脂肪抽吸术与脂类代谢

Liposuction and lipid metabolism

目的:通过综述国内外脂肪抽吸术对人体脂类代谢影响的研究与应用,探讨脂肪抽吸术的安全性和有效性。资料来源:应用计算机检索Medline1995-01/2004-12相关脂肪抽吸术和脂类代谢的文献,检索词“lipectomy,lipids”,并限定文献语种为English。同时计算机检索万方数据库2000-01/2004-12相关脂肪抽吸术和脂类代谢的文献,检索词″脂肪切除术″,并限定文献语种为中文。资料选择:对资料的摘要进行阅读初审,开始查找全文。纳入标准:①临床研究性文章。②基础研究文章。排除标准:重复研究、综述、Meta分析类文献。资料提炼:共收集到28篇研究脂肪抽吸术对脂类代谢影响的文献,26篇符合纳入标准。排除的2篇文献为综述。纳入的试验包括281例患者(或实验动物),分别对脂肪抽吸术后脂类代谢的变化情况进行评价。资料综合:吸脂术可能会改变受术者的血脂水平,从而影响其心血管疾病的发病率。吸脂术可能有助于提高受术者体内胰岛素的敏感性,降低其胰岛素抵抗状况。脂肪组织能够调节性激素和糖皮质激素的代谢,性激素也反馈调节体内的脂类代谢。瘦素通过与中枢神经系统的瘦素受体直接结合来调节体内的能量平衡、脂肪贮存及某些内分泌功能,某些研究认为吸脂术后受术者体内瘦素水平发生一定变化。脂肪细胞能够合成分泌肿瘤坏死因子α,肿瘤坏死因子α能调节食欲、产热和脂质代谢等,从而限制体质量的增加,有研究认为吸脂术不会影响肿瘤坏死因子α的合成与分泌。吸脂术直接引起手术区脂肪含量减少,受术者体质量降低,同时体脂的分布比例发生变化。结论:脂肪抽吸术后脂类代谢在一定时期内有一定的变化,但是脂类代谢变化所维持的时间和对人体健康的影响尚不肯定。

OBJECTIVE： To explore the safety and effectiveness of liposuction by reviewing the research about the effect of liposuction on lipid metabolism and its application. DATA SOURCES： A computer-based online search of Medline was undertaken to identify literatures about liposuction and lipid metabolism published in English from January 1995 to December 2004 by using the keywords of “lipectomy, lipids”. Meanwhile Chinese articles about liposuction and lipid metabolism published between January 2000 and December 2004 were searched in Wanfang database with computer, the keyword was “lipectomy”. STUDY SELECTION： The abstracts of the data were checked firstly, and the full-texts were searched. Inclusive criteria： ① clinical studies; ② basic studies. Exclusive criteria： repetitive studies, reviews and Meta analysis. DATA EXTRACTION： A total of 28 articles about the effect of liposuction on lipid metabolism were retrieved, 26 accorded the inclusion criteria, and the 2 excluded articles were reviews. In the trials, totally 281 patients （or experimental animals） were involved, and the changes of lipid metabolism after liposuction were evaluated. DATA SYNTHESIS： To some extent, liposuction may affect the morbidity and mortality resulting from changing the preoperative level of serum lipids. Liposuction also contributes to increase the insulin sensitivity, which reduces insulin resistance. Fat tissue may play a role in regulation of sextual and eorticosteroid hormones. Conversely, sexual hormone, as a type of feedback, regulates the lipid metabolism. Leptin, directly combining with its receptor in central nervous system, regulates energy balance, fat store and certain endocrine functions. Some researches have demonstrated a significant change in leptin level after liposuction. Tumor necrosis factor-α （TNF-α） from fat cells can adjust individual appetite and energy metabolism, limiting increase of body mass. It has been shown, however, that liposuction will not influence TNF-α level. Simply, the procedure individually reduces body mass, through direct decrease of fat mass in local areas. At the same time, changes in fat distribution occur. CONCLUSION： Certain changes appear in lipid metabolism after liposuction, but it is not certain about the changing time and its influences on body health.