[1]马骥,都健.代谢手术影响骨代谢的机制研究[J].国际内分泌代谢杂志,2017,37(05):312-315,344.
　Ma Ji,Du Jian..Mechanism study of effects of metabolic surgery on bone metabolism[J].International Journal of Endocrinology and Metabolism,2017,37(05):312-315,344.
点击复制

代谢手术影响骨代谢的机制研究()
分享到：

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
37
期数:
2017年05期
页码:
312-315,344
栏目:
综述
出版日期:
2017-09-20

文章信息/Info

Title:
Mechanism study of effects of metabolic surgery on bone metabolism
作者:
马骥; 都健
110032 沈阳,中国医科大学附属第四医院内分泌科
Author(s):
Ma Ji;  Du Jian.
Department of Endocrinology, The Forth Hospital Affiliated to China Medical University, Shenyang 110032, China Corresponding author: Du Jian, Email: dujianbox@126.com
关键词:
代谢手术;  骨密度;  骨代谢;  肥胖症
Keywords:
Metabolic surgery;  Bone mineral density;  Bone metabolism;  Obesity
文献标志码:
A
摘要:
代谢手术是目前治疗肥胖症的有效方法,但其引起的骨密度降低,甚至骨质疏松已受到广泛关注,是亟待解决的问题。代谢手术的作用包括改变胃肠道结构,影响钙、维生素D的吸收,导致骨骼中钙盐沉积减少,直接降低骨密度,同时可引起甲状旁腺激素升高,导致继发性甲状旁腺功能亢进症,以及术后骨质疏松发病率的升高; 升高肽YY水平,降低ghrelin水平,从而抑制成骨细胞增殖,促进破骨细胞活动及骨吸收,抑制骨形成,降低骨密度; 减少脂肪组织,降低瘦素水平,使骨吸收增加,骨形成减少,骨密度降低,增加骨质疏松甚至骨折风险; 升高胰高血糖素样肽-1(GLP-1)与脂联素水平,促进成骨活动; 降低雌二醇水平,升高性激素结合球蛋白、游离睾酮、促性腺激素水平,作用于成骨细胞,影响骨代谢; 改变相关骨代谢标志物。外源性补充维生素D、钙剂甚至GLP-1受体激动剂可保护骨密度,从而预防骨质疏松。
Abstract:
Metabolic surgery is an effective method for the treatment of obesity. The reduction of bone mineral density caused by metabolic surgery has received extensive attention and become an urgent problem need to be tackled. The effects of metabolic surgery include altering gastrointestinal structure and decreasing absorption of calcium and vitamin D, leading to reduced bone calcium salt deposition, decreasing bone mineral density, resulting in secondary hyperparathyroidism and more postoperative incidence of osteoporosis. The increased level of peptide YY, and the decreased level of ghrelin, which could inhibit the proliferation of osteoblasts, promote osteoclast activity and bone resorption, resulting in inhibition of bone formation and reduction of bone density. The decrease of the adipose tissue and the leptin level could increase bone resorption, decrease bone formation and bone density, which may increase the risk of osteoporosis even fracture. After the operation, the levels of adiponectin and glucagon-like peptide 1(GLP-1)were increased, which could promote the osteogenic activity. After metabolic surgery, estradiol levels decreased, sex hormone-binding globulin, free testosterone and gonadotropin levels increased, which could directly affect osteoblasts and bone metabolism. Metabolic surgery can also lead to changes in bone turnover markers. Bone mineral density can be protected by exogenous vitamin D, calcium and even GLP-1 agonists, therefore osteoporosis could be prevented.

参考文献/References:

[1] WHO. Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en.
[2] Kearns K, Dee A, Fitzgerald AP,et al. Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level[J].BMC Public Health,2014,14:143. DOI:10.1186/1471-2458-14-143.
[3] Angrisani L, Santonicola A, Iovino P,et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014[J].Obes Surg,2017,[Epub ahead of print]. DOI:10.1007/s11695-017-2666-x.
[4] Schauer PR, Bhatt DL, Kirwan JP,et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes[J].N Engl J Med,2014,370(21):2002-2013. DOI:10.1056/NEJMoa1401329.
[5] Skubleny D, Switzer NJ, Gill RS,et al. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis[J].Obes Surg,2016,26(1):169-176. DOI:10.1007/s11695-015-1902-5.
[6] Ikramuddin S, Korner J, Lee WJ,et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial[J].JAMA,2013,309(21):2240-2249. DOI:10.1001/jama.2013.5835.
[7] Canales BK, Schafer AL, Shoback DM,et al. Gastric bypass in obese rats causes bone loss, vitamin D deficiency, metabolic acidosis, and elevated peptide YY[J].Surg Obes Relat Dis,2014,10(5):878-884. DOI:10.1016/j.soard.2014.01.021.
[8] Karefylakis C, Näslund I, Edholm D,et al. Vitamin D status 10 years after primary gastric bypass: gravely high prevalence of hypovitaminosis D and raised PTH levels[J].Obes Surg,2014,24(3):343-348. DOI:10.1007/s11695-013-1104-y.
[9] Myint KS, Greenfield JR, Farooqi IS,et al. Prolonged successful therapy for hyperinsulinaemic hypoglycaemia after gastric bypass: the pathophysiological role of GLP1 and its response to a somatostatin analogue[J].Eur J Endocrinol,2012,166(5):951-955. DOI:10.1530/EJE-11-1065.
[10] Verhaeghe R, Zerrweck C, Hubert T,et al. Gastric bypass increases postprandial insulin and GLP-1 in nonobese minipigs[J].Eur Surg Res,2014,52(1-2):41-49. DOI:10.1159/000355678.
[11] Lindegaard KK, Jorgensen NB, Just R,et al. Effects of Roux-en-Y gastric bypass on fasting and postprandial inflammation-relatedparameters in obese subjects with normal glucose tolerance and in obese subjects with type 2 diabetes[J].Diabetol Metab Syndr,2015,7:12. DOI:10.1186/s13098-015-0012-9.
[12] Iepsen EW, Lundgren JR, Hartmann B, et al. GLP-1 receptor agonist treatment increases bone formation and prevents bone loss in weight-reduced obese women[J].J Clin Endocrinol Metab,2015,100(8):2909-2917. DOI:10.1210/jc.2015-1176.
[13] Major P, Matok M, Pdziwiatr M,et al. Changes in levels of selected incretins and appetite-controlling hormones following surgical treatment for morbid obesity[J].Wideochir Inne Tech Maloinwazyjne,2015,10(3):458-465. DOI:10.5114/wiitm.2015.54003.
[14] Wong IP, Driessler F, Khor EC,et al. Peptide YY regulates bone remodeling in mice: a link between gut and skeletal biology[J].PLoS One,2012,7(7):e40038. DOI:10.1371/journal.pone.0040038.
[15] Amini P, Cahill F, Wadden D,et al. Beneficial association of serum ghrelin and peptide YY with bone mineral density in the Newfoundland population[J].BMC Endocr Disord,2013,13:35. DOI:10.1186/1472-6823-13-35.
[16] Delhanty PJ, van der Velde M, van der Eerden BC,et al. Genetic manipulation of the ghrelin signaling system in male mice reveals bone compartment specificity of acylated and unacylated ghrelin in the regulation of bone remodeling[J].Endocrinology,2014,155(11):4287-4295. DOI:10.1210/en.2013-2055.
[17] Ma C, Fukuda T, Ochi H,et al. Genetic determination of the cellular basis of the ghrelin-dependent bone remodeling[J].Mol Metab,2015,4(3):175-185. DOI:10.1016/j.molmet.2015.01.002.
[18] Aleidi S, Issa A, Bustanji H,et al. Adiponectin serum levels correlate with insulin resistance in type 2 diabeticpatients[J].Saudi Pharm J,2015,23(3):250-256. DOI:10.1016/j.jsps.2014.11.011.
[19] Zhang J, Li T, Xu L,et al. Leptin promotes ossification through multiple ways of bone metabolism in osteoblast: a pilot study[J].Gynecol Endocrinol,2013,29(8):758-762. DOI:10.3109/09513590.2013.798278.
[20] Chen T, Wu YW, Lu H,et al. Adiponectin enhances osteogenic differentiation in human adipose-derived stem cells by activating the APPL1-AMPK signaling pathway[J].Biochem Biophys Res Commun,2015,461(2):237-242. DOI:10.1016/j.bbrc.2015.03.168.
[21] Alosco ML, Spitznagel MB, Strain G,et al. Improved serum leptin and ghrelin following bariatric surgery predict better postoperative cognitive function[J].J Clin Neurol,2015,11(1):48-56. DOI:10.3988/jcn.2015.11.1.48.
[22] Auguet T, Terra X, Hernández M,et al. Clinical and adipocytokine changes after bariatric surgery in morbidly obese women[J].Obesity(Silver Spring),2014,22(1):188-194. DOI:10.1002/oby.20470.
[23] El Maataoui A, El Maghraoui A, Biaz A,et al. Relationships between vertebral fractures, sex hormones and vitamin D in Moroccan postmenopausal women: a cross sectional study[J].BMC Womens Health,2015,15:41. DOI:10.1186/s12905-015-0199-9.
[24] Samavat J, Facchiano E, Lucchese M,et al. Hypogonadism as an additional indication for bariatric surgery in male morbid obesity [J].Eur J Endocrinol,2014,171(5):555-560. DOI:10.1530/EJE-14-0596.
[25] Costa TL, Paganotto M, Radominski RB,et al. Calcium metabolism, vitamin D and bone mineral density after bariatric surgery[J].Osteoporos Int,2015,26(2):757-764. DOI:10.1007/s00198-014-2962-4.
[26] Valderas JP, Padilla O, Solari S,et al. Feeding and bone turnover in gastric bypass[J].J Clin Endocrinol Metab,2014,99(2):491-497. DOI:10.1210/jc.2013-1308.
[27] Moore CE, Sherman V. Vitamin D supplementation efficacy: sleeve gastrectomy versus gastric bypass surgery[J].Obes Surg,2014,24(12):2055-2060. DOI:10.1007/s11695-014-1261-7.
[28] Meng J, Ma X, Wang N,et al. Activation of GLP-1 receptor promotes bone marrow stromal cell osteogenic differentiation through β-catenin[J].Stem Cell Reports,2016,6(4):579-591. DOI:10.1016/j.stemcr.2016.02.002.

相似文献/References:

[1]刘洲君,胡咏新,刘超.肠道益生菌对骨代谢的影响[J].国际内分泌代谢杂志,2016,36(01):55.[doi:10.3760/cma.j.issn.1673-4157.2016.01.014]
　Liu Zhoujun,Hu Yongxin,Liu Chao..Effects of intestinal probiotics on bone metabolism[J].International Journal of Endocrinology and Metabolism,2016,36(05):55.[doi:10.3760/cma.j.issn.1673-4157.2016.01.014]
[2]赵建林,耿秀琴,李胜兰,等.2型糖尿病患者血戊糖素水平与椎体骨折的 研究[J].国际内分泌代谢杂志,2016,36(03):153.[doi:10.3760/cma.j.issn.1673-4157.2016.03.03]
　Zhao Jianlin*,Geng Xiuqin,Li Shenglan,et al.Relationship between serum pentosidine and vertebral fractures in type 2 diabetic patients[J].International Journal of Endocrinology and Metabolism,2016,36(05):153.[doi:10.3760/cma.j.issn.1673-4157.2016.03.03]
[3]谷君,权玉玲,任卫东,等.阻塞性睡眠呼吸暂停低通气综合征患者 IGF-1水平和骨密度相关性研究[J].国际内分泌代谢杂志,2016,36(05):289.[doi:10.3760/cma.j.issn.1673-4157.2016.05.01]
　Gu Jun*,Quan Yuling,Ren Weidong,et al.Relationship between IGF-1 and bone mineral density in patients with obstructive sleep apnea hypopnea syndrome[J].International Journal of Endocrinology and Metabolism,2016,36(05):289.[doi:10.3760/cma.j.issn.1673-4157.2016.05.01]
[4]王荣 马江卫.替勃龙联合唑来膦酸治疗绝经后 骨质疏松症的临床疗效[J].国际内分泌代谢杂志,2019,39(02):77.[doi:10.3760/cma.j.issn.1673-4157.2019.02.002]
　Wang Rong,Ma Jiangwei.Clinical effect of tibolone combined with zoledronic acid in the treatment of patients with postmenopausal osteoporosis[J].International Journal of Endocrinology and Metabolism,2019,39(05):77.[doi:10.3760/cma.j.issn.1673-4157.2019.02.002]
[5]高虹,杨静,高飞.维生素D受体基因多态性与亚洲绝经后女性骨密度相关性的荟萃分析[J].国际内分泌代谢杂志,2021,41(03):158.[doi:10.3760/cma.j.cn121383-20210225-02058]
　Gao Hong,Yang Jing,Gao Fei..A meta-analysis of the association between vitamin D receptor gene polymorphism and bone mineral density in Asian postmenopausal women[J].International Journal of Endocrinology and Metabolism,2021,41(05):158.[doi:10.3760/cma.j.cn121383-20210225-02058]
[6]方向南,王瑒,郭莉,等.血清非磷酸化未羧化基质Gla蛋白与绝经后骨质疏松症的关系[J].国际内分泌代谢杂志,2021,41(03):164.[doi:10.3760/cma.j.cn121383-20200615-06039]
　Fang Xiangnan,Wang Yang,Guo Li,et al.Relationship between serum desphospho-uncarboxylated matrix Gla protein and postmenopausal osteoporosis[J].International Journal of Endocrinology and Metabolism,2021,41(05):164.[doi:10.3760/cma.j.cn121383-20200615-06039]
[7]蔡美丽,张曼娜,曲伸.代谢手术对肥胖女性生殖内分泌系统疾病影响的研究进展[J].国际内分泌代谢杂志,2023,43(06):469.[doi:10.3760/cma.j.cn121383-20230830-08071]
　Cai Meili,Zhang Manna,Qu Shen..Research progress on the impact of metabolic surgery on reproductive endocrine system diseases in obese women[J].International Journal of Endocrinology and Metabolism,2023,43(05):469.[doi:10.3760/cma.j.cn121383-20230830-08071]

备注/Memo

备注/Memo:
基金项目:辽宁省科技厅公益基金项目(2014001016); 辽宁省教育厅项目(L2015567)
通信作者:都健,Email:dujianbox@126.com
更新日期/Last Update: 2017-09-30