Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Gastrointest Surg. 2014 Feb;18(2):321-7. doi: 10.1007/s11605-013-2298-y. Epub 2013 Aug 6.
Many transplant centers require that patients maintain a BMI below 40 kg/m(2) in order to be eligible for listing, rendering many morbidly obese patients with end-stage liver disease unable to access liver transplantation as a method of treatment. In order to determine the safest and most efficacious weight loss regimen in this challenging population, Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and diet and exercise were modeled to assess their impact on life expectancy in morbidly obese patients with cirrhosis. A Markov state transition model was developed to assess the survival benefit of undergoing RYGB, AGB, or 1 year of diet and exercise in morbidly obese patients with compensated cirrhosis. A base case analysis of no weight loss intervention in a 45-year-old patient with compensated cirrhosis and a BMI of 45 kg/m(2) revealed an average survival of 7.93 years. The average survival for the weight loss simulations was 9.14, 8.84, and 8.16 years for RYGB, AGB, and diet and exercise, respectively. In morbidly obese patients with compensated cirrhosis, RYGB allows patients to lose more weight more rapidly than is probable with either AGB or diet and exercise, thus having the greatest impact on survival.
许多移植中心要求患者的 BMI 低于 40kg/m(2)，才有资格接受登记，这使得许多患有终末期肝病的肥胖患者无法接受肝移植作为治疗方法。为了确定在这一具有挑战性的人群中最安全和最有效的减肥方案，我们对 Roux-en-Y 胃旁路术（RYGB）、可调胃束带术（AGB）和饮食加运动进行建模，以评估它们对肝硬化肥胖患者预期寿命的影响。我们建立了一个马尔可夫状态转移模型，以评估 RYGB、AGB 或 1 年饮食加运动对肝硬化代偿期肥胖患者的生存获益。对一名 45 岁、BMI 为 45kg/m(2)、代偿期肝硬化患者不进行减肥干预的基础案例分析显示，平均预期寿命为 7.93 年。在肥胖的代偿期肝硬化患者中，RYGB 允许患者比 AGB 或饮食加运动更快地减轻更多体重，因此对生存的影响最大。
