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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2019, Vol. 05 ›› Issue (02) : 70 -78. doi: 10.3877/cma.j.issn.2095-9605.2019.02.002

所属专题： 文献；

论著

肥胖症患者行腹腔镜Roux-en-Y胃旁路术后早期体脂含量的变化与胰岛素抵抗改善的相关性研究
李影1, 贾珏2, 付真真3, 潘瑞蓉4, 杨宁俐5, 管蔚5, 梁辉5, 周红文3,†()   
  1. 1. 225001　扬州，江苏省苏北人民医院内分泌代谢科；210029　南京，南京医科大学第一附属医院内分泌代谢科
    2. 212000　镇江，江苏大学附属医院急诊科
    3. 210029　南京，南京医科大学第一附属医院内分泌代谢科
    4. 210029　南京，南京医科大学第一附属医院内分泌代谢科；212000　镇江，江苏大学附属医院内分泌代谢科
    5. 210029　南京，南京医科大学第一附属医院减重代谢外科
  • 收稿日期:2019-03-10 出版日期:2019-05-30
  • 通信作者: 周红文
  • 基金资助:
    国家自然青年科学基金项目(81500351)

Study on the relationship between the short-term changes of body fat and improvement of insulin resistance in obesity after laparoscopic Roux-en-Y gastric bypass surgery

Ying Li1, Jue Jia2, Zhenzhen Fu3, Ruirong Pan4, Ningli Yang5, Wei Guan5, Hui Liang5, Hongwen Zhou3,†()   

  1. 1. Department of Endocrinology, Subei People′s Hospital of Jiangsu Province, Yangzhou, 225001; Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029
    2. Department of Emergency, the affiliated hospital of Jiangsu University, Zhenjiang 212000
    3. Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029
    4. Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029; Department of Endocrinology and Metabolism, the affiliated hospital of Jiangsu University, Zhenjiang 212000
    5. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2019-03-10 Published:2019-05-30
  • Corresponding author: Hongwen Zhou
  • About author:
    Correspongding author: Zhou Hongwen, Email:
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引用本文：

李影, 贾珏, 付真真, 潘瑞蓉, 杨宁俐, 管蔚, 梁辉, 周红文. 肥胖症患者行腹腔镜Roux-en-Y胃旁路术后早期体脂含量的变化与胰岛素抵抗改善的相关性研究[J]. 中华肥胖与代谢病电子杂志, 2019, 05(02): 70-78.

Ying Li, Jue Jia, Zhenzhen Fu, Ruirong Pan, Ningli Yang, Wei Guan, Hui Liang, Hongwen Zhou. Study on the relationship between the short-term changes of body fat and improvement of insulin resistance in obesity after laparoscopic Roux-en-Y gastric bypass surgery[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2019, 05(02): 70-78.

目的

探讨腹腔镜Roux-en-Y胃旁路术（LRYGB）后短期内对肥胖患者身体成分和糖脂代谢水平的影响，并分析体脂含量的变化与胰岛素抵抗改善的相关性。

方法

回顾性分析2017年8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住院的20例行LRYGB的肥胖症患者的临床资料。统计分析术前及术后3月的身体成分和糖脂代谢指标变化及相关性，计算稳态模型评估胰岛素抵抗指数（HOMA-IR）。

结果

术后3个月患者的体重、空腹血糖、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、总甘油三酯（TG）均显著下降（P<0.05）。HOMA-IR从（7.70±4.17）降至（2.63±1.52）。腹型肥胖指标腰围、腰臀比和内脏脂肪面积明显降低（P<0.05）；体脂肪含量从术前（47.89±13.01）kg降至（30.40±10.89）kg，体脂率从（43.11±1.27）%降低到（34.89±1.77）%。体脂率减少量是术后HOMA-IR和FINS改善的独立影响因素（HOMA-IR，r=0.58，P=0.007；FINS，r=0.69，P=0.001），而HbA1c的改善与腰臀比减少量独立正相关（r=0.48，P=0.031）；同时，内脏脂肪面积减少量与术后TG的改变量呈独立正相关（r=0.53，P=0.016）。

结论

LRYGB术后短期内体重、腰围和腰臀比下降的同时，体脂肪含量、体脂率和内脏脂肪面积也显著下降。手术引起的体脂率的变化是术后HOMA-IR改善程度的独立影响因素，而术后腰臀比的变化是HbA1c改善的独立影响因素。LRYGB术后体脂分布的改变与胰岛素抵抗的减轻及糖脂代谢的早期获益密切相关。

关键词: 腹腔镜Roux-en-Y胃旁路术, 肥胖症, 2型糖尿病, 体脂分布, 胰岛素抵抗
Objective

To investigate the short-term effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery on body composition and glycolipid metabolism in obese subjects, and to analyze the correlation between body fat changes and insulin resistance improvement.

Methods

20 Chinese adults with obesity receiving LRYGB at Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital with Nanjing Medical University were included to this study between Aug 2017 and Oct 2018. The body composition and glycolipid metabolism indexes were analyzed before and 3 months after surgery. Homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated.

Results

Weight, fasting glucose, fasting insulin (FINS), HbA1c and total triglycerides (TG) decreased significantly 3 months after surgery (P<0.05). HOMA-IR decreased from (7.70±4.17) to (2.63±1.52). The abdominal obesity indexes, including waist circumference, waist-hip ratio and visceral fat area were remarkably decreased (P<0.05). The body fat decreased from (47.89±13.01) kg to (30.40±10.89) kg, and the body fat percentage decreased from (43.11±1.27) % to (34.89±1.77) %. After 3 months postoperatively, the reduction of body fat was an independent factor affecting the improvement of HOMA-IR and FINS (HOMA-IR, r=0.58, P=0.007; FINS, r=0.69, P=0.001), while the improvement of HbA1c was independently and positively correlated with the reduction of waist-hip ratio (r=0.48, P=0.031). Meanwhile, the decrease of visceral fat area was independently and positively correlated with the change of TG (r=0.53, P=0.016).

Conclusions

Apart from reduction in weight, waist circumference and waist-hip ratio, the levels of body fat, body fat percentage and visceral fat area also decreased significantly in obesity in the short term after LRYGB. Moreover, the variation of body fat was an independent factor affecting the improvement of HOMA-IR after surgery, and the short-term change of waist-hip ratio was strongly associated with reduced HbA1c. In the early stage after the LRYGB procedure, by regulating the distribution of body fat, it may lead to a decrease in insulin resistance and an improvement in the benefit of glycolipid metabolism.

Key words: Laparoscopic Roux-en-Y gastric bypass, Obesity, Type 2 diabetes mellitus, Body fat distribution, Insulin resistance
表1 LRYGB术前20例受试者的基本资料
指标 术前
性别(男/女) 12/8 (60%，40%)
年龄(岁) 37.30±10.36
体重(kg) 110.56±21.85
BMI(kg/m2) 38.25±5.89
合并症 ?
高血压病 9 (45%)
高脂血症 12 (60%)
T2DM 16 (80%)
IR 19 (95%)
HbA1c(%) 8.15 ±1.10
表2 20例肥胖受试者LRYGB术后3月身体成分指标的变化
指标 体重（kg） BMI（kg/m2） SBP（mmHg） DBP（mmHg） BF（kg） PBF（%） VFA（cm2） WC（cm） HC（cm） WHR BMR（kcal）
术前 110.56±21.85 38.25±5.89 142.85±22.63 88.65±15.89 47.89±13.01 43.11±1.27 210.20±40.45 120.68±12.68 120.60±13.00 1.02±0.06 1721±255.19
术后3月 86.96±16.28 30.10±4.16 123.35±12.87 76.50±6.86 30.40±10.89 34.89±1.77 135.02±53.53 103.07±13.46 107.75±9.55 0.95±0.06 1585.25±217.12
P值 <0.001a <0.001a 0.007a 0.004a <0.001a <0.001a <0.001a <0.001a <0.001a <0.001a <0.001a
表3 20例肥胖受试者LRYGB术后3月糖代谢指标的变化
指标 FPG（mmol/L） FINS（pmol/L） FCP（pmol/L） HbA1c（%） HOMA-IR ISI
术前 5.67（5.07，7.07） 156.40（107.28，253.40） 1236.00（952.70，1866.75） 7.70（7.40，8.68） 7.70±4.17 0.15(0.10，0.24)
术后3月 5.29（4.82，5.68） 71.50（36.95，97.98） 810.30（505.95，1188.75） 5.10（4.83，5.98） 2.63±1.52 0.28(0.44，0.73)
P值 0.005b <0.001b <0.001b <0.001b <0.001a <0.001b
表4 20例肥胖受试者LRYGB术后3月肝功能和脂代谢指标的变化
指标 TG（mmol/L） TC（mmol/L） LDL-c（mmol/L） HDL-c（mmol/L） ALT（U/L） AST（U/L） GGT（U/L） UA（umol/L）
术前 1.47（1.28，2.69） 4.55±1.14 3.22（2.45，3.71） 0.94 （0.76，1.11） 48.45（25.03，74.25） 27.60（21.70，44.48） 38.80（24.13，53.40） 432.80±99.48
术后3月 1.08（0.91，1.37） 4.29±0.84 2.82（2.71，3.37） 0.94（0.85，1.04） 24.45（17.65，34.85） 25.35（18.53，33.85） 23.40（13.83，36.08） 387.30±99.89
P值 0.003b 0.272a 0.455b 0.809b 0.01b 0.179b 0.009b 0.038a
图1 RYGB术后3月后身体成分的改变量与糖脂代谢指标改变量的相关性分析
表5 RYGB术后3月身体成分的改变量与糖脂代谢指标改变量的相关性分析
. ΔFPG ΔFINS ΔFCP ΔHOMA-IR ΔHbA1c ΔTG ΔUA
r P r P r P r P r P r P r P
ΔBW -0.19 0.41 0.30 0.20 0.22 0.35 0.22 0.35 -0.02 0.93 -0.28 0.23 0.14 0.57
ΔBMI -0.20 0.39 0.30 0.21 0.18 0.44 0.24 0.30 -0.07 0.78 -0.27 0.25 0.16 0.51
ΔBF -0.20 0.40 0.61 0.004 0.33 0.16 0.46 0.04 0.32 0.17 -0.17 0.48 -0.07 0.76
ΔPBF 0.04 0.86 0.69 0.001 0.50 0.023 0.58 0.007 0.48 0.031 0.02 0.92 -0.32 0.17
ΔWC 0.01 0.98 0.58 0.008 -0.03 0.92 0.56 0.011 0.23 0.33 0.22 0.35 -0.03 0.91
ΔCC -0.07 0.78 0.21 0.39 -0.01 0.98 0.19 0.42 0.30 0.20 -0.24 0.31 0.26 0.28
ΔWHR -0.18 0.44 0.38 0.10 0.33 0.16 0.07 0.77 0.48 0.031 0.51 0.023 -0.07 0.76
ΔVFA -0.12 0.63 0.28 0.24 0.13 0.59 0.12 0.61 0.48 0.032 0.53 0.016 0.32 0.17
ΔMHR 0.10 0.69 -0.24 0.30 -0.14 0.56 -0.10 0.67 -0.30 0.20 -0.40 0.08 0.27 0.26
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