腹腔镜可调式胃捆扎术治疗代谢综合征的临床与实验研究
摘要
目的和意义
探讨腹腔镜可调式胃捆扎术(LAGB)诱导的减重对代谢综合征(MS)的治疗价值,同时评估减重对空腹血清瘦素、抵抗素、脂联素、Ghrelin的影响,并探讨其相互关系,分析潜在的疗效预测因子,为拓展和推广LAGB治疗MS提供科学依据。
方法
对符合2005年IDF诊断标准的连续15例MS患者施行LAGB手术并随访6个月。监测LAGB术后体重变化和血压、血脂、血压等代谢指标的改善情况。并于术前、术后1月、术后3月、术后6月检测患者血液中瘦素、抵抗素、脂联素、Ghrelin水平的变化。各组数据均以平均数±标准差表示,应用SPSS11.5for windows统计分析软件对各组数据进行分析。
结果
1.手术均获得成功,无中转开腹及手术死亡。手术时间41～103(平均71.34)分钟,出血量5～40(平均13.50)ml,术后住院天数2～5(平均3.26)天。未发生术中大出血、胃肠穿孔、胃瘫、穿刺孔感染等手术相关并发症。
2.LAGB术后1月、3月、6月EWL为3.48±1.73kg、9.65±3.69kg、18.32±5.10kg,平均BMI由术前36.53kg/m2下降至35.29 kg/m2、33.03 kg/m2、29.36kg/m2,EWL%分别为(9.53±4.58)%,(26.87±11.89)%、(51.48±16.54)%。伴随体重的下降,术后6个月收缩压由术前136.00±18.21 mmHg降至121.10±12.56mmHg,空腹血糖水平由7.93±2.78 mmol/L降至5.52±1.36 mmol/L,甘油三酯(TG)水平由2.95±1.34 mmol/L下降至1.64±0.54 mmol/L,高密度脂蛋白(HDL-C)水平由0.89±0.10mmol/L升高至1.20±0.13mmol/L;术后6个月,仅剩1例仍符合MS诊断标准,总有效率为93.3%。
3.术后1月、3月、6月,FINS水平由术前47.85±20.59mU/L分别下降至37.24±18.46mU/L、26.10±14.31mU/L、19.48±10.59mU/L,HOMA-IR从术前的2.93±0.98下降至2.21±0.86、1.86±0.82、1.56±0.74mU/L。
4.术后6个月,瘦素水平从术前的59.85±23.46 ng/ml下降至18.85±9.46ng/ml,脂联素从术前的14.52±5.87ug/ml增高至40.85±7.46ug/ml。Pearson相关分析显示,HOMA-IR的变化与空腹血清瘦素下降程度及脂联素增高程度呈正相关,而LAGB术后6个月EWL%与术前抵抗素水平呈正相关。
结论
①LAGB手术创伤小、恢复快,可有效减轻体重,显著改善MS的各项代谢组分,对MS具有良好的治疗效果。②伴随体重的下降,MS患者胰岛素抵抗显著改善。③LAGB可导致MS患者瘦素水平显著下降、脂联素水平显著上升,而对抵抗素和Ghrelin水平的影响不显著。④胰岛素抵抗改善程度与空腹血清瘦素下降程度及脂联素增高程度显著相关。⑤术前抵抗素水平可作为预测LAGB术后减重效果的指标。
Objectives
①To evaluate the therapeutic effects of laparoscopic adjustable gastric banding(LAGB) -induced weight loss on metabolic syndrome.②To assess the correlations between the weight loss and serum levels of leptin,adiponectin, ghrelin and resistin,and to identify the potential predictors of the effects.
Methods
15 consecutive patients with MS(defined by IDF criteria 2005 ) underwent LAGB in our single center and took a subsequent six-month follow-up.The clinical data related to MS,ie,body weight,BMI,blood pressure and metabolic parameters of glucose,lipids were analyzed and the plasma levels of leptin, resistin,Ghrelin and adiponectin were determined before and 1,3 and 6 months postoperatively.The results were statistically analyzed using SPSS v11.5 for windows.
Results
All operations were successful without conversions and deaths.The mean operative time was 71.34 minutes(range,41- 103).The mean blood loss was 13.5ml(range,5～40).The mean postoperative stay was 3.26 days(range,2～5).There were no major operative complications.
1,3,6 months postoperatively,the weight loss was 3.48±1.73kg,9.65±3.69kg,18.32±5.10kg,and the EWL%were(9.53±4.58)%,(26.87±11.89)%、(51.48±16.54)%,respectively.Thus significant changes of the metabolic parameters were observed.These improvements resulted in a 93.3%resolution of the MS 6 months after LAGB.Meanwhile,the HOMA-IR dropped from 2.93±0.98 preopratively to 2.21±0.86 mU/L,1.86±0.82 mU/L,1.56±0.74mU/L after LAGB,showing a great improvement in insulin resistance.
Following LAGB,the levels of leptin dropped significantly,whereas adiponectin increased significantly.Howerver,the levels of serum Ghrelin and resistin changed insignificantly.By multivariate regression analysis,the preoprative level of resistin correlated with the weight loss.
Conclusions
①LAGB is a minimal invasive,safe and effective procedure for metabolic syndrome.②Significant weight loss 6 months after LAGB can greatly improve all aspects of MS and result in a cure rate of 93.3%.③Insulin resistance improves significantly after LAGB and correlates with high adiponectin levels and low leptin levels.④The preoperative level of resistin may be a predictor of the extent of the weight loss after surgery.
探讨腹腔镜可调式胃捆扎术(LAGB)诱导的减重对代谢综合征(MS)的治疗价值,同时评估减重对空腹血清瘦素、抵抗素、脂联素、Ghrelin的影响,并探讨其相互关系,分析潜在的疗效预测因子,为拓展和推广LAGB治疗MS提供科学依据。
方法
对符合2005年IDF诊断标准的连续15例MS患者施行LAGB手术并随访6个月。监测LAGB术后体重变化和血压、血脂、血压等代谢指标的改善情况。并于术前、术后1月、术后3月、术后6月检测患者血液中瘦素、抵抗素、脂联素、Ghrelin水平的变化。各组数据均以平均数±标准差表示,应用SPSS11.5for windows统计分析软件对各组数据进行分析。
结果
1.手术均获得成功,无中转开腹及手术死亡。手术时间41～103(平均71.34)分钟,出血量5～40(平均13.50)ml,术后住院天数2～5(平均3.26)天。未发生术中大出血、胃肠穿孔、胃瘫、穿刺孔感染等手术相关并发症。
2.LAGB术后1月、3月、6月EWL为3.48±1.73kg、9.65±3.69kg、18.32±5.10kg,平均BMI由术前36.53kg/m2下降至35.29 kg/m2、33.03 kg/m2、29.36kg/m2,EWL%分别为(9.53±4.58)%,(26.87±11.89)%、(51.48±16.54)%。伴随体重的下降,术后6个月收缩压由术前136.00±18.21 mmHg降至121.10±12.56mmHg,空腹血糖水平由7.93±2.78 mmol/L降至5.52±1.36 mmol/L,甘油三酯(TG)水平由2.95±1.34 mmol/L下降至1.64±0.54 mmol/L,高密度脂蛋白(HDL-C)水平由0.89±0.10mmol/L升高至1.20±0.13mmol/L;术后6个月,仅剩1例仍符合MS诊断标准,总有效率为93.3%。
3.术后1月、3月、6月,FINS水平由术前47.85±20.59mU/L分别下降至37.24±18.46mU/L、26.10±14.31mU/L、19.48±10.59mU/L,HOMA-IR从术前的2.93±0.98下降至2.21±0.86、1.86±0.82、1.56±0.74mU/L。
4.术后6个月,瘦素水平从术前的59.85±23.46 ng/ml下降至18.85±9.46ng/ml,脂联素从术前的14.52±5.87ug/ml增高至40.85±7.46ug/ml。Pearson相关分析显示,HOMA-IR的变化与空腹血清瘦素下降程度及脂联素增高程度呈正相关,而LAGB术后6个月EWL%与术前抵抗素水平呈正相关。
结论
①LAGB手术创伤小、恢复快,可有效减轻体重,显著改善MS的各项代谢组分,对MS具有良好的治疗效果。②伴随体重的下降,MS患者胰岛素抵抗显著改善。③LAGB可导致MS患者瘦素水平显著下降、脂联素水平显著上升,而对抵抗素和Ghrelin水平的影响不显著。④胰岛素抵抗改善程度与空腹血清瘦素下降程度及脂联素增高程度显著相关。⑤术前抵抗素水平可作为预测LAGB术后减重效果的指标。
Objectives
①To evaluate the therapeutic effects of laparoscopic adjustable gastric banding(LAGB) -induced weight loss on metabolic syndrome.②To assess the correlations between the weight loss and serum levels of leptin,adiponectin, ghrelin and resistin,and to identify the potential predictors of the effects.
Methods
15 consecutive patients with MS(defined by IDF criteria 2005 ) underwent LAGB in our single center and took a subsequent six-month follow-up.The clinical data related to MS,ie,body weight,BMI,blood pressure and metabolic parameters of glucose,lipids were analyzed and the plasma levels of leptin, resistin,Ghrelin and adiponectin were determined before and 1,3 and 6 months postoperatively.The results were statistically analyzed using SPSS v11.5 for windows.
Results
All operations were successful without conversions and deaths.The mean operative time was 71.34 minutes(range,41- 103).The mean blood loss was 13.5ml(range,5～40).The mean postoperative stay was 3.26 days(range,2～5).There were no major operative complications.
1,3,6 months postoperatively,the weight loss was 3.48±1.73kg,9.65±3.69kg,18.32±5.10kg,and the EWL%were(9.53±4.58)%,(26.87±11.89)%、(51.48±16.54)%,respectively.Thus significant changes of the metabolic parameters were observed.These improvements resulted in a 93.3%resolution of the MS 6 months after LAGB.Meanwhile,the HOMA-IR dropped from 2.93±0.98 preopratively to 2.21±0.86 mU/L,1.86±0.82 mU/L,1.56±0.74mU/L after LAGB,showing a great improvement in insulin resistance.
Following LAGB,the levels of leptin dropped significantly,whereas adiponectin increased significantly.Howerver,the levels of serum Ghrelin and resistin changed insignificantly.By multivariate regression analysis,the preoprative level of resistin correlated with the weight loss.
Conclusions
①LAGB is a minimal invasive,safe and effective procedure for metabolic syndrome.②Significant weight loss 6 months after LAGB can greatly improve all aspects of MS and result in a cure rate of 93.3%.③Insulin resistance improves significantly after LAGB and correlates with high adiponectin levels and low leptin levels.④The preoperative level of resistin may be a predictor of the extent of the weight loss after surgery.
引文
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1.Paul E.O'Brien,John B.,et al.Obesity is a surgical disease:overview of obesity and bariatric surgery . ANZ. J. Surg. 2004; 74(4): 200.
2. National Institutes of Health. Health implications of obesity. National Institutes of Health Consensus Development Conference Statement. Ann Intern Med 1985; 103: 1073 — 7.
3. Hu FB, Manson JE. Stampfer MI, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790-797.
4. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217-1239.
5. Wolff GI. Body weight and cancer. Am J Clin Nutr. 1987;45:168-180.
6. Roberts RE, Kaplan GA, Shema SJ,et al. Are the obese at greater risk for depression? Am J Epidemiol. 2000;152:163-170.
7. V J. Antipatis , T P. Gill. In : International Textbook of Obesity. Obesity as a Global Problem . Per Bjorntorp. 2001:3
8. DM Herron . The surgical management of severe obesity. Mt Sinai J Med, 2004; 71(1): 63-71.
9. Marije Libeton , JB.Dixon , MBBS,et al . Patient Motivation for Bariatric Surgery:Characteristics and Impact on Outcomes. Mt Sinai J Med, 2004; 71(1): 63-71. Obesity Surg, 14, 392-398
10. A E. Chapman, BA (Hons.), George Kiroff, et al . Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review . Surgery, 2004; 135(3): 326-351.
11.Forsell P, Hallberg D, Hellers G. Gastric banding for morbid obesity: initial experience with a new adjustable band. Obesity Surg 1993; 3: 369-74.
12. AE. Ponson, M.C. Janssen, H.G. Klinkenbijl. Laparoscopic Adjustable Gastric Banding: A Prospective Comparison of Two Commonly Used Bands . Obesity Surg, 12, 579-582.
13.Paul E.O'Brien,John B.,et al.Obesity is a surgical disease:overview of obesity and bariatric surgery.ANZ.J.Surg.2004;74(4):200.
14.Tretbar LL,Taylor TL,Sifers EC.Weight reduction.Gastric plication for morbid obesity.J Kans Med Soc.1976;77(11):488-90.
15.Wilkinson LH,Peloso OA.Gastric(reservoir) reduction for morbid obesity.Arch Surg 1981;116:602-5.
16.Sjoberg EJ,Andersen E,Hoel R,et al:Gastric banding in the treatment of morbid obesity.Factors influencing immediate and long-term results.Acta Chir Scand 155:31-34,1989
17.Kuzmak LI.A preliminary report on silicone gastric banding for morbid obesity.Clin Nutr.1986(5):73-77.
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20.郑成竹,胡兵,胡明根等.腹腔镜可调节捆扎带胃减容术治疗肥胖症.中国实用外科杂志.2003;23(10):634.
21.Dorothy,Roedel,Ferraro.Laparoscopic adjustable gastric banding for morbid obesity.AORN Journal;2003:77(5):924-944
22.Sagar P.Surgical treatment of morbid obesity.Br J Surg,1995,82:732-739
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