文章摘要
钱春花,温 馨,朱翠玲,卜 乐,王海权,曲 伸.腹腔镜袖状胃手术对青年男性黑棘皮病患者性激素水平的影响和机制探讨[J].南京医科大学学报,2020,(6):852~857
腹腔镜袖状胃手术对青年男性黑棘皮病患者性激素水平的影响和机制探讨
Study on effects and mechanisms of laparoscopic sleeve gastrectomy on the variation of sexual hormone in young male obesity with acanthosis nigricans
投稿时间:2019-10-31  
DOI:10.7655/NYDXBNS20200614
中文关键词: 腹腔镜胃袖状切除术  肥胖  胰岛素抵抗  睾酮  黑棘皮病
英文关键词: laparoscopic sleeve gastrectomy  obesity  insulin resistance  testosterone  acanthosis nigricans
基金项目:国家自然科学基金(81500650);中央高校基本科研业务费?交叉类项目(1501219107)
作者单位
钱春花 上海市第十人民医院内分泌与代谢病科上海 200072 
温 馨 上海市第十人民医院内分泌与代谢病科上海 200072 
朱翠玲 上海市第十人民医院内分泌与代谢病科上海 200072 
卜 乐 上海市第十人民医院内分泌与代谢病科上海 200072 
王海权 上海市第一人民医院普外科上海 200080 
曲 伸 上海市第十人民医院内分泌与代谢病科上海 200072 
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中文摘要:
      目的:评估腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对肥胖伴黑棘皮病青年男性患者性激素水平变化的影响,并探讨相关机制。方法:选取45例接受LSG手术的青年男性肥胖患者[体重指数(body mass index,BMI)≥30 kg/m2]的临床资料,分为单纯性肥胖组(OB组,n=23)和肥胖伴黑棘皮病组(AN组,n=22),检测和计算术前和术后6个月各组患者的人体测量学指标(体重、BMI、腰围、体脂比例)、糖代谢指标(血糖、糖化血红蛋白、胰岛素、胰岛素抵抗指数)、脂代谢指标(总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)、炎症因子(血尿酸、白介素6和肿瘤坏死因子)及性激素水平,并与术前进行比较。结果:LSG可以明显提高青年男性肥胖患者的总睾酮(total testosterone,TT)水平。术前AN组TT仅为(7.60±4.43)nmol/L,低于正常水平,也显著低于OB组(P < 0.01),OB组TT为(10.42±5.14)nmol/L,也较正常偏低。术后6个月时OB组和AN组的TT水平较术前明显升高(P < 0.05),OB组的TT升高到(15.58±5.32)nmol/L,AN组则达到(21.13±23.43)nmol/L,其中AN组TT升高较OB组更明显(P < 0.05)。术后6个月时,AN组、OB组的炎症因子、血浆胰岛素水平和胰岛素抵抗指数均明显降低(P < 0.05),且AN组下降更为明显。两组患者术后6个月的TT均与BMI、体脂比例、胰岛素抵抗指数、空腹及餐后2 h胰岛素呈负相关(P < 0.05),与空腹和餐后2 h血糖无相关性(P > 0.05)。结论:LSG不仅能有效降低肥胖患者的体重,而且通过改善胰岛素抵抗和炎症状态明显改善了肥胖伴黑棘皮病男性患者的低睾酮血症。
英文摘要:
      Objective:This study aims to evaluate effects and mechanisms of laparoscopic sleeve gastrectomy(LSG)on the changes of sex hormone level in obese young men with acanthosis nigricans. Methods:The clinical data of 45 young male obesity patients[body mass index(BMI)≥30 kg/m2]who underwent LSG was collected. The obesity patients were divided into obesity without acanthosis nigricans group(OB group,n=23)and obesity with acanthosis nigricans group(AN group,n=22). The anthropometries parameters(weight,BMI,waist circumference,and body fat percentage),glucose metabolic indices[plasma glucose,glycosylated hemoglobin(HbAlc),insulin,homeostasis model assessment?insulin resistance index(HOMA?IR)],lipid profiles(total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol),inflammatory factors(serum uric acid,interleukin?6,tumor necrosis factor α) and sexual hormones were evaluated and calculated. Changes of these variables before and after surgery were analyzed. Results:LSG can significantly improve the level of total testosterone(TT)in obese young men. Before operation,the TT of AN group was only(7.60 ± 4.43)nmol/L,which was lower than the normal level and significantly lower than that of OB group(P < 0.01). TT of OB group was(10.42 ± 5.14)nmol/L,which was also lower than the normal level. At 6 months after operation,TT levels in OB group and AN group were significantly higher than those before operation(P < 0.05),TT level in OB group was(15.58 ± 5.32)nmol/L,was(21.13 ± 23.43)nmol/L in AN group,and TT level in AN group increased more significantly than that in OB group(P < 0.05). At 6 months after operation,inflammatory factors,plasma insulin level and HOMA?IR decreased significantly in OB group and AN group(P < 0.05),especially in AN group. TT was negatively correlated with BMI,body fat ratio,HOMA?IR,fasting and 2 hours postprandial insulin(P < 0.05),but not with fasting and 2 hours postprandial blood glucose(P > 0.05). Conclusion:LSG can not only effectively reduce the weight of obese patients,but also significantly alleviate the hypotestosterone of obese men with acanthosis nigricans by improving insulin resistance and inflammation.
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