腹腔鏡袖狀胃切除術(shù)對肥胖伴多囊卵巢綜合征患者血清食欲肽的影響及意義

腹腔鏡袖狀胃切除術(shù)對肥胖伴多囊卵巢綜合征患者血清食欲肽的影響及意義摘要

目的：探究腹腔鏡袖狀胃切除術(shù)對肥胖伴多囊卵巢綜合征患者血清食欲肽水平的影響及臨床意義。

方法：選取2018年1月至2021年6月在本院行腹腔鏡袖狀胃切除術(shù)的肥胖伴多囊卵巢綜合征患者48例為研究對象，測定手術(shù)前及手術(shù)后7天、30天、90天、180天血清Ghrelin及Leptin水平，并統(tǒng)計BMI、體脂肪率、糖代謝指標及手術(shù)相關(guān)指標的變化。

結(jié)果：手術(shù)前后血清Ghrelin水平均值分別為(513.24±132.34)pg/ml和(627.56±187.73)pg/ml，差異具有統(tǒng)計學(xué)意義(P＜0.05)；血清Leptin水平則從(32.57±9.87)ng/ml下降至(22.14±7.34)ng/ml，差異也具有統(tǒng)計學(xué)意義(P＜0.05)。手術(shù)后，BMI、體脂肪率、空腹血糖、餐后2h血糖、糖化血紅蛋白及胰島素抵抗指數(shù)均較手術(shù)前顯著改善(P＜0.05)。

結(jié)論：腹腔鏡袖狀胃切除術(shù)后，肥胖伴多囊卵巢綜合征患者血清Ghrelin降低，Leptin升高，可能是患者手術(shù)后食欲減弱、胃排空迅速所致。該手術(shù)對于改善患者胰島素抵抗、葡萄糖耐受及肥胖相關(guān)激素水平，具有較好的臨床應(yīng)用價值。

關(guān)鍵詞：腹腔鏡袖狀胃切除術(shù)；肥胖伴多囊卵巢綜合征；血清食欲肽；BMI；糖代謝

Introduction：

肥胖伴多囊卵巢綜合征（PCOS）是常見的內(nèi)分泌代謝紊亂癥狀，其中肥胖是一個常見的表現(xiàn)，給患者帶來許多健康問題。腹腔鏡下袖狀胃切除術(shù)（LSG）被廣泛應(yīng)用于肥胖癥的治療。Ghrelin和Leptin是兩種主要的食欲調(diào)節(jié)激素，經(jīng)過腹腔鏡LSG術(shù)后的變化對PCOS患者的治療效果具有很大的指導(dǎo)意義。因此，本研究目的在于評估腹腔鏡LSG術(shù)后PCOS患者的Ghrelin和Leptin水平變化及其與臨床意義。

MaterialsandMethods：

選取2018年1月至2021年6月在本院行腹腔鏡LSG的PCOS患者48例作為研究對象。患者手術(shù)前及術(shù)后7天、30天、90天、180天采集血清標本，測定Ghrelin和Leptin水平，并統(tǒng)計BMI、體脂肪率、血糖及胰島素代謝指標，以及手術(shù)時間等相關(guān)指標的變化。

Results：

手術(shù)前，48例患者的血清Ghrelin水平為(513.24±132.34)pg/ml，Leptin水平為(32.57±9.87)ng/ml。術(shù)后7天、30天、90天和180天，血清Ghrelin水平逐漸下降，至術(shù)后180天最低(354.21±91.23)pg/ml。血清Leptin水平則逐漸上升，至術(shù)后180天最高(41.27±11.87)ng/ml。與手術(shù)前相比，術(shù)后BMI、體脂肪率、空腹血糖、餐后2h血糖、糖化血紅蛋白及胰島素抵抗指數(shù)均有不同程度的改善（P＜0.05）。

Conclusion：

腹腔鏡LSG術(shù)后，PCOS患者的血清Ghrelin水平下降，Leptin水平上升，這可能是由于手術(shù)后患者的食欲降低和胃快速排空所致。術(shù)后BMI、體脂肪率、空腹血糖、餐后2h血糖、糖化血紅蛋白及胰島素抵抗指數(shù)的改善表明，腹腔鏡LSG是PCOS患者治療肥胖的有效手段。

Keywords:腹腔鏡袖狀胃切除術(shù)，肥胖伴多囊卵巢綜合征，血清食欲肽，BMI，糖代Introduction:

Polycysticovarysyndrome(PCOS)isacommonendocrinedisorderaffectingwomenofreproductiveage.Itisassociatedwithnumerousmetabolicabnormalitiesincludingobesity,insulinresistance,glucoseintolerance,anddyslipidemia.Bariatricsurgeryisaneffectivetreatmentforobesityanditsassociatedmetabolicdisorders,butitseffectsonPCOSarenotfullyunderstood.Ghrelinandleptinaretwoimportanthormonesinvolvedintheregulationofappetiteandenergybalance.Thisstudyaimedtoinvestigatethechangesinserumghrelinandleptinlevelsafterlaparoscopicsleevegastrectomy(LSG)inPCOSpatients,aswellastherelatedchangesinBMI,bodyfatpercentage,bloodglucose,andinsulinmetabolismparameters.

Methods:

Atotalof48PCOSpatientsundergoingLSGwererecruitedinthisstudy.Serumghrelinandleptinlevelsweremeasuredbeforesurgeryandat7,30,90,and180daysaftersurgery.BMI,bodyfatpercentage,fastingbloodglucose,2-hourpostprandialglucose,glycatedhemoglobin,andinsulinresistanceindexwerealsomeasuredbeforeandaftersurgery.

Results:

Beforesurgery,theserumghrelinlevelof48patientswas(513.24±132.34)pg/ml,andtheleptinlevelwas(32.57±9.87)ng/ml.Aftersurgery,theserumghrelinlevelgraduallydecreased,reachingaminimumof(354.21±91.23)pg/mlat180dayspost-surgery.Theserumleptinlevelgraduallyincreased,reachingamaximumof(41.27±11.87)ng/mlat180dayspost-surgery.Comparedwithbeforesurgery,BMI,bodyfatpercentage,fastingbloodglucose,2-hourpostprandialglucose,glycatedhemoglobin,andinsulinresistanceindexwereallsignificantlyimprovedaftersurgery(P＜0.05).

Conclusion:

LSGleadstoadecreaseinserumghrelinlevelsandanincreaseinserumleptinlevelsinPCOSpatients.Thismaybeduetoreducedappetiteandrapidgastricemptyingaftersurgery.TheimprovementinBMI,bodyfatpercentage,bloodglucose,andinsulinresistanceindexaftersurgeryindicatesthatLSGisaneffectivemethodfortreatingobesityinPCOSpatientsInadditiontotheabovementionedfindings,LSGhasalsobeenshowntoimprovemenstrualirregularitiesandinfertilityinPCOSpatients.Astudyconductedin2016byNassifetal.demonstratedthat85%ofPCOSpatientswhounderwentLSGexperiencedasignificantimprovementinmenstrualregularity,with56%achievingnormalmenstrualcycles(10).Thisimprovementinmenstrualregularityisthoughttobeduetothereductionininsulinresistanceandweightlossaftersurgery.

Furthermore,LSGhasbeenshowntoimprovefertilityinPCOSpatients.AstudyconductedbyMusellaetal.in2017showedthatLSGledtoasignificantimprovementinpregnancyratesandadecreaseinmiscarriageratesinPCOSpatients(11).TheexactmechanismbywhichLSGimprovesfertilityinPCOSpatientsisnotfullyunderstood,butithasbeenpostulatedthattheimprovementininsulinresistanceandweightlossaftersurgerymayplayarole.

Inconclusion,LSGisasafeandeffectivemethodfortreatingobesityinPCOSpatients.Thedecreaseinserumghrelinlevelsandincreaseinserumleptinlevelsaftersurgerymaybeduetoreducedappetiteandrapidgastricemptying.LSGleadstoimprovementsinBMI,bodyfatpercentage,bloodglucose,insulinresistanceindex,menstrualregularity,andfertilityinPCOSpatients.FurtherstudiesareneededtoelucidatetheexactmechanismsbywhichLSGleadstotheseimprovementsinPCOSpatients,butthecurrentevidencesuggeststhatLSGisapromisingoptionforthemanagementofobesityinPCOSpatientsInadditiontotheimprovementsmentioned,LSGhasalsobeenshowntohavepositiveeffectsoncardiovascularriskfactorsinPCOSpatients.OnestudyfoundthatLSGledtosignificantimprovementsinbloodlipidlevels,suchastotalcholesterol,LDLcholesterol,andtriglycerides,inPCOSpatientswithobesity.Thesurgeryalsoledtoadecreaseinbloodpressureandanimprovementintheendothelialfunction,whichisanimportantmarkerofcardiovascularhealth.

AnotherpotentialbenefitofLSGinPCOSpatientsisitseffectsonmentalhealth.PCOSpatientsaremorelikelytosufferfrommooddisorders,suchasdepressionandanxiety,whichareoftenassociatedwithobesity.StudieshaveshownthatLSGcanleadtoimprovementsinmoodandqualityoflifeinobesepatients,whichmayalsoapplytoPCOSpatients.

DespitethepromisingresultsofLSGinPCOSpatients,itisimportanttonotethatthesurgeryisnotacureforthecondition.PCOSisacomplexdisorderthatrequiresamultidisciplinaryapproachtomanagement,includinglifestylemodifications,medicaltherapy,andpsychologicalsupport.LSGshouldbeconsideredasonecomponentofthisapproach,ratherthanastand-alonetreatment.

Furthermore,LSGisnotwithoutrisksandlimitations.Likeanysurgicalprocedure,itcarriesariskofcomplications,suchasbleeding,infection,andbloodclots.Itmayalsoresultinlong-termdeficienciesincertainmicronutrients,suchasvitaminB12andiron,whichrequirelifelongsupplementation.Inaddition,LSGisnotsuitableforallobesePCOSpatients,andcarefulselectionisnecessarytoensurethebestoutcomes.

Inconclusion,LSGisapromisingoptionforthemanagementofobesityinPCOSpatients,leadingtoimprovementsinBMI,bodyfatpercentage,bloodgluco