Brolin R E, Bradley L J, Wilson A C, Cody R P
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, St. Peter's University Hospital, New Brunswick, NJ 08903, USA.
J Gastrointest Surg. 2000 Sep-Oct;4(5):464-9. doi: 10.1016/s1091-255x(00)80087-6.
There are no longitudinal data that address weight loss stability and lipid levels in bariatric surgical patients. The goal of this study was to determine whether weight regain adversely affected reduction in lipid levels after gastric bariatric operations. Of 651 consecutive patients undergoing gastric restrictive surgery for morbid obesity, 227 (35%) had increased serum levels of total cholesterol (TC), triglycerides, or both preoperatively. High-density lipoprotein cholesterol (HDL-C) levels were subnormal (</=35 mg/dl) in 45 (20%) of the hyperlipidemic patients. Fasting lipid profiles were determined at 6-month intervals postoperatively. This series included the following three operations: gastroplasty (GP; N = 13), standard Roux-en-Y gastric bypass (RYGB; N = 205), and distal Roux-en-Y gastric bypass (DRY; N = 9). By 6 months postoperatively, patients had a >/=15% mean reduction in TC and a >/=50% mean reduction in triglycerides, both of which were significant in comparison with preoperative levels (P </=0.05). Mean HDL-C levels had increased significantly vs. preoperative levels by 12 months postoperative y (P <0.05) and continued to increase through 5 years. By 18 months both HDL-C and TC were significantly lower after DRY than after GP or RYGB. In 91 patients who were followed for 2 years or longer (mean 48 +/- 25 months), mean excess weight loss was 55% with mean body mass index reduced from 48 to 33 kg/m(2). This group was divided into patients whose weight remained stable (N = 54) and patients who regained >/=15% of their lost weight or lost less than 50% of excess weight (N = 37). Although mean excess weight loss and body mass index were significantly different between the two groups (P <0.0001) at 2 years, there was no difference in the lipid profile (TC/HDL) between the two groups at any interval through 5 years. These results show that abnormal lipid profiles can be permanently improved after gastric bariatric surgery and are not adversely affected by mediocre weight loss or regaining >/=15% of lost weight. DRY appears to be a superior operation for TC reduction in comparison with GP and RYGB.
目前尚无关于减重手术患者体重减轻稳定性和血脂水平的纵向数据。本研究的目的是确定体重反弹是否会对减重手术后血脂水平的降低产生不利影响。在651例连续接受减重手术治疗病态肥胖的患者中，227例（35%）术前血清总胆固醇（TC）、甘油三酯水平或两者均升高。45例（20%）高脂血症患者的高密度脂蛋白胆固醇（HDL-C）水平低于正常（≤35mg/dl）。术后每隔6个月测定一次空腹血脂谱。该系列包括以下三种手术：胃成形术（GP；n = 13）、标准Roux-en-Y胃旁路术（RYGB；n = 205）和远端Roux-en-Y胃旁路术（DRY；n = 9）。术后6个月时，患者的TC平均降低≥15%，甘油三酯平均降低≥50%，与术前水平相比均有显著差异（P≤0.05）。术后12个月时，HDL-C平均水平与术前相比显著升高（P < 0.05），并持续升高至5年。到18个月时，DRY术后的HDL-C和TC均显著低于GP或RYGB术后。在91例随访2年或更长时间（平均48±25个月）的患者中，平均超重减轻55%，平均体重指数从48降至33kg/m²。该组患者分为体重保持稳定的患者（n = 54）和体重反弹≥15%或超重减轻不足50%的患者（n = 37）。虽然两组在2年时平均超重减轻和体重指数有显著差异（P < 0.0001），但在5年的任何时间段内，两组的血脂谱（TC/HDL）均无差异。这些结果表明，减重手术后异常的血脂谱可得到永久性改善，且不受中等程度的体重减轻或体重反弹≥15%的不利影响。与GP和RYGB相比，DRY似乎是一种更有利于降低TC的手术。
