袖状胃切除术早期对肥胖症患者血清白脂素水平的影响

目的初步探讨腹腔镜袖状胃切除术（LSG）后短期内肥胖症患者血清白脂素（asprosin）和代谢指标的变化，并分析asprosin与代谢指标改善的相关性。 方法回顾性分析2017年11月至2018年10月在南京医科大学第一附属医院减重代谢外科接受LSG治疗的20例肥胖症患者的病例资料，所有患者的体质量指数（BMI）>35 kg/m²。收集术前和术后3个月患者临床资料和空腹血清标本，使用Inbody 770测定人体成分指标。采用全自动生化分析仪测定生化指标，计算稳态模型评估胰岛素抵抗指数（HOMA-IR）。采用酶联免疫吸附法检测血清asprosin水平。 结果术后3个月，患者的体重从（105.37±17.79）kg下降到（90.13±16.13）kg，BMI从（37.85±4.64）kg/m²显著下降至（32.31±4.10）kg/m²（P<0.001）。同时，HOMA-IR水平从基线时的（8.44±5.24）显著降低至（3.17±1.44），（P<0.001），胰岛素抵抗得到明显改善。血清asprosin浓度从术前的347.33（267.25，451.18）pg/mL下降至254.95（233.94，311.88）pg/mL，差异有统计学意义（P<0.01）。相关性分析和多元回归分析发现，术前受试者空腹血清asprosin水平与HOMA-IR呈独立正相关（r=0.564，P=0.01）；术后3月，asprosin的减少量与HOMA-IR的改善水平也呈独立正相关（r=0.517，P=0.019），与体重、BMI、空腹血糖、血脂等代谢指标变化水平无相关性。 结论肥胖患者空腹血清asprosin水平与胰岛素抵抗密切相关，LSG手术短期内引起血清asprosin水平显著下降，且asprosin水平的变化与胰岛素抵抗的减轻及早期代谢获益密切相关，asprosin可能在胰岛素抵抗、肥胖和糖尿病之间发挥重要作用。

Short-term effect of sleeve gastrectomy on serum asprosin level in obese patients.

ObjectiveTo investigate the short-term effect of laparoscopic sleeve gastrectomy (LSG) on serum asprosin level in obesity, and to analyze the correlation with clinical outcomes. Methods20 adults with obesity (BMI>35 kg/m²) receiving LSG at Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital with Nanjing Medical University were included to this study between Nov 2017 and Oct 2018. Clinical measurements and laboratory determinations were performed before surgery and 3 months after surgery. The body composition indexes were measured by inbody770 and the biochemical indexes were measured by automatic biochemical analyzer. Homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated. Fasting serum asprosin was analyzed by ELISA. Results3 months after LSG, mean total body weight decreased from (105.37±17.79) kg at baseline to (90.13±16.13) kg (P<0.001). The subjects showed a marked weight loss accompanied by significantly lower BMI values (pre, 37.85±4.64 kg/m², vs. post, 32.31±4.10 kg/m², P<0.001) after LSG. Meanwhile, insulin resistance improved remarkably after LSG as displayed by reductions in HOMA-IR levels (pre, 8.44±5.24 vs. post, 3.17±1.44, P<0.001). Serum fasting asprosin levels markedly reduced from 347.33 (267.25, 451.18) pg/mL to 254.95 (233.94, 311.88) pg/ml at 3 month after LSG (P<0.01). Multivariate analyses showed that the fasting serum asprosin was positively correlated with HOMA-IR (r=0.564, P=0.01) before LSG. Moreover, when assessing 3-months postoperative changes, a positive correlation was found between the variation of asprosin and the reduction of HOMA-IR (r=0.517, P=0.019). However, there was no association between asprosin and the changes of body weight, BMI, fasting glucose and blood lipids in our study. ConclusionsFasting serum asprosin in obesity was closely related to insulin resistance before surgery and reduced significantly in the short term after LSG. Moreover, the early change of asprosin was strongly associated with the improvement of insulin resistance. Asprosin may play an important role in insulin resistance, obesity and diabetes.