Williams D Brandon, Hagedorn Judith C, Lawson Elise H, Galanko Joseph A, Safadi Bassem Y, Curet Myriam J, Morton John M
Department of Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305-5655, USA.
Surg Obes Relat Dis. 2007 Jan-Feb;3(1):8-13. doi: 10.1016/j.soard.2006.10.003. Epub 2006 Dec 27.
Coronary artery disease (CAD) is the leading cause of death in the United States, with obesity as a leading preventable risk factor for CAD. Certain biochemical markers have demonstrated strong prediction for cardiovascular events. We hypothesized that in addition to weight reduction, gastric bypass will also induce a salutary effect on the biochemical cardiac risk factors.
At a single academic institution, from 2003 to 2004, we measured the biochemical cardiac risk factors in gastric bypass patients preoperatively and at 3, 6, and 12 months postoperatively. These risk factors included total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, total cholesterol/HDL cholesterol ratio, triglyceride/HDL cholesterol ratio, triglycerides, lipoprotein A, high-sensitivity C-reactive protein, and homocysteine. The data were analyzed using the Wilcoxon signed rank test.
The mean age of the 356 patients was 43 years; 84% were women; the mean body mass index was 47 kg/m(2); 33% were diabetic; 50% were hypertensive; 23% were taking lipid-lowering medications; and 2% had known CAD. Significant improvement occurred in the biochemical cardiac factors from preoperatively to 12 months. The beneficial changes were as follows: total cholesterol, 192 mg/dL preoperatively to 166 mg/dL at 12 months; HDL cholesterol, 46 mg/dL preoperatively to 54 mg/dL at 12 months; low-density lipoprotein, 125 mg/dL preoperatively to 88 mg/dL at 12 months; total cholesterol/HDL cholesterol ratio, 4 preoperatively to 3 at 12 months; triglyceride/HDL cholesterol ratio, 3 preoperatively to 2 at 12 months; triglycerides, 133 mg/dL preoperatively to 92 mg/dL at 12 months; lipoprotein A, 14 mg/dL preoperatively to 13 mg/dL at 12 months; high-sensitivity C-reactive protein, 8 mg/L preoperatively to 1 mg/L; and homocysteine, 10 mumol/L preoperatively to 8 mumol/L at 12 months.
The results of our study have shown that gastric bypass significantly improves all biochemical markers of CAD risk, particularly C-reactive protein, which had an 80% reduction. As a result, gastric bypass decreases the cardiac risk by both weight loss and advantageous alterations of biochemical cardiac risk factors.
冠状动脉疾病（CAD）是美国的主要死因，肥胖是CAD的主要可预防风险因素。某些生化标志物已显示出对心血管事件的强大预测能力。我们假设，除了减轻体重外，胃旁路手术还将对生化心脏危险因素产生有益影响。
在一所学术机构，于2003年至2004年期间，我们测量了胃旁路手术患者术前以及术后3个月、6个月和12个月时的生化心脏危险因素。这些危险因素包括总胆固醇、高密度脂蛋白（HDL）胆固醇、低密度脂蛋白胆固醇、总胆固醇/HDL胆固醇比值、甘油三酯/HDL胆固醇比值、甘油三酯、脂蛋白A、高敏C反应蛋白和同型半胱氨酸。数据采用Wilcoxon符号秩检验进行分析。
356例患者的平均年龄为43岁；84%为女性；平均体重指数为47kg/m²；33%患有糖尿病；50%患有高血压；23%正在服用降脂药物；2%患有已知的CAD。从术前到12个月，生化心脏因素有显著改善。有益变化如下：总胆固醇，术前192mg/dL至12个月时166mg/dL；HDL胆固醇，术前46mg/dL至12个月时54mg/dL；低密度脂蛋白，术前125mg/dL至12个月时88mg/dL；总胆固醇/HDL胆固醇比值，术前4至12个月时3；甘油三酯/HDL胆固醇比值，术前3至12个月时2；甘油三酯，术前133mg/dL至12个月时92mg/dL；脂蛋白A，术前14mg/dL至12个月时13mg/dL；高敏C反应蛋白，术前8mg/L至1mg/L；同型半胱氨酸，术前10μmol/L至12个月时8μmol/L。
我们的研究结果表明，胃旁路手术显著改善了CAD风险的所有生化标志物，尤其是C反应蛋白，降低了80%。因此，胃旁路手术通过减轻体重和生化心脏危险因素的有利改变降低了心脏风险。
