Impact of laparoscopic sleeve gastrectomy on glycolipid metabolism of patients with morbid obesity

doi:10.16139/j.1007-9610.2020.02.009

Abstract

Abstract:

Objective: To investigate the impact of laparoscopic sleeve gastrectomy (LSG) on glycolipid metabolism of patients with morbid obesity and the associated mechanisms. Methods: Clinical data of 82 patients with morbid obesity were analyzed retrospectively including 25 cases with type 2 diabetes mellitus (T2DM), 30 cases with impaired glucose to-lerance and 27 cases with both glucose and glucose tolerance normal. Fifty healthy individuals of normal weight in the period from January 2012 to June 2017 were as control. Postoperative weight loss, index of glycolipid metabolism, Uric acid (UA) and tumor necrosis factor α (TNF-α) were compared between pre and post operation. Correlation between homeostasis model assessment of insulin resistance (HOMA-IR) and some index of metabolism was performed. Results: ①Body mass index (BMI) and waist circumference of obese patients 6 months post operation were significantly lower than pre operation (P<0.05). Higher postoperative excess weight loss (EWL) was found in the obese patients with T2DM compared with normal blood glucose and glucose tolerance (P<0.05). ②Fasting blood glucose (FBG), 2 h postprandial blood glucose and insulin of obese patients 6 months post operation were significantly lower than pre operation (P<0.05). HOMA-IR of obese patients 6 months post operation was significantly lower than pre operation (P<0.05). ③Low density lipoprotein cholesterol of obese patients 6 months post operation was significantly higher than control (P<0.05). Body fat ratio of obese patients 6 months post operation was significantly lower than pre operation (P<0.05). UA and TNF-α of obese patients pre operation, which were significantly higher than control (P<0.05), decreased at 6 months post operation significantly (P<0.05). ④The levels of insulin in 120 min and 180 min after meal at 6 months post operation of obese patients were significantly lower than pre operation (P<0.05). Insulin of obese patients 30 min and 60 min postprandial were significantly higher than control (P<0.05). The peak of insulin secretion curve of patients with impaired glucose tolerance and T2DM pre operation moved to 120 min postprandial and returned to 60 min postprandial. Insulin secretion rhythm of the patients was basically normal. ⑤There were three types of positive correlation of HOMA-IR in obese patients 6 months post operation. It was present with BMI, FBG and fasting insulin (P<0.05). It was present with UA in the obese patients of blood glucose and glucose tolerance normal(P<0.05). It was present with triglyceride and TNF-α of obesity patients of impaired glucose tolerance and T2DM(P<0.05). Conclusions: LSG in the treatment of patients with morbid obese could effectively recover abnormal insulin secretion curve, improve hyperinsulinemia, and correct insulin resistance and metabolic disorders. Insulin resistance of obese patients was closely related to BMI, UA, TNF-α and lipid metabolism disorders.

Key words: Operation, Obesity, Glycolipid metabolism

CLC Number:

R589.2

ZHANG Huaibo, MA Ronglong, ZHANG Dejing. Impact of laparoscopic sleeve gastrectomy on glycolipid metabolism of patients with morbid obesity[J]. Journal of Surgery Concepts & Practice, 2020, 25(02): 129-133.

Figures/Tables 3

指标	体重正常（n=50）	血糖和糖耐量正常（n=27）		糖耐量异常（n=30）		T2DM（n=25）
指标	体重正常（n=50）	术前	术后6个月	术前	术后6个月	术前	术后6个月
体重（kg）	69.26±6.30	121.40±25.60^b）	90.96±22.30^a）b）	108.93±14.97^b）	76.99±13.42^a）b）	109.54±21.60^b）	79.67±15.75^a）b）
BMI	23.70±1.52	41.52±5.84^b）	31.70±7.52^a）b）	38.56±3.73^b）	27.54±4.35^a）b）	37.81±6.72^b）	27.10±4.34^a）b）
EWL（%）	-	-	61.92±7.70	-	76.47±20.31	-	77.85±27.14
腰围（cm）	60.85±5.51	121.02±14.80^b）	102.12±12.90^a）b）	116.93±8.42^b）	91.83±9.77^a）b）	122.91±13.50^b）	101.92±9.81^a）b）
体脂比例（%）	21.93±4.55	41.17±2.52^b）	31.20±3.94^a）b）	40.03±3.27^b）	32.01±5.83^a）b）	38.20±4.31^b）	28.84±5.78^a）b）
HbA1c（%）	5.23±0.74	5.64±0.43	5.34±1.06^a）	6.15±0.93^b）	5.16±0.30^a）	8.08±1.76^b）	5.64±1.26^a）
FBG（mmol/L）	5.28±0.85	5.02±0.60	4.51±0.57^a）	5.61±0.57	4.63±0.37^a）	8.72±2.32^b）	5.29±1.48^a）
2 hPG（mmol/L）	6.86±0.64	6.64±0.96	4.15±0.52^a）	9.25±1.32^b）	4.17±1.02^a）	15.30±4.56^b）	6.23±2.02^a）
空腹胰岛素（mU/L）	12.52±5.20	33.51±17.10^b）	11.48±4.60^a）	35.30±16.39^b）	14.71±5.60^a）	35.74±19.18^b）	11.28±4.14^a）
餐后2 h胰岛素（mU/L）	54.76±16.80	161.39±73.80^b）	37.61±19.58^a）	217.69±89.71^b）	33.53±14.57^a）	125.50±70.62^b）	46.69±17.34^a）
HOMA-IR	1.82±1.16	7.52±3.77^b）	2.40±0.39^a）	9.77±3.80^b）	2.07±1.35^a）	13.58±5.67^b）	2.17±0.86^a）
TC（mmol/L）	4.23±0.74	4.34±1.31	4.16±0.92	4.80±1.37^b）	4.42±0.86^b）	4.94±1.35^b）	4.36±0.84^a）
HDL-C（mmol/L）	1.53±0.36	1.10±0.53^b）	1.33±0.45^a）	1.08±0.20^b）	1.29±0.20^a）	0.91±0.24^b）	1.44±0.32^a）
LDL-C（mmol/L）	2.19±0.76	2.56±1.04^b）	2.64±0.91^b）	3.16±1.20^b）	3.00±1.04^b）	2.97±1.09^b）	2.62±0.78^b）
TG（mmol/L）	0.90±0.13	1.50±0.89^b）	0.97±0.35^a）	1.89±1.06^b）	1.06±0.41^a）	2.84±1.04^b）	1.37±0.40^a）
UA（μmol/L）	267.94±63.59	435.60±94.46^b）	398.92±98.00^a）b）	410.17±121.80^b）	355.70±82.58^a）b）	400.62±101.26^b）	363.74±71.42^a）b）
TNF-α（pg/ml）	6.20±2.33	10.75±4.11^b）	7.68±3.02^a）b）	14.88±4.52^b）	8.62±2.55^a）b）	10.25±3.81^b）	8.68±2.69^a）b）

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胰岛素（mU/L）	体重正常（n=50）	血糖和糖耐量正常（n=27）	糖耐量异常（n=30）	T2DM（n=25）
术前
餐后30 min	42.28±6.85	175.02±29.60	128.51±21.57	73.61±7.57
餐后60 min	52.86±8.64	218.64±31.96	188.15±34.52	126.25±12.32
餐后120 min	39.52±4.20	162.51±25.10	219.48±45.60	138.30±16.39
餐后180 min	24.76±3.80	70.39±12.80	114.61±19.58	77.69±10.71
术后6个月
餐后30 min	38.53±4.36	115.10±13.53^b)	112.33±12.45^b)	140.08±18.20^b)
餐后60 min	54.19±7.76	110.56±11.04^b)	136.64±16.91^b)	197.16±21.20^b)
餐后120 min	47.90±6.13	51.50±5.89	50.97±6.35	55.89±9.06^a)
餐后180 min	17.94±2.59	20.60±3.46	21.92±3.00	24.17±4.80^a)