内镜下胃壁注射A型肉毒杆菌毒素对单纯性肥胖患者食欲相关激素的影响

摘要

Background: Obesity has become one of the major public health problems in China and developed countries. Botulinum toxin type A (BTX-A) can induce muscle paralysis by blocking the release of acetylcholine at neuromuscular junction. Aims: To investigate the impact of endoscopic gastric wall injection of BTX-A on weight loss and peripheral appetite-related hormones in patients with simple obesity. Methods: Twenty simple obesity patients were randomized into two groups and received endoscopic gastric wall injection of BTX-A 200 U and 300 U, respectively. Twenty puncture sites were selected at gastric antrum, body and fundus in each subject. Body weight and body mass index (BMI), as well as fasting serum insulin, leptin and plasma motilin, peplide YY (PYY) , ghrelin levels were measured before and 4, 12 weeks after treatment. Results; Nineteen patients completed the 12 weeks follow up. After treatment, the body weight and BMI decreased significantly ( P < 0. 05), while no significant changes were found in serum insulin, leptin and plasma motilin levels. Significant decrease was found in plasma level of ghrelin 4 weeks after treatment and in plasma level of PYY 12 weeks after treatment (P<0.05). There were no significant differences in weight loss and 5 appetite-related hormones between the two treatment groups. No clinically significant side effects were observed. Conclusions: Endoscopic gastric wall injection of BTX-A is a safe and effective choice for weight loss in patients with simple obesity. Effect of BTX-A on weight loss might be related to the inhibition of ghrelin secretion in gastric fundus.%肥胖已成为我国以及发达国家面临的严重公共健康问题之一.A型肉毒杆菌毒素( BTX-A)可阻断神经肌肉接头处的胆碱能传递,使肌肉松弛.目的:探讨内镜下胃壁注射BTX-A治疗单纯性肥胖的减重效果及其对外周血食欲相关激素的影响.方法:20例单纯性肥胖患者随机分为两组,分别内镜下胃壁注射BTX-A 200 U或300 U,胃窦、胃体、胃底共20个注射点.患者分别于治疗前和治疗后4周、12周接受检测和随访,项目包括体质量、体质指数( BMI)以及空腹血清胰岛素、瘦素和血浆胃动素、肽YY(PYY)、ghrelin水平.结果:19例患者完成12周随访.患者治疗后体质量和BMI均较治疗前显著降低(P＜0.05);治疗前后血清胰岛素、瘦素和血浆胃动素水平无明显变化;治疗后4周血浆ghrelin水平和治疗后12周血浆PYY水平较治疗前显著降低(P＜0.05).两试验组间减重效果和5种食欲相关激素水平差异均无统计学意义,且均未出现明显不良反应.结论:内镜下胃壁注射BTX-A能安全、有效地减轻单纯性肥胖患者的体质量,该作用可能与抑制胃底ghrelin分泌有关.