The Relationship Between Cholecystectomy And Metabolic Syndrome And Preliminary Exploration Of The Mechanism

Background: Gallbladder disease is one of the most common digestive diseases in general surgery.Currently,the most effective treatment for benign gallbladder diseases is laparoscopic cholecystectomy(LC).The short-term and long-term results of cholecystectomy are very good.The mortality and complication rate are very low,and the traditional view is that cholecystectomy is not harmful to the body.However,with the continuous deepening of studies in recent years,the latest research has proved that the gallbladder plays an important role in maintaining the balance of intestinal flora and bile acid metabolism in addition to the digestive function,and is closely related to the body’s blood lipid,blood glucose metabolism and cardiovascular diseases.As a result,after cholecystectomy,it may lead to metabolic changes in the body,causing metabolic syndrome(MetS).Such metabolic changes are likely to be related to the secretion of fgf-19 protein in the gallbladder mucosa.FGF-19 protein is highly expressed in gallbladder mucosa,but what is the relationship between FGF-19 secreted by gallbladder and its content in circulating serum?And after gallbladder excision,whether can airframe metabolize produce change,how to change?It is not clear how fgf-19 levels in circulating serum change.To this end,this study preliminarily investigated the relationship between gallbladder resection and the content of fgf-19 in serum by measuring the content of fgf-19 in serum before,3 days after and 3 months after LC in patients.Postoperative liver function,fasting blood glucose and lipid series,blood pressure and body mass index were compared 3 months after surgery to further study the relationship between gallbladder resection and MetS.Materials and methods: According to the inclusion and exclusion criteria,22 patients with gallbladder stones and gallbladder polyps who underwent LC surgery in our hospital from July 2018 to November 2018 were collected.The specific items included blood pressure,body weight,body mass index,liver function,fasting blood glucose and blood lipid series,fasting and 1.5h post-meal serum,and gallbladder tissue.The expression of fgf-19 protein in the gallbladder was detected by Wstern Blotting method,and the content of fgf-19 in the serum was detected by ELISA.Results: 3 months after surgery,the patient gained 0.84 kg in weight,P=0.047.BMI increased by 0.33kg/m2,P=0.036;Systolic blood pressure increased by 3.73 MMHG,P=0.021;diastolic blood pressure increased by 3.27 MMHG.HDL increased by 0.13ummol/L,P=0.013;Fasting blood glucose was higher than that before surgery,P=0.049.However,thechanges of total bile acid,total bilirubin,direct bilirubin,indirect bilirubin,LDL,VLDL,TC,TG,ALT,AST and other indicators 3 months after surgery and before surgery were all greater than 0.05,with no significant difference.FGF-19 protein was highly expressed in gallbladder mucosa,and its expression was higher than that of the terminal ileum.Serum fgf-19 level was increased at 1.5h after meal compared with that before meal,preoperative,3days after operation and 3 months after operation,and the difference was statistically significant.Preoperative,postoperative 3 days,and postoperative 3 months,fgf-19 content in the fasting serum of the patients showed an increasing trend,but no statistical difference(P=0.62).The serum fgf-19 level was significantly increased by 237.14pg/ml(P=0.01)at 1.5h after meal 3 months after surgery compared with that before surgery.No statistical difference was found in serum fgf-19 levels at 1.5h postprandial in patients before and 3 days after surgery,3 days after surgery and 3 months after surgery.Conclusion:(1)after cholecystectomy,patients’ weight and BMI increased,blood pressure and HDL content increased,and cholecystectomy may make patients in the pre-diabetes stage,cholecystectomy is a risk factor for metabolic syndrome.(2)After cholecystectomy,the content of FGF-19 in serum did not decrease,but increased.(3)The gallbladder can highly express FGF-19 protein.(4)whether the gallbladder resection or not,1.5h after meals in the serum fgf-19 content was increased than before meals;The content of FGF-19 in serum was significantly higher at 1.5h after morning meal 3 months after operation compared with preoperative.