Aydin Neslihan, Topsever Pinar, Kaya Ayça, Karasakal Müzeyyen, Duman Celal, Dağar Arslan
Department of Internal Medicine, Haydarpaşa Numune Teaching and Research Hospital, Istanbul, Turkey.
Tohoku J Exp Med. 2004 Mar;202(3):173-80. doi: 10.1620/tjem.202.173.
The aim of this study was to evaluate decrease in waist circumference in obese patients receiving different anti-obesity treatments. The study was designed as a short-term (12 weeks), open-label, and randomized trial. Eighty six patients (70 females, 81.4%; mean age 41.09+/-8.73 years, mean BMI 36.1+/-4.3 kg/m2) were randomized to four different therapy groups. The primary outcome parameters were waist circumference and body mass index (BMI). The therapy groups were a) diet+sibutramine 1 x 10 mg/d (n=22), b) diet+orlistat 3 x 120 mg/d (n=25), c) combination of diet+sibutramine+orlistat (n=20) and d) diet (n=19). Combination therapy was more effective than diet and orlistat mono-therapy (p<0.0001 for all), but not significantly superior to sibutramine mono-therapy (p=0.072) in decreasing BMI. Sibutramine mono-therapy was significantly more effective in inducing BMI decrease compared with orlistat mono-therapy (p=0.039). The association between change in BMI and change in waist circumference was strongest in the orlistat mono-therapy group (P interaction=0.003). This means that patients taking orlistat experienced more decrease in waist circumference (3.4 cm, R2=0.29) per unit decrease in BMI compared to patients under combination therapy (2.6 cm, R2=0.25, P interaction = 0.015) and patients taking sibutramine (1.8 cm, R2=0.19, P interaction=0.026). In the diet therapy group decline in waist circumference was independent of BMI (1.9 cm, R2=0.02, P interaction=0.076). Although combination therapy and sibutramine mono-therapy were more effective in decreasing BMI, reduction in waist circumference and BMI was most significantly associated with the orlistat mono-therapy group. This may hint at the possibility of orlistat inducing weight loss mainly in the abdominal area targeted to reduce cardiovascular risk.
本研究的目的是评估接受不同抗肥胖治疗的肥胖患者腰围的减小情况。该研究设计为一项短期（12周）、开放标签的随机试验。86例患者（70例女性，占81.4%；平均年龄41.09±8.73岁，平均BMI 36.1±4.3kg/m²）被随机分为四个不同的治疗组。主要结局参数为腰围和体重指数（BMI）。治疗组分别为：a）饮食+西布曲明1×10mg/d（n=22），b）饮食+奥利司他3×120mg/d（n=25），c）饮食+西布曲明+奥利司他联合治疗（n=20），d）单纯饮食治疗（n=19）。联合治疗在降低BMI方面比饮食和奥利司他单药治疗更有效（所有比较p<0.0001），但在降低BMI方面并不显著优于西布曲明单药治疗（p=0.072）。与奥利司他单药治疗相比，西布曲明单药治疗在诱导BMI降低方面显著更有效（p=0.039）。在奥利司他单药治疗组中，BMI变化与腰围变化之间的关联最强（P交互作用=0.003）。这意味着与联合治疗组患者（2.腹围减小2.6cm，R²=0.25，P交互作用=0.015）和服用西布曲明的患者（腹围减小1.8cm，R²=0.19，P交互作用=0.026）相比，服用奥利司他的患者每单位BMI降低时腹围减小更多（3.4cm，R²=0.29）。在饮食治疗组中，腰围的下降与BMI无关（腹围减小1.9cm，R²=0.02，P交互作用=0.076）。虽然联合治疗和西布曲明单药治疗在降低BMI方面更有效，但腰围和BMI的降低与奥利司他单药治疗组最显著相关。这可能暗示奥利司他诱导体重减轻主要发生在旨在降低心血管风险的腹部区域的可能性。
