Lubrano C, Cornoldi A, Pili M, Falcone S, Brandetti F, Fabbrini E, Ginanni-Corradini S, Eramo A, Marini M, Migliaccio S, Giancotti V, Badiali M, Falsetto N, Prossomariti G, Spera G
Dipartimenti di Fisiopatologia Medica, Università degli Studi di Roma La Sapienza, Policlinico Umberto I, Roma, Italia.
Int J Obes Relat Metab Disord. 2004 Dec;28(12):1600-6. doi: 10.1038/sj.ijo.0802782.
Obese patients are often affected by hypertension, dyslipidaemia, impaired glucose metabolism, and suffer from cardiovascular disease (CVD), related to the characteristic metabolic alterations.
To evaluate reduction of risk factors for CVDs in morbid-obese patients (body mass index (BMI)>40 kg/m2) after weight loss upon bariatric surgery intervention of biliary-intestinal bypass.
45 (17 men, 28 women) morbid-obese patients (age: 19-49 y, BMI>40 kg/m2). All patients were selected on the basis of medical history, physical and biochemical evaluation and of psychiatric tests, which were performed on all individuals admitted to our Day Hospital to verify the safety of surgical intervention.
Body weight, body composition (by dual X-ray absorptiometry, DXA), blood pressure, lipid profile, fibrinogen and glucose metabolism were monitored at baseline and 1, 3, 6, 9, 12, 24 and 36 months after surgery.
A significant and persistent weight loss was present in all patients at the end of the 3 y follow-up period (P<0.001), with a progressive reduction of total and trunk fat mass as evaluated by means of DXA. Additionally, a parallel significant reduction in systolic (P<0.001) and diastolic (P<0.001) blood pressure was observed. Total and LDL cholesterol were significantly reduced (P<0.001), while HDL showed no modifications; triglycerides declined progressively during the 3 y follow-up (P<0.001). Fibrinogen decreased from 364.5+/-82.4 to 266.4+/-45.7 mg/dl at the end of the period (P<0.001). Fasting glucose levels and glucose levels 120 min after an oral glucose tolerance test were reduced from 95.1+/-20.3 to 78.6+/-9.1 mg/dl (P<0.001) and from 116.9+/-34.7 to 77.6+/-15.5 mg/dl (P<0.001), respectively, at baseline and at the end of the study. Moreover, fasting insulin decreased from 30.0+/-20.4 to 8.6+/-2.9 microUI/ml (P<0.001) after 3 y, while insulin levels after (120 min) oral glucose load decreased from 105.5+/-61.5 to 12.0+/-6.0 microUI/ml (P<0.001).
Our results show that biliary-intestinal bypass may represent a valid and alternative therapeutic approach in patients with morbid obesity since it induces a significant and stable reduction of body weight and obesity-related risk factors for CVD.
肥胖患者常受高血压、血脂异常、糖代谢受损影响，并患有与特征性代谢改变相关的心血管疾病（CVD）。
评估病态肥胖患者（体重指数（BMI）>40kg/m²）在接受胆肠转流减肥手术后体重减轻后CVD危险因素的降低情况。
45例（17例男性，28例女性）病态肥胖患者（年龄：19 - 49岁，BMI>40kg/m²）。所有患者均根据病史、体格和生化评估以及精神测试进行选择，这些测试对入住我们日间医院的所有个体进行，以验证手术干预的安全性。
在基线以及术后1、3、6、9、12、24和36个月监测体重、身体成分（通过双能X线吸收法，DXA）、血压、血脂谱、纤维蛋白原和糖代谢。
在3年随访期结束时，所有患者均出现显著且持续的体重减轻（P<0.001），通过DXA评估，总体脂肪和躯干脂肪量逐渐减少。此外，观察到收缩压（P<0.001）和舒张压（P<0.001）平行显著降低。总胆固醇和低密度脂蛋白胆固醇显著降低（P<0.001），而高密度脂蛋白无变化；甘油三酯在3年随访期间逐渐下降（P<0.001）。随访期末纤维蛋白原从364.5±82.4降至266.4±45.7mg/dl（P<0.001）。空腹血糖水平和口服葡萄糖耐量试验120分钟后的血糖水平分别从基线时的95.1±20.3降至78.6±9.1mg/dl（P<0.001）以及从116.9±34.7降至77.6±15.5mg/dl（P<0.001）。此外，3年后空腹胰岛素从30.0±20.4降至8.6±2.9μU/ml（P<0.001），而口服葡萄糖负荷后（120分钟）胰岛素水平从105.5±61.5降至12.0±6.0μU/ml（P<0.001）。
我们的结果表明，胆肠转流术可能是病态肥胖患者一种有效的替代治疗方法，因为它能显著且稳定地减轻体重以及降低与肥胖相关的CVD危险因素。
