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减重手术对瑞典肥胖人群2型糖尿病的预防作用
Bariatric Surgery and Prevention of Type 2 Diabetes in Swedish Obese Subjects


Lena M.S. Carlsson ... 糖尿病 • 2012.08.23
相关阅读
• 重度肥胖症胃旁路手术随访12年结局 • 胃旁路术12年后的体重和代谢结局

摘要


背景

减轻体重可预防2型糖尿病,但单靠矫正行为方式难以维持这种效应。我们通过对一项非随机、前瞻性、对照研究的数据进行分析,评估了减重手术对预防2型糖尿病的效果。

 

方法

在这项分析中,我们纳入了1,658名接受减重手术的肥胖患者和1,771名匹配的肥胖者作为对照(在分组水平而不是个体水平进行匹配)。基线状态,所有参与者均未患糖尿病。减重手术队列的患者分别接受胃束带术(19%)、垂直束带胃成形术(69%)或胃旁路术(12%);非随机的、匹配的、预设的对照组患者接受常规治疗。参与者年龄在37~60岁,体质指数(BMI;以体重的千克数除以身高米数的平方)男性≥34、女性≥38。本研究着重关注2型糖尿病的发生率,在主要研究中将其设定为次要终点。在进行本研究分析时(2012年1月1日),参与者已接受长达15年的随访。尽管进行了匹配,组间的一些基线特征仍存在显著性差异,减重手术组的基线体重较对照组高,且多种危险因素更明显。在15年里,最初的参与者中有36.2%退出本研究,30.9%的参与者尚未达到15年的随访检查时间。

 

结果

在随访期间,对照组和减重手术组中分别有392名和110名参与者发生了2型糖尿病,对应的发病率分别为:对照组28.4/1000人年,减重手术组6.8/1000人年(减重手术组的校正风险比为0.17;95%的可信区间为0.13~0.21;P<0.001)。减重手术的效果受是否存在空腹血糖受损影响(交互效应检验,P=0.002),而与BMI(P=0.54)无关。敏感性分析(包括终点差补)不改变整体结论。术后死亡率为0.2%,且有2.8%接受减重手术的患者在90天内由于并发症而需要再次手术。

 

结论

在预防肥胖者发生2型糖尿病方面,减重手术比常规治疗具有更为显著的效果(本研究由瑞典研究理事会[Swedish Research Council]和其他资助;ClinicalTrials.gov注册号为NCT01479452)。





作者信息

Lena M.S. Carlsson, M.D., Ph.D., Markku Peltonen, Ph.D., Sofie Ahlin, M.D., Åsa Anveden, M.D., Claude Bouchard, Ph.D., Björn Carlsson, M.D., Ph.D., Peter Jacobson, M.D., Ph.D., Hans Lönroth, M.D., Ph.D., Cristina Maglio, M.D., Ingmar Näslund, M.D., Ph.D., Carlo Pirazzi, M.D., Stefano Romeo, M.D., Ph.D., Kajsa Sjöholm, Ph.D., Elisabeth Sjöström, M.D., Hans Wedel, Ph.D., Per-Arne Svensson, Ph.D., and Lars Sjöström, M.D., Ph.D.
From the Institutes of Medicine (L.M.S.C., M.P., S.A., Å.A., B.C., P.J., C.M., C.P., S.R., K.S., E.S., P.-A.S., L.S.) and Surgery (H.L.), Sahlgrenska Academy at the University of Gothenburg, and the Nordic School of Public Health (H.W.), Gothenburg, and the Department of Surgery, University Hospital, Örebro (I.N.) — all in Sweden; the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki (M.P.); and Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (C.B.). Address reprint requests to Dr. Lars Sjöström at the SOS Secretariat, Vita Stråket 15, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden, or at lars.v.sjostrom@medfak.gu.se.

 

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