Geloneze Bruno, Pareja José Carlos
Departamento de Endocrinologia e Metabolismo, Faculdade de Ciências Médicas, UNICAMP, SP.
Arq Bras Endocrinol Metabol. 2006 Apr;50(2):400-7. doi: 10.1590/s0004-27302006000200026. Epub 2006 May 23.
Metabolic syndrome (MS) is a risk condition for the development of systemic atherosclerotic disease. Morbid obesity is a state of insulin resistance (IR) associated with visceral fat accumulation, which is involved in the development of MS. In severe obesity, conservative therapies promote an improvement of MS, but weight regain is frequent, whereas bariatric surgery promotes a more significant and sustained weight loss. Bariatric surgery is recommended for patients with unsatisfactory response to clinical treatment and with IMC > 40 kg/m(2) or > 35 in case of co-morbidities. In those cases, surgical risk must be acceptable and patients submitted to surgery must be informed about complications and postoperative care. Prevention, improvement and reversion of diabetes (DM2) (70 to 90% of cases) are seen in several bariatric surgery modalities. Disabsorptive are more efficient than restrictive procedures in terms of weight reduction and insulin sensitivity improvement, but chronic complications, such as malnutrition, are also more frequent. Vertical gastroplasty with jejunoileal derivation is a mixed surgery in which the restrictive component predominates. In this modality, reversion of DM2 is due to an increase in insulin sensitivity associated with improved beta cell function. Reversion of MS and its manifestations after bariatric surgery are associated with reduction of cardiovascular mortality and, thus, in severe obesity cases, MS can be considered a surgical condition.
代谢综合征（MS）是全身性动脉粥样硬化疾病发生的一种风险状况。病态肥胖是一种与内脏脂肪堆积相关的胰岛素抵抗（IR）状态，其与MS的发生有关。在重度肥胖中，保守治疗可促进MS的改善，但体重经常会反弹，而减肥手术则能促进更显著且持续的体重减轻。对于临床治疗反应不佳且体重指数（BMI）>40kg/m²或存在合并症时BMI>35的患者，建议进行减肥手术。在这些情况下，手术风险必须是可接受的，并且接受手术的患者必须了解并发症及术后护理。在几种减肥手术方式中都可见到糖尿病（DM2）（70%至90%的病例）的预防、改善和逆转。在减轻体重和改善胰岛素敏感性方面，吸收不良型手术比限制型手术更有效，但诸如营养不良等慢性并发症也更常见。垂直胃成形术加空肠回肠改道术是一种以限制成分占主导的混合型手术。在这种手术方式中，DM2的逆转是由于胰岛素敏感性增加以及β细胞功能改善所致。减肥手术后MS及其表现的逆转与心血管死亡率的降低相关，因此，在重度肥胖病例中，MS可被视为一种手术适应症。
