Reduced cardiovascular risk following bariatric surgeries is related to a partial recovery from "adiposopathy".
Reduced cardiovascular risk following bariatric surgeries is related to a partial recovery from "adiposopathy".
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DOI：
10.1007/s11695-011-0447-5
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发表时间：
2011-12
期刊：
影响因子：
2.9
通讯作者：
Kashyap, Sangeeta R.
中科院分区：
文献类型：
--
作者：
Appachi, Swathi;Kelly, Karen R.;Schauer, Philip R.;Kirwan, John P.;Hazen, Stanley;Gupta, Manjula;Kashyap, Sangeeta R.
关键词：
功能失调的脂肪组织或“脂肪病”分泌的细胞因子改变与肥胖相关的炎症有关，并可能介导减肥手术后体重减轻带来的心血管风险降低。我们假设，减肥手术通过有利地改变脂肪组织的促炎状态来降低心血管疾病的风险。在这项重复测量的观察性研究中，142例患者接受了减肥手术，其中45例在6个月后复查。观察两个时间点的血脂和血浆脂联素、瘦素、肿瘤坏死因子-α水平。各种脂肪因子参数的比率与手术前和手术后(胃旁路手术与其他限制性减肥手术)的血脂比率有关。在手术前，循环脂联素和脂联素/肿瘤坏死因子-高密度脂蛋白的比值与心血管疾病的风险密切相关，其特征是甘油三酯、高密度脂蛋白以及总胆固醇/高密度脂蛋白、低密度脂蛋白/高密度脂蛋白和甘油三酯/高密度脂蛋白的比值(均P<0.05)。减肥手术后，与基线相比，体重指数下降了22%，脂联素上升了93%，瘦素下降了50%(均为P<；0.01)。术后肿瘤坏死因子-α水平升高120%(P<；0.01)。术后脂联素和瘦素/脂联素比值的变化与甘油三酯、高密度脂蛋白、TC/高密度脂蛋白、低密度脂蛋白/高密度脂蛋白和甘油三酯/高密度脂蛋白比值的逐渐改善密切相关(均P<；0.05)。与其他减重手术相比，Roux-en-y胃旁路手术(RYGB)在体重指数、高密度脂蛋白和瘦素/脂联素比率方面比其他胃限制性手术有更显著的改善(P<；0.05)。因此，减肥手术，特别是RYGB，通过部分恢复“脂肪病”来改善心血管疾病的风险，其显著特征是脂联素和瘦素/脂联素比率的改善。
Altered cytokine secretion from dysfunctional adipose tissue or “adiposopathy” is implicated in obesity related inflammation and may mediate reduced CVD risk in response to weight loss after bariatric surgery. We hypothesized that bariatric surgery reduces CVD risk by favorably altering the pro-inflammatory profile of adipose tissue as a result of weight loss. In this observational study with repeated measures, 142 patients underwent bariatric surgery of which 45 returned for follow up at ~6 months. At both time-points, lipid profiles and levels of plasma adiponectin, leptin, and TNF-α were obtained. Ratios of various adipokine parameters were related to pre- and post- surgical (gastric bypass vs. other restrictive bariatric procedures) lipid ratios. Prior to surgery, circulating adiponectin and the adiponectin/TNF-α ratio was strongly associated with CVD risk characterized by levels of triglycerides, HDL, and the TC/HDL, LDL/HDL and TG/HDL ratios (all P < 0.05). Following bariatric surgery, BMI was decreased by 22%, adiponectin was increased by 93%, and leptin decreased by 50% as compared to baseline (all P < 0.01). TNF-α levels increased by 120% (P < 0.01) following surgery. Post-surgical changes in adiponectin and the leptin/adiponectin ratio were strongly associated with incremental improvements in triglycerides, HDL, and TC/HDL, LDL/HDL and TG/HDL ratios (all P < 0.05). Roux-en-y gastric bypass surgery (RYGB) as compared to other bariatric procedures was associated with more robust improvements in BMI, HDL, and leptin/adiponectin ratio than other gastric restrictive procedures (P < 0.05). Thus, bariatric surgery, especially RYGB, ameliorates CVD risk through a partial recovery from “adiposopathy”, distinctively characterized by improved adiponectin and the leptin/adiponectin ratio.
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