Department of Surgery/Division of Pediatric Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61603.
J Pediatr Surg. 2012 Sep;47(9):1633-9. doi: 10.1016/j.jpedsurg.2012.02.002.
The aim of the study was to compare the baseline and the 18-month follow-up for weight and metabolic characteristics of superobese (SO) (body mass index [BMI] ≥50 kg/m(2)) and morbidly obese (MO) (BMI <50 kg/m(2)) adolescents who participated in a prospective longitudinal study of gastric banding delivered in an adolescent multidisciplinary treatment program.
Clinical information was extracted from an institutional review board-approved database of bariatric adolescents. Fasting cytokine and acute phase protein serum levels were analyzed by enzyme-linked immunosorbent assay. Liver histopathologies were assessed using the Kleiner's classification score.
Other than BMI, MO (n = 11) and SO (n = 7) patients have similar degree of insulin resistance, dyslipidemia, and nonalcoholic fatty liver disease. Serum C-reactive protein (10.2 ± 5.6 SO vs 4 ± 3.9 μg/mL MO [P < .02]) and leptin (71 ± 31 SO vs 45 ± 28 MO ng/mL [P = .04]) were more elevated in SO patients. Although weight loss is similar (30 ± 19 kg MO vs 28 ± 12 kg SO, P = .8 at 18 months; mean percent change in BMI, 22.8% ± 11.6% vs 20.5% ± 10.3% SO, P = .2), SO patients has less resolution of insulin resistance and dyslipidemia but experienced significantly improved health-related quality of life.
The SO adolescents demonstrate equivalent short-term weight loss and improved quality of life but delayed metabolic response to a gastric banding-based weight loss treatment program compared with MO patients, illustrating the importance of early referral for timely intervention of MO patients.
本研究旨在比较参加青少年多学科治疗计划中胃带治疗前瞻性纵向研究的超级肥胖（SO）（体重指数 [BMI]≥50kg/m(2)）和病态肥胖（MO）（BMI<50kg/m(2)）青少年的基线和 18 个月随访时的体重和代谢特征。
从机构审查委员会批准的减肥青少年数据库中提取临床信息。通过酶联免疫吸附试验分析空腹细胞因子和急性相蛋白血清水平。使用 Kleiner 分类评分评估肝组织病理学。
除 BMI 外，MO（n=11）和 SO（n=7）患者的胰岛素抵抗、血脂异常和非酒精性脂肪性肝病程度相似。SO 患者的血清 C 反应蛋白（10.2±5.6 SO 与 4±3.9μg/mL MO [P<.02]）和瘦素（71±31 SO 与 45±28 MO ng/mL [P=0.04]）水平更高。尽管体重减轻相似（MO 为 30±19kg，SO 为 28±12kg，18 个月时 P=0.8；BMI 的平均百分比变化，22.8%±11.6%与 20.5%±10.3%SO，P=0.2），但 SO 患者的胰岛素抵抗和血脂异常缓解较少，但健康相关生活质量显著改善。
与 MO 患者相比，SO 青少年在胃带减肥治疗计划中表现出同等的短期体重减轻和改善的生活质量，但代谢反应延迟，这表明 MO 患者早期转介进行及时干预的重要性。
