网膜脂肪细胞大小与胃转流手术后代谢改善的相关性分析

Relationship between visceral adipocyte size and metabolic improvement after bariatric surgery

目的探讨网膜脂肪细胞大小与胃转流手术(RYGB)术后代谢改善的关系。方法本研究纳入了2015年12月至2018年10月在南京鼓楼医院行RYGB手术的113例肥胖患者,评估患者术前和术后的血糖、血脂、体重、体质指数(BMI)、腰围等相关代谢指标,收集患者的网膜脂肪组织,脂肪组织经福尔马林固定后,进行HE染色,使用显微镜随机拍摄15张组织形态照片,利用Image J进行细胞体积测量。采用Spearman相关性分析进行临床血糖、血脂等参数与网膜脂肪细胞大小的相关性分析。结果113例患者中网膜脂肪组织的体积与患者术前空腹血糖(FPG)、空腹胰岛素、空腹C肽、稳态模型评估胰岛素抵抗指数(HOMA-IR)呈正相关(r=0.231,0.432,0.397,0.421,均P<0.05),与低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B呈正相关(r=0.298、0.325,均P<0.01),与载脂蛋白A、高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.224、-0.278,均P<0.05),与体重、BMI、腰围、臀围呈正相关(r=0.397、0.231、0.310、0.232,均P<0.05);113例患者中网膜脂肪细胞的体积与术后3个月糖化血红蛋白(HbA1c)、FPG、空腹胰岛素、HOMA-IR的改善呈正相关(r=0.441、0.301、0.236、0.341,均P<0.05),网膜脂肪细胞体积与术后3个月甘油三酯、总胆固醇、低密度脂蛋白胆固醇和载脂蛋白B的改善呈正相关(r=0.204、0.296、0.196、0.253,均P<0.05)。113例肥胖患者中有50例患者合并2型糖尿病(T2DM),63例患者不合并T2DM,网膜的脂肪细胞的体积大小与肥胖合并T2DM患者术后3个月HbA1c和FPG的改善呈正相关(r=0.309、0.342,均P<0.05),与术后3个月HOMA-IR改善在两组中均呈正相关(r=0.281、0.333,均P<0.05),与总胆固醇的改善在两组患者中均呈正相关(r=0.254、0.369,均P<0.05)。结论网膜脂肪细胞的体积大小与代谢手术后3个月肥胖患者代谢指标改善密切相关,网膜脂肪细胞体积越大,血糖和血脂改善越明显。这可以为代谢手术改善全身代谢状态机制研究和预测代谢手术预后提供新的病理学思路。

Objective To explore the relationship between omental adipocyte size and metabolic benefits after gastric bypass surgery(RYGB).Methods 113 obese patients undergoing RYGB surgery were recruited between December 2015 and October 2018 at Nanjing Drum Tower Hospital.Omental adipose tissues were obtained during the surgery.Preoperative and postoperative blood glucose,blood lipid,body weight,body mass index(BMI),waist circumference and other metabolic indexes were measured.The diameter and volume of adipocytes were calculated through pathological section HE staining.Spearman correlation analysis was used to analyze the correlation between clinical parameters and the omental adipocyte size.Result The Omental adipocyte size was positively correlated with preoperative fasting plasma glucose(FPG),fasting insulin,fasting C peptide,homeostasis model assessment of insulin resistance(HOMA-IR)(r=0.231,0.432,0.397,0.421,all P<0.05),and there was a positive correlation between low density lipoprotein cholesterol(LDL-C),apolipoprotein B,body weight,BMI,waist circumference,and hip circumference(r=0.298,0.325,0.397,0.231,0.310,and 0.232,all P<0.05)while as apolipoprotein A and high-density lipoprotein cholesterol(HDL-C)showed a negative correlation(r=0.224,0.278,all P<0.05).The omental adipocyte size and the change of postoperative glycosylated hemoglobin A1c(HbA1c),FPG,fasting insulin,HOMA-IR were positively correlated(r=0.441,0.301,0.236,0.341,all P<0.05)after 3 months.,and also positive correlation between the change with 3 moths postoperative of triglyceride,total cholesterol,low-density lipoprotein cholesterol,apolipoprotein B(r=0.204,0.296,0.196,0.253,all P<0.05).63 obese nondiabetic,50 obese with type 2 diabetes mellitus(T2DM),the omental adipocyte size and the change of postoperative HbA1c,FPG were positively correlated(r=0.309,0.342,all P<0.05)in obesity T2DM patients,and the change of postoperative HOMA-IR(r=0.281,0.333,all P<0.05),total cholesterol(r=0.254,0.369,all P<0.05)were positively correlated in the two groups after 3 months.Conclusion The omental adipocyte size was significantly related to the change of the metabolic index in obese patients during the first 3 months after surgery.The larger omental adipocyte size was accompanied by the more obvious the improvement of blood glucose and lipid.This retrospective study may offer insights into a novel pathological target for the clinical treatment of obesity.