Batsis John A, Romero-Corral Abel, Collazo-Clavell Maria L, Sarr Michael G, Somers Virend K, Lopez-Jimenez Francisco
Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Mayo Clin Proc. 2008 Aug;83(8):897-907. doi: 10.4065/83.8.897.
To assess the effect of weight loss by bariatric surgery on the prevalence of the metabolic syndrome (MetS) and to examine predictors of MetS resolution.
We performed a population-based, retrospective study of patients evaluated for bariatric surgery between January 1, 1990, and December 31, 2003, who had MetS as defined by the American Heart Association/National Heart, Lung, and Blood Institute (increased triglycerides, low high-density lipoprotein, increased blood pressure, increased fasting glucose, and a measure of obesity). Of these patients, 180 underwent Roux-en-Y gastric bypass, and 157 were assessed in a weight-reduction program but did not undergo surgery. We determined the change in MetS prevalence and used logistic regression models to determine predictors of MetS resolution. Mean follow-up was 3.4 years.
In the surgical group, all MetS components improved, and medication use decreased. Nonsurgical patients showed improvements in high-density lipoprotein cholesterol levels. After bariatric surgery, the number of patients with MetS decreased from 156 (87%) of 180 patients to 53 (29%); of the 157 nonsurgical patients, MetS prevalence decreased from 133 patients (85%) to 117 (75%). A relative risk reduction of 0.59 (95% confidence interval [CI], 0.48-0.67; P<.001) was observed in patients who underwent bariatric surgery and had MetS at follow-up. The number needed to treat with surgery to resolve 1 case of MetS was 2.1. Results were similar after excluding patients with diabetes or cardiovascular disease or after using diagnostic criteria other than body mass index for MetS. Significant predictors of MetS resolution included a 5% loss in excess weight (odds ratio, 1.26; 95% CI, 1.19-1.34; P<.001) and diabetes mellitus (odds ratio, 0.32; 95% CI, 0.15-0.68; P=.003).
Roux-en-Y gastric bypass induces considerable and persistent improvement in MetS prevalence. Our results suggest that reversibility of MetS depends more on the amount of excess weight lost than on other parameters.
评估减肥手术对代谢综合征（MetS）患病率的影响，并研究MetS缓解的预测因素。
我们对1990年1月1日至2003年12月31日期间接受减肥手术评估的患者进行了一项基于人群的回顾性研究，这些患者符合美国心脏协会/美国国立心肺血液研究所定义的MetS（甘油三酯升高、高密度脂蛋白降低、血压升高、空腹血糖升高以及一项肥胖指标）。在这些患者中，180例行Roux-en-Y胃旁路手术，157例接受减肥计划评估但未接受手术。我们确定了MetS患病率的变化，并使用逻辑回归模型确定MetS缓解的预测因素。平均随访时间为3.4年。
手术组中，所有MetS组分均得到改善，药物使用减少。非手术患者的高密度脂蛋白胆固醇水平有所改善。减肥手术后，MetS患者数量从180例中的156例（87%）降至53例（29%）；157例非手术患者中，MetS患病率从133例（85%）降至117例（75%）。在随访时患有MetS且接受减肥手术的患者中，观察到相对风险降低0.59（95%置信区间[CI]，0.48 - 0.67；P <.001）。通过手术解决1例MetS所需治疗人数为2.1。排除糖尿病或心血管疾病患者后，或使用除体重指数外的其他MetS诊断标准后，结果相似。MetS缓解的显著预测因素包括超重减轻5%（比值比，1.26；95% CI，1.19 - 1.34；P <.001）和糖尿病（比值比，0.32；95% CI，0.15 - 0.68；P =.003）。
Roux-en-Y胃旁路手术可使MetS患病率得到显著且持续的改善。我们的结果表明，MetS的可逆性更多地取决于超重减轻的量而非其他参数。
