Imperial Weight Centre, Department of Investigative Medicine, Imperial College London, London, United Kingdom.
Surg Obes Relat Dis. 2013 Jul-Aug;9(4):559-68. doi: 10.1016/j.soard.2012.03.009. Epub 2012 Apr 10.
Bariatric surgery improves arterial hypertension and renal function; however, the underlying mechanisms and effect of different surgical procedures are unknown. In the present prospective study, we compared the 12-month follow-up results after Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy on weight loss, hypertension, renal function, and inflammatory status.
A total of 34 morbidly obese patients were investigated before, one and 12 months after Roux-en-Y gastric bypass (n = 10), laparoscopic adjustable gastric banding (n = 13), and laparoscopic sleeve gastrectomy (n = 11) for hypertension, kidney function, urinary and serum cytokine levels of macrophage migration inhibitory factor, monocyte chemotactic protein-1, and chemokine ligand-18.
At 12 months after surgery, the patients in all 3 treatment arms showed a significant decrease in the mean body mass index, mean arterial pressure, and urinary and serum inflammatory markers (all P < .001). The reduction in urinary and serum cytokine levels correlated directly with body weight loss (P < .05). Patients with impaired renal function at baseline (corresponding to serum cystatin C >.8 mg/L) had a marked improvement in renal function 12 months after surgery (P < .05).
Surgically induced weight loss is associated with a marked decrease in renal and systemic inflammation and arterial hypertension and improvement in renal function in patients with pre-existing renal impairment. These effects appear to be independent of surgical procedure. The improvement in renal inflammation could be 1 of the mechanisms contributing to the beneficial effects of bariatric surgery on arterial blood pressure, proteinuria, and renal function.
减重手术可改善动脉高血压和肾功能；然而，不同手术程序的潜在机制和效果尚不清楚。在本前瞻性研究中，我们比较了 Roux-en-Y 胃旁路术、腹腔镜可调胃带术和腹腔镜袖状胃切除术在减重、高血压、肾功能和炎症状态方面的 12 个月随访结果。
共纳入 34 例肥胖症患者，在 Roux-en-Y 胃旁路术（n = 10）、腹腔镜可调胃带术（n = 13）和腹腔镜袖状胃切除术（n = 11）治疗高血压、肾功能、尿和血清细胞因子水平（巨噬细胞移动抑制因子、单核细胞趋化蛋白-1 和趋化因子配体-18）前后 1 个月和 12 个月进行调查。
术后 12 个月，所有 3 种治疗组的患者平均体重指数、平均动脉压和尿及血清炎症标志物均显著降低（均 P <.001）。尿和血清细胞因子水平的降低与体重减轻直接相关（P <.05）。基线肾功能受损（对应血清胱抑素 C >.8 mg/L）的患者术后 12 个月肾功能明显改善（P <.05）。
手术引起的体重减轻与肾脏和全身炎症以及动脉高血压的明显降低以及肾功能受损患者的肾功能改善相关。这些影响似乎独立于手术程序。减轻肾脏炎症可能是减重手术对动脉血压、蛋白尿和肾功能有益影响的机制之一。
