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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 ›› 2020, Vol. 06 ›› Issue (04) : 227 -232. doi: 10.3877/cma.j.issn.2095-9605.2020.04.004

所属专题： 总编推荐； 文献；

论著

袖状胃切除术早期对肥胖症患者血清白脂素水平的影响
李影1, 付真真2, 周红文2, 梁辉3, 管蔚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. 210029　南京，南京医科大学第一附属医院内分泌代谢科
    3. 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:2020-04-29 出版日期:2020-11-30
  • 通信作者: 管蔚
  • 基金资助:
    吴阶平基金会临床科研专项基金(编号：320.2710.1807)

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

Ying Li1, Zhenzhen Fu2, Hongwen Zhou2, Hui Liang3, Wei Guan3,†()   

  1. 1. Department of Endocrinology, Northern Jiangsu People’s Hospital, Yangzhou 225001; Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    2. Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    3. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2020-04-29 Published:2020-11-30
  • Corresponding author: Wei Guan
  • About author:
    Corresponding author: Guan Wei, Email:
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引用本文：

李影, 付真真, 周红文, 梁辉, 管蔚. 袖状胃切除术早期对肥胖症患者血清白脂素水平的影响[J]. 中华肥胖与代谢病电子杂志, 2020, 06(04): 227-232.

Ying Li, Zhenzhen Fu, Hongwen Zhou, Hui Liang, Wei Guan. Short-term effect of sleeve gastrectomy on serum asprosin level in obese patients.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(04): 227-232.

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。

关键词: 肥胖症, 白脂素, 胰岛素抵抗, 代谢手术, 袖状胃切除术
Objective

To investigate the short-term effect of laparoscopic sleeve gastrectomy (LSG) on serum asprosin level in obesity, and to analyze the correlation with clinical outcomes.

Methods

20 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.

Results

3 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.

Conclusions

Fasting 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.

Key words: Obesity, Asprosin, Insulin resistance, Bariatric surgery, Sleeve gastrectomy
表1 LSG术前20例受试者的基本资料
指标 术前
年龄（岁） 28.55±6.69
性别（男：女） 5:15
体重（kg） 105.37±17.79
BMI（kg/m2） 37.85±4.64
高血压病（人/%） 7 (35%)
高脂血症（人/%） 8 (40%)
T2DM（人/%） 2 (10%)
IR（人/%） 17 (85%)
HbA1c（%） 5.92 ±1.06
表2 20例肥胖受试者LSG术后3月人体成分指标的变化
指标 体重（kg） BMI （kg/m2） BF（kg） PBF（%） VFA（cm2） 腰围（cm）
术前 105.37±17.79 37.85±4.64 47.82±11.23 44.89±5.68 212.56±41.47 116.78±12.24
3月 90.13±16.13 32.31±4.10 40.14±10.68 42.41±5.90 190.64±45.15 103.38±13.68
P值 <0.001a <0.001a <0.001a 0.014a <0.001a <0.001a
指标 体重（kg） 臀围（cm） WHR BMR（kcal） SBP（mmHg） DBP（mmHg）
术前 105.37±17.79 119.37±8.30 1.01±0.05 1568.00(1487.75, 1799.75) 137.35±13.12 85.20±11.43
3月 90.13±16.13 110.55±9.11 0.99±0.06 1397.50(1315.50, 1656.25) 122.50±11.44 77.90±8.84
P值 <0.001a <0.001a 0.001a <0.001b <0.001a 0.006a
图1 LSG术后3月肥胖患者血清asprosin水平变化（*表示差异有统计学意义，P<0.001）
表3 20例肥胖受试者LSG术后3月代谢指标的变化
指标 FPG(mmol/L) FINS(pmol/L) HbA1c(%) HOMA-IR TG(mmol/L) TC(mmol/L)
术前 5.54±0.81 239.30 (115.40, 291.00) 5.80 (5.23, 6.08) 8.44 ±5.24 1.60±0.83 5.02 ±0.99
3月 5.07±0.72 80.80(59.45, 129.10) 5.00(4.90, 5.35) 3.17±1.44 1.25±0.35 4.21±0.97
P值 0.01a <0.001b <0.001b <0.001a 0.075a <0.001a
指标 LDL-C(mmol/L) HDL-C(mmol/L) ALT(U/L) AST(U/L) GGT(U/L) asprosin(pg/ml)
术前 3.58 ±0.83 0.99 ±0.19 46.10 (19.45, 105.50) 39.82±25.92 29.75(20.53, 48.48) 347.33(267.25, 451.18)
3月 2.94±0.78 0.91±019 45.10(35.83, 67.00) 46.78±19.89 19.90(13.85, 27.43) 254.95(233.94, 311.88)
P值 0.001a 0.060a 0.247b 0.196a 0.009b <0.001b
图2 术前肥胖患者血清asprosin与HOMA-IR相关性分析
图3 LSG术后3月血清asprosin的改变量与糖脂代谢指标改变量的相关性分析
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