Effects of lung volume reduction surgery for emphysema on glycolipidic hormones.
Effects of lung volume reduction surgery for emphysema on glycolipidic hormones.
复制标题
肺气肿肺减容手术对糖脂激素的影响。
作者：
D. Mineo;V. Ambrogi;L. Frasca;M. E. Cufari;E. Pompeo;T. Mineo
背景
肺气肿与恶病质、调节糖脂代谢的激素失调、胰岛素抵抗和底物利用改变有关。本研究旨在确定肺减容手术（LVRS）与呼吸康复（RR）相比对糖脂激素的影响。
方法
将33例接受电视胸腔镜LVRS的中重度肺气肿患者与31例拒绝手术并遵循标准化RR程序的类似患者进行比较。所有患者在治疗前和治疗后12个月评估呼吸功能、身体成分、糖脂激素、代谢参数和胰岛素抵抗，胰岛素抵抗使用稳态模型胰岛素抵抗评估指数（HOMA-IR）计算。将这些组与匹配的健康对照人群进行比较。
结果
只有在LVRS后，呼吸功能才有显著改善（FEV 1，+25.2%; p<0.0001;残气量，-19.5%; p<0.0001），代谢参数（总胆固醇，+13.1%; p<0.01;高密度脂蛋白胆固醇，+11.2%; p<0.01;甘油三酯，+18.4; p<0.001;非酯化脂肪酸，-19.7%; p<0.001）和身体组成（无脂肪质量[FFM]，+6.5%; p<0.01;脂肪质量[FM]，+11.9%; p<0.01）。Leptin/FM比值（-6.1%; p<0.01）和抵抗素/FM比率（-5.6%; p<0.01）降低，而脂联素/FM比值（+6.9%; p<0.01）和生长激素释放肽（+9.2%; p<0.01）增加，同时胰岛素水平（-20.4%; p <0.001）和HOMA-IR（-27.2%; p<0.0001）降低。残余容量的减少与FFM（rho=-0.49; p<0.02）、FM（rho=-0.55; p<0.009）和ghrelin（rho=-0.52; p<0.01）的增加相关，并且还与经FM校正的瘦素（rho=0.50; p<0.02）和HOMA-IR（rho=0.35; p=0.07）的轻微降低相关。
结论
LVRS后，糖脂激素水平和营养状况显著改善，沿着胰岛素抵抗减轻和更多的底物生理利用。残气量和身体成分以及糖脂激素水平之间的相关性表明，与RR相比，呼吸动力学的术后恢复可能会引起有利的临床变化。
BACKGROUND
Pulmonary emphysema is associated with cachexia and disregulation of the hormones regulating the glycolipid metabolism, insulin resistance, and altered substrate utilization. This study aimed at identifying the effects of lung volume reduction surgery (LVRS) on glycolipidic hormones compared to respiratory rehabilitation (RR).
METHODS
Thirty-three patients with moderate-to-severe emphysema who were undergoing video-assisted thoracoscopic LVRS were compared to 31 similar patients who refused the operation and followed a standardized RR program. All patients were evaluated before and 12 months after treatment for respiratory function, body composition, glycolipidic hormones, metabolic parameters, and insulin resistance, which was calculated using the homeostatic model assessment index for insulin resistance (HOMA-IR). These groups were compared to a matched healthy control population.
RESULTS
Only after LVRS significant improvements were obtained in respiratory function (FEV1, +25.2%; p<0.0001; residual volume, -19.5%; p<0.0001), metabolic parameters (total cholesterol, +13.1%; p<0.01; high-density lipoprotein cholesterol, +11.2%; p<0.01; triglycerides, +18.4; p<0.001; nonesterified fatty acid, -19.7%; p<0.001), and body composition (fat-free mass [FFM], +6.5%; p<0.01; fat mass [FM], +11.9%; p<0.01). The leptin/FM ratio (-6.1%; p<0.01) and resistin/FM ratio (-5.6%; p<0.01) decreased, whereas the adiponectin/FM ratio (+6.9%; p<0.01) and ghrelin (+9.2%; p<0.01) increased, together with reductions in glycemia (-8.8%; p<0.01), insulin level (-20.4%; p<0.001), and HOMA-IR (-27.2%; p<0.0001). The decrement in residual volume was correlated with increment of FFM (rho=-0.49; p<0.02), FM (rho=-0.55; p<0.009), and ghrelin (rho=-0.52; p<0.01), and also with decreases in leptin corrected for FM (rho=0.50; p<0.02) and, marginally, HOMA-IR (rho=0.35; p=0.07).
CONCLUSIONS
After LVRS, glycolipidic hormone levels and nutritional status significantly improved, along with insulin resistance reduction and more physiologic utilization of substrates. Correlations between residual volume and body composition as well as glycolipidic hormone levels suggest that postoperative recovery in respiratory dynamics may induce favorable clinical changes when compared to RR.