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胃旁路术12年后的体重和代谢结局
Weight and Metabolic Outcomes 12 Years after Gastric Bypass


Ted D. Adams ... 心脑血管疾病 糖尿病 • 2017.09.21
相关阅读
• 重度肥胖症胃旁路手术随访12年结局 • 糖尿病患者减肥手术与强化药物疗法的5年结局比较研究 • 减重手术与传统药物对2型糖尿病疗效的比较 • 减重手术与强化药物治疗合并糖尿病的肥胖患者的比较 • 减重手术对瑞典肥胖人群2型糖尿病的预防作用

摘要


背景

到目前为止,有关减肥手术的长期或有对照的研究仍很少。我们报告一项在美国对Roux-en-Y胃旁路术开展的观察性前瞻性研究的12年随访结果。

 

方法

共计1,156例重度肥胖患者被分为3组:418例寻求手术治疗并行Roux-en-Y胃旁路术(手术组),417例寻求但未行手术治疗(主要因保险方面原因)(非手术1组),321例未寻求手术治疗(非手术2组)。研究者分别在基线时、第2年、第6年和第12年进行临床检查,确定患者是否存在2型糖尿病、高血压以及血脂异常。

 

结果

第12年随访时,随访率超过90%。与基线水平相比,手术组的校正后体重平均变化如下:第2年随访时为-45.0 kg(95%置信区间[CI],-47.2~-42.9;平均变化百分比,-35.0%),第6年随访时为-36.3 kg(95% CI,-39.0~-33.5;平均变化百分比,-28.0%),第12年为-35.0 kg(95% CI,-38.4~-31.7;平均变化百分比,-26.9%)。非手术1组第12年随访时的平均变化为-2.9 kg(95% CI,-6.9~1.0;平均变化百分比,-2.0%),非手术2组第12年随访时的平均变化为0 kg(95% CI,-3.5~3.5;平均变化百分比,-0.9%)。

手术组基线时已患2型糖尿病的患者中,2型糖尿病的缓解情况如下:第2年随访时有66例(66/88,75%)缓解,第6年随访时有54例(54/87,62%)缓解、第12年随访时有43例(43/84,51%)缓解。第12年随访时,手术组与非手术1组比较,2型糖尿病发病率比值比(OR)为0.08(95% CI,0.03~0.24;P<0.001),手术组与非手术2组比较,2型糖尿病发病率OR为0.09(95% CI,0.03~0.29;P<0.001)。与非手术1组相比,手术组的高血压和血脂异常的缓解率高且发病率低(P均小于0.05)。

 

结论

研究显示,Roux-en-Y胃旁路术后,患者可长期保持体重减轻,能够有效缓解及预防2型糖尿病、高血压和血脂异常(由美国国立糖尿病、消化和肾脏疾病研究所[National Institute of Diabetes and Digestive and Kidney Diseases]等资助)。





作者信息

Ted D. Adams, Ph.D., M.P.H., Lance E. Davidson, Ph.D., Sheldon E. Litwin, M.D., Jaewhan Kim, Ph.D., Ronette L. Kolotkin, Ph.D., M. Nazeem Nanjee, Ph.D., Jonathan M. Gutierrez, B.S., Sara J. Frogley, M.B.A., Anna R. Ibele, M.D., Eliot A. Brinton, M.D., Paul N. Hopkins, M.D., M.S.P.H., Rodrick McKinlay, M.D., Steven C. Simper, M.D., and Steven C. Hunt, Ph.D.
From Intermountain Live Well Center Salt Lake, Intermountain Healthcare (T.D.A.), the Division of Cardiovascular Genetics, Department of Internal Medicine (T.D.A., L.E.D., M.N.N., J.M.G., S.J.F., P.N.H., S.C.H.), Division of General Surgery, Department of Surgery (A.R.I.), and Division of Cardiovascular Medicine, Department of Internal Medicine (P.N.H.), University of Utah School of Medicine, the Department of Health, Kinesiology and Recreation, College of Health, University of Utah (J.K.), the Utah Foundation for Biomedical Research and Utah Lipid Center (E.A.B.), and Rocky Mountain Associated Physicians (R.M., S.C.S.), Salt Lake City, and the Department of Exercise Sciences, Brigham Young University, Provo (L.E.D.) — all in Utah; the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston (S.E.L.); Quality of Life Consulting, and the Department of Community and Family Medicine, Duke University Health System, Durham, NC (R.L.K.); Western Norway University of Applied Sciences, Department of Health Studies, and Førde Hospital Trust, Førde, and the Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg — all in Norway (R.L.K.); and the Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar (S.J.F., S.C.H.). Address reprint requests to Dr. Adams at Intermountain Live Well Center Salt Lake, 389 S. 900 E., Salt Lake City, UT 84102, or at ted.adams@imail.org.

 

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