Effects of lung volume reduction surgery for emphysema on glycolipidic hormones.
BACKGROUND
Pulmonary emphysema is associated with cachexia and disregulation of the hormones regulating the glycolipid metabolism, insulin resistance, and altered substrate utilization. This study aimed at identifying the effects of lung volume reduction surgery (LVRS) on glycolipidic hormones compared to respiratory rehabilitation (RR).


METHODS
Thirty-three patients with moderate-to-severe emphysema who were undergoing video-assisted thoracoscopic LVRS were compared to 31 similar patients who refused the operation and followed a standardized RR program. All patients were evaluated before and 12 months after treatment for respiratory function, body composition, glycolipidic hormones, metabolic parameters, and insulin resistance, which was calculated using the homeostatic model assessment index for insulin resistance (HOMA-IR). These groups were compared to a matched healthy control population.


RESULTS
Only after LVRS significant improvements were obtained in respiratory function (FEV1, +25.2%; p<0.0001; residual volume, -19.5%; p<0.0001), metabolic parameters (total cholesterol, +13.1%; p<0.01; high-density lipoprotein cholesterol, +11.2%; p<0.01; triglycerides, +18.4; p<0.001; nonesterified fatty acid, -19.7%; p<0.001), and body composition (fat-free mass [FFM], +6.5%; p<0.01; fat mass [FM], +11.9%; p<0.01). The leptin/FM ratio (-6.1%; p<0.01) and resistin/FM ratio (-5.6%; p<0.01) decreased, whereas the adiponectin/FM ratio (+6.9%; p<0.01) and ghrelin (+9.2%; p<0.01) increased, together with reductions in glycemia (-8.8%; p<0.01), insulin level (-20.4%; p<0.001), and HOMA-IR (-27.2%; p<0.0001). The decrement in residual volume was correlated with increment of FFM (rho=-0.49; p<0.02), FM (rho=-0.55; p<0.009), and ghrelin (rho=-0.52; p<0.01), and also with decreases in leptin corrected for FM (rho=0.50; p<0.02) and, marginally, HOMA-IR (rho=0.35; p=0.07).


CONCLUSIONS
After LVRS, glycolipidic hormone levels and nutritional status significantly improved, along with insulin resistance reduction and more physiologic utilization of substrates. Correlations between residual volume and body composition as well as glycolipidic hormone levels suggest that postoperative recovery in respiratory dynamics may induce favorable clinical changes when compared to RR.
Mineo
Davide
D
Department of Thoracic Surgery, Tor Vergata University, School of Medicine, Tor Vergata University Policlinic, Viale Oxford, 81, 00133 Rome, Italy. mineo@med.uniroma2.it
Ambrogi
Vincenzo
V
Frasca
Luca
L
Cufari
Maria Elena
ME
Pompeo
Eugenio
E
Mineo
Tommaso Claudio
TC
D052242:Adiponectin / Q000378:metabolism*; D000368:Aged; D001823:Body Composition / Q000502:physiology; D054439:Ghrelin / Q000378:metabolism*; D006017:Glycolipids / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D020738:Leptin / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D011013:Pneumonectomy; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000378:metabolism* / Q000601:surgery*; D052243:Resistin / Q000378:metabolism*
D052242:Adiponectin; D054439:Ghrelin; D006017:Glycolipids; D020738:Leptin; D052243:Resistin