Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery
Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery
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DOI：
10.1016/j.amjmed.2008.06.033
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发表时间：
2008-11-01
影响因子：
5.9
通讯作者：
Taegtmeyer, Heinrich
中科院分区：
文献类型：
--
作者：
Leichman, Joshua G.;Wilson, Erik B.;Taegtmeyer, Heinrich
目的：本研究的目的是确定肌肉代谢和心血管的变化，手术干预后，在临床上严重的肥胖patients.METHODS：肥胖是一种状态的代谢失调，可导致适应不良的变化，在心脏和骨骼肌，包括胰岛素抵抗和心力衰竭。在一项前瞻性纵向研究中，43名连续患者在基线和减肥手术后3个月和9个月进行了代谢分析、骨骼肌活检和静息超声心动图检查。（平均变化，95%置信区间[CI]）：7.7 kg/m（2）（95%CI，6.70-8.89）和术后9个月时5.6 kg/m2（95%CI，4.45-6.80; P < .0001），在相同时间点胰岛素敏感性恢复，血浆瘦素降低。与这些变化同时发生的是，在3个月和9个月时，硬脂酰辅酶A去饱和酶和丙酮酸脱氢酶激酶-4的骨骼肌转录水平显著降低（P <0.0001），在9个月时，过氧化物酶体增殖激活受体α调节基因显著降低。左心室舒张功能障碍，组织多普勒成像评估，正常化9个月后surgery.CONCLUSION：体重减轻的结果在逆转全身和肌肉代谢紊乱，并伴随着左心室舒张功能的正常化。(C)2008年爱思唯尔公司All rights reserved.
OBJECTIVE: The study objective was to define muscle metabolic and cardiovascular changes after surgical intervention in clinically severe obese patients.METHODS: Obesity is a state of metabolic dysregulation that can lead to maladaptive changes in heart and skeletal muscle, including insulin resistance and heart failure. In a prospective longitudinal study, 43 consecutive patients underwent metabolic profiling, skeletal muscle biopsies, and resting echocardiograms at baseline and 3 and 9 months after bariatric surgery.RESULTS: Body mass index decreased (mean changes, 95% confidence interval [CI]): 7.7 kg/m(2) (95% CI, 6.70-8.89) at 3 months and 5.6 kg/m(2) (95% CI, 4.45-6.80; P < .0001) at 9 months after surgery, with restoration of insulin sensitivity and decreases in plasma leptin at the same time points. Concurrent with these changes were dramatic decreases in skeletal muscle transcript levels of stearoyl coenzyme-A desaturase and pyruvate dehydrogenase kinase-4 at 3 and 9 months (P < .0001, for both) and a significant decrease in peroxisome proliferation activated receptor-alpha-regulated genes at 9 months. Left ventricular relaxation impairment, assessed by tissue Doppler imaging, normalized 9 months after surgery.CONCLUSION: Weight loss results in the reversal of systemic and muscle metabolic derangements and is accompanied by a normalization of left ventricular diastolic function. (C) 2008 Elsevier Inc. All rights reserved.