Lopez-Jimenez Francisco, Bhatia Sundeep, Collazo-Clavell Maria L, Sarr Michael G, Somers Virend K
Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Mayo Clin Proc. 2005 Sep;80(9):1157-62. doi: 10.4065/80.9.1157.
To determine the safety and efficacy of bariatric surgery in obese patients with documented coronary artery disease (CAD).
Among patients with class II or III obesity who underwent bariatric surgery between March 1995 and January 2002 at the Mayo Clinic in Rochester, Minn, the rates of major in-hospital cardiovascular complications and mortality of 52 patients with clinical CAD were compared with those of 507 patients without CAD. The efficacy of bariatric surgery was measured by changes in body weight and other cardiovascular risk factors at follow-up.
There were no in-hospital deaths in either group. Three patients with documented CAD (5.8%; 95% confidence interval, 0%-12.2%) and 7 patients without CAD (1.4%; 95% confidence interval, 0.4%-2.4%) had cardiovascular complications (P=.06). After a mean follow-up of 2.5 years (range, 77-2403 days) of patients with CAD, the following values decreased postoperatively (all at P<.001): weight, from 147+/-36 kg to 103+/-22 kg; body mass index, from 50+/-11 kg/m2 to 36+/-9 kg/m2; fasting serum glucose, from 149+/-52 mg/dL to 113+/-31 mg/dL; glycosylated hemoglobin, from 9%+/-3% to 6%+/-2%; and blood pressure, from 142/82 mm Hg to 132/73 mm Hg. Low-density lipoprotein cholesterol decreased postoperatively from 116+/-31 mg/dL to 75+/-26 mg/dL, and triglycerides decreased from 198+/-85 mg/dL to 119+/-52 mg/dL (P<.01 for both).
Bariatric surgery should be considered for treating patients with CAD and class II or III obesity.
确定减肥手术对有冠状动脉疾病（CAD）记录的肥胖患者的安全性和有效性。
在1995年3月至2002年1月于明尼苏达州罗切斯特市梅奥诊所接受减肥手术的II级或III级肥胖患者中，将52例临床确诊CAD患者的主要院内心血管并发症发生率和死亡率与507例无CAD患者进行比较。通过随访时体重及其他心血管危险因素的变化来衡量减肥手术的疗效。
两组均无院内死亡。3例确诊CAD患者（5.8%；95%置信区间，0%-12.2%）和7例无CAD患者（1.4%；95%置信区间，0.4%-2.4%）发生心血管并发症（P = 0.06）。对CAD患者平均随访2.5年（范围77 - 2403天）后，术后以下指标下降（均P < 0.001）：体重，从147±36 kg降至103±22 kg；体重指数，从50±11 kg/m²降至36±9 kg/m²；空腹血清葡萄糖，从149±52 mg/dL降至113±31 mg/dL；糖化血红蛋白，从9%±3%降至6%±2%；血压，从142/82 mmHg降至132/73 mmHg。低密度脂蛋白胆固醇术后从116±31 mg/dL降至75±26 mg/dL，甘油三酯从198±85 mg/dL降至119±52 mg/dL（两者均P < 0.01）。
对于患有CAD且为II级或III级肥胖的患者，应考虑进行减肥手术。
