Svacina S
III. interní klinika 1. lékarské fakulty UK a VFN Praha.
Vnitr Lek. 2009 Jul-Aug;55(7-8):622-5.
Fat accumulation is an important pathogenetic factor in metabolic syndrome. Weight reduction, at the same time, has a positive effect on metabolic syndrome components. Lifestyle changes are important in the treatment of obesity although they are usually unlikely to provide permanent effect. At present, bariatric surgery and pharmacotherapy represent easily accessible and effective treatment options. In addition, bariatric surgery often results in full remission of type 2 diabetes. Unlike older anti-obesity agents, currently available anti-obesitics sibutramine and orlistat might be taken long-term for years, allowing avoidance of the typical weight increase following treatment completion phenomenon. Furthermore, both agents provide broad therapeutic effect as they affect all components ofmetabolic syndrome. The weigh of obese patients with impaired glucose tolerance and increased fasting glycaemia might be reduced with metformin. A range of other substances is in development, of which incretin analogues, expected to be used in obese non-diabetic patients, appear the most promising. Bariatric surgery decreases significantly mortality of obese patients with metabolic syndrome. It is likely that mortality reduction following the use of anti-obesity agents will soon be proven as well.
脂肪堆积是代谢综合征的一个重要致病因素。与此同时，体重减轻对代谢综合征各组分具有积极影响。生活方式的改变在肥胖治疗中很重要，尽管它们通常不太可能产生永久性效果。目前，减肥手术和药物治疗是容易获得且有效的治疗选择。此外，减肥手术常常导致2型糖尿病完全缓解。与旧的抗肥胖药物不同，目前可用的抗肥胖药西布曲明和奥利司他可以长期服用数年，从而避免治疗结束后典型的体重增加现象。此外，这两种药物都具有广泛的治疗效果，因为它们会影响代谢综合征的所有组分。二甲双胍可降低糖耐量受损和空腹血糖升高的肥胖患者的体重。一系列其他物质正在研发中，其中预计用于肥胖非糖尿病患者的肠促胰岛素类似物似乎最有前景。减肥手术可显著降低患有代谢综合征的肥胖患者的死亡率。使用抗肥胖药物后死亡率降低可能也很快会得到证实。
