或0．01），ISI则明显降低（P〈0．01），提示胰岛素抵抗模型诱导成功。经6周运动干预后，与胰岛素抵抗组比较，运动干预组大鼠脂肪组织GSK-3β表达显著下降（P〈0．05），与正常对照组比较，差异无统计学意义（P〉0．05）。结论 运动可下调胰岛素抵抗大鼠脂肪组织GSK-3β的表达，促进葡萄糖的摄取及糖原合成，具有改善胰岛素抵抗功能。     

支气管哮喘患儿血清瘦素水平与临床严重程度的关系

目的：探讨支气管哮喘患儿血清瘦素水平与临床严重程度的关系。方法：将支气管哮喘患儿依据病情严重程度分为轻度间歇组（A组）、轻度持续组（B组）及中度持续组（C组）,比较各组间及组内治疗前后血清瘦素水平,并对瘦素和身体质量指数（body mass index,BMI）进行相关性分析。结果：A组治疗前后血清瘦素水平比较差异无统计学意义（P〉0.05）;B、C组治疗后血清瘦素水平均低于治疗前（P〈0.05）。A、B、C三组治疗前血清瘦素水平依次升高（P〈0.05）,治疗后A、B、C三组血清瘦素水平比较差异均无统计学意义（P〉0.05）;治疗前血清瘦素水平与BMI无相关性（r=-0.061,P〉0.05）。结论：哮喘患儿血清瘦素水平与病情严重程度相关,其原因可能与瘦素介导炎症细胞活化和炎症介质释放的功能有关,具体机制尚需进一步研究。     

有氧运动通过胃促生长素调节肥胖及肥胖抵抗大鼠摄食量的研究

目的:探讨有氧运动对肥胖及肥胖抵抗大鼠摄食量的影响及机制。方法:4周龄雄性Sprague-Dawley大鼠,随机分为普饲对照组(C组)和高脂饲料组,饲养10周后,筛选出高脂饮食诱导的肥胖组(OB组)大鼠和肥胖抵抗组(OR组)大鼠。再分别将OB组和OR组随机分为运动组(OB-Sw组,OR-Sw组)大鼠和非运动组(OB-Sed组,OR-Sed组)大鼠,运动组大鼠进行8周60%的个体力竭强度的有氧游泳运动,45min/d,5次/周,每周监测大鼠体重和摄食量。8周干预结束后,取血清和胃组织,血清检测TG、TC、LDL-c、HDLc,胃组织检测促生长素(Ghrelin)表达情况。结果:10周后,高脂饲料组大鼠体重与普饲对照组相比,显著性增高(P0.05);OB-Sed组大鼠的血清低密度脂蛋白(LDL)与C组的相比,显著性增高(P0.05);通过8周的有氧运动,OB-Sed组大鼠的相对摄食量多于OB-Sw组,OR-Sed组大鼠的相对摄食量多于OR-Sw组;OB-Sed组、OR-Sed组大鼠胃组织Ghrelin表达程度高于OB-Sw组、OR-Sw组和C组。结论:运动可通过降低大鼠胃组织Ghrelin的表达来降低摄食量。     

SIRT2在胃癌组织中的表达与临床预后的关系

目的探讨胃癌组织中SIRT2的表达及其与临床病理特征及预后的相关性,并初步研究SIRT2在胃癌细胞中的作用。方法采用Western-blot法检测胃癌组织和癌旁正常胃黏膜组织中SIRT2蛋白表达的差异;用免疫组织化学法,检测100例胃癌组织及癌旁正常胃黏膜组织中SIRT2的表达情况,分析其表达水平与临床病理特征及预后的关系;将SIRT2-siRNA质粒转染胃癌细胞,通过Transwell实验观察下调SIRT2表达对胃癌细胞迁移侵袭能力的影响。结果 SIRT2在胃癌组织和癌旁正常胃黏膜组织中阳性表达率分别为67%(67/100)、16%(24/100),差异有统计学意义(P0.01);胃癌组织中SIRT2的高表达与胃癌的淋巴结转移、临床分期及患者预后显著相关;体外细胞实验显示下调SIRT2表达可抑制胃癌细胞的迁移和侵袭。结论 SIRT2可作为判断胃癌患者预后的一个独立指标,并有潜力成为一个胃癌靶向治疗的新靶点。     

高血压病患者血清瘦素及可溶性瘦素受体水平检测分析

目的　研究血清瘦素和可溶性瘦素受体水平与高血压病的关系。方法　应用放射免疫分析法(RIA)及 酶联免疫吸附分析法(ELISA)检测45例高血压病患者及33例健康对照组血清瘦素(Lp)、可溶性瘦素受体(sLR),同 时检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL C)、低密度脂蛋白胆固醇(LDL C)、载脂蛋白 ApoA、ApoB、ApoA/B、胰岛素(Ins)、C肽(C P)、胰岛素抵抗指数(HOMA IR)、体质量指数(BMI)、腰围、臀围等指 标,分析Lp、sLR与高血压、血脂异常、体形改变、BMI及胰岛素抵抗(IR)的关系。结果　高血压病组血清Lp、TC、 LDL C、ApoB明显高于对照组(P<0.05),sLR、ApoA/B明显低于对照组(P<0.01),TG、HDL C及BMI差异无 统计学意义。Lp与Ins、C P、HOMA IR、BMI、腰围及臀围呈正相关,与sLR呈负相关(P<0.05);sLR与Lp、C P、 BMI、腰围及臀围呈负相关(P<0.05),与Ins及HOMA IR无显著相关。结论　高血压病与Lp及sLR异常有关,其 与血脂异常、体形改变、BMI、IR密切相关,共同参与高血压病的形成。     

子宫腺肌病患者血清及腹腔液瘦素水平的比较分析

目的探讨瘦素在子宫腺肌病患者血清和腹腔液中的变化及其在内异症发病中的作用。方法采用ELISA方法测定40例子宫腺肌病患者和30例非子宫腺肌病患者(对照组)血清和腹腔液中瘦素的含量,并根据伴有痛经与否进行统计学分析。结果子宫腺肌病患者血清瘦素水平与对照组比较,无显著性差异,但其腹腔液中瘦素水平明显高于对照组(P<0.01)。伴有痛经及不伴痛经子宫肌腺症患者腹腔液瘦素水平均明显高于对照组,但子宫腺肌病2组之间无明显差异。结论子宫腺肌病患者腹腔液中瘦素水平明显升高,说明瘦素可能在子宫腺肌病的发生发展中发挥重要作用,但与伴有痛经与否无明显关系。     

睡眠质量与维持性血液透析患者心包脏层脂肪体积相关性研究

目的探讨血液透析患者睡眠障碍与心包脏层脂肪组织(EAT)体积的潜在关系。方法选择透析时间超过3个月且病情比较稳定的维持性血液透析(MHD)患者82例,根据匹兹堡睡眠质量量表(PSQI)积分分为两组,睡眠障碍组(PQSI5分)和对照组(PQSI≤5分)。观察两组PQSI、爱泼沃思嗜睡量表(ESS)、心包脏层脂肪的体积,并探讨血液透析患者睡眠质量与心包脏层脂肪的体积的相关性。结果两组患者性别和年龄均差异无统计学意义(P0.05),但睡眠障碍组患者CRP,瘦素较对照组更高,差异有统计学意义。睡眠障碍组EAT体积(170.0±17.0)cm3,对照组EAT体积(141.9±22.4)cm3,两组EAT差异有统计学意义(P0.05)。结论维持性血液透析患者发生睡眠质量与EAT体积的改变存在相关关系。