Agrawal V, Khan I, Rai B, Krause K R, Chengelis D L, Zalesin K C, Rocher L L, McCullough P A
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Clin Nephrol. 2008 Sep;70(3):194-202. doi: 10.5414/cnp70194.
Bariatric surgery achieves long-term weight loss in obese adults with improvement of diabetes and hypertension. Little is known about the effect of this weight loss on renal parameters.
We performed a retrospective study of 94 obese adults who had Roux-en-Y gastric bypass surgery with a mean 12-month follow-up. Baseline (preoperative) mean age was 49 years, 76% were female, 37 had blood pressure (BP) >or= 140/90 mmHg and 32 had Type 2 diabetes. 73 patients had normoalbuminuria (urine albumin creatinine ratio (ACR) <30 mg/g) while 21 had microalbuminuria (ACR 30<300 mg/g).
At follow-up (postoperative), we observed a decrease in mean body weight (133.6 to 97.9 kg, p<0.0001), mean hemoglobin A1c (6.3 to 5.6%, p<0.0001) and mean systolic blood pressure (132.7 to 114.0 mmHg, p<0.0001). There was a significant reduction in ACR (median with interquartile range) from 9.5 (5-28) to 5.5 (3-10) mg/g, p < 0.0001. Fewer patients had microalbuminuria (22.2 to 6.2%, p=0.004) after surgery. Subgroup analysis revealed that significant decrease in ACR was present in the 32 patients with diabetes (16.5 (5-67) to 6.0 (4-11) mg/g, p=0.001) and in the 37 patients with metabolic syndrome (8.0 (5-16) to 6.0 (3-13) mg/g, p=0.012), while 25 patients with obesity alone had a lower ACR (6.5 (4-13) to 4.5 (3-8) mg/g, p=0.270). Multiple linear regression analysis showed change in hemoglobin A1c (p=0.011) and baseline level of ACR (p<0.0001) to be significantly associated with change in ACR.
We conclude that obese adults have a reduction in albuminuria after surgical weight loss, most importantly in patients with diabetes or metabolic syndrome.
减肥手术可使肥胖成年人长期减重，并改善糖尿病和高血压状况。关于这种体重减轻对肾脏参数的影响，人们了解甚少。
我们对94例接受了Roux-en-Y胃旁路手术的肥胖成年人进行了一项回顾性研究，平均随访12个月。基线（术前）平均年龄为49岁，76%为女性，37人血压（BP）≥140/90 mmHg，32人患有2型糖尿病。73例患者为正常白蛋白尿（尿白蛋白肌酐比值（ACR）<30 mg/g），而21例为微量白蛋白尿（ACR 30<300 mg/g）。
在随访（术后）时，我们观察到平均体重下降（从133.6 kg降至97.9 kg，p<0.0001）、平均糖化血红蛋白下降（从6.3%降至5.6%，p<0.0001）以及平均收缩压下降（从132.7 mmHg降至114.0 mmHg，p<0.0001）。ACR（中位数及四分位间距）从9.5（5 - 28）显著降至5.5（3 - 10）mg/g，p < 0.0001。术后微量白蛋白尿患者减少（从22.2%降至6.2%，p = 0.004）。亚组分析显示，32例糖尿病患者（从16.5（5 - 67）降至6.0（4 - 11）mg/g，p = 0.001）和37例代谢综合征患者（从8.0（5 - 16）降至6.0（3 - 13）mg/g，p = 0.012）的ACR显著下降，而仅25例肥胖患者的ACR有所降低（从6.5（4 - 13）降至4.5（3 - 8）mg/g，p = 0.270）。多元线性回归分析显示糖化血红蛋白的变化（p = 0.011）和ACR的基线水平（p<0.0001）与ACR的变化显著相关。
我们得出结论，肥胖成年人在手术减重后白蛋白尿减少，最重要的是在糖尿病或代谢综合征患者中。
