Iancu M, Copăescu C, Şerban M, Ginghină C
Chirurgia (Bucur). 2013 Sep-Oct;108(5):659-65.
Obesity is associated with high prevalence of coronary heart disease (CHD) and long term increased cardiovascular morbi-mortality. There are no data regarding the effect of laparoscopic sleeve gastrectomy (LSG) on long-term CHD - risk. It is known that "a man is as old as his arteries" and this concept is illustrated by Framingham coronary risk score, which can predict vascular age.
To assess the 10-year CHD risk in patients with obesity, preoperatively, and 6 and 12 months after LSG.
47 consecutive obese subjects (44.7% males, mean age 39.8 years) scheduled for LSG were prospectively studied before and 6 and 12 months after surgery. The 10 years CHD risk and corresponding vascular age were calculated using Framingham risk score.
The body mass index (BMI) decreased from 44.6 ± 10.6 kg m2 preoperatively to 32.2 ± 6.9 kg m2 and to 29.4 ± 5.4 kg m2 at 6 and 12 months follow-up (both p 0.05). Mean excessive weight loss (EWL) was 67.3 ± 23.7% and 78.3 ± 23.4% at 6 and 12 months postoperatively. At 6 and 12 months after LSG, there was a marked improvment of lipid profile(decrease of total cholesterol, LDL-cholesterol, triglycerides and increase of HDL-cholesterol) and a significant decrease in prevalence of diabetes mellitus, systemic hypertension and smoking. The 10-year CHD risk reduced from 10.1% preoperatively to 3.5% and to 2.2% at 6 and 12 months after surgery (both p 0.05). Patients' mean vascular age was 65.6 years preoperatively and decreased to 45.8 years 6 month spostoperatively (p 0.05) and to 40.7 years one year after LSG (p 0.05 vs. 6 months postoperatively, p=NS vs.chronological age).
In obese subjects, CHD risk is significantly reduced early, beginning with 6 months after LSG and is diminished with 80% one year postoperatively. Despite the fact that not all patients had achieved the ideal weight yet,mean vascular age is similar to their chronological age one year after surgery.
肥胖与冠心病（CHD）的高患病率以及心血管疾病长期病残率和死亡率的增加相关。目前尚无关于腹腔镜袖状胃切除术（LSG）对长期CHD风险影响的数据。众所周知，“血管的年龄决定人的年龄”，弗雷明汉姆冠心病风险评分就说明了这一概念，该评分可预测血管年龄。
评估肥胖患者术前、LSG术后6个月和12个月时的10年CHD风险。
对47例计划接受LSG的连续肥胖受试者（男性占44.7%，平均年龄39.8岁）在手术前以及术后6个月和12个月进行前瞻性研究。使用弗雷明汉姆风险评分计算10年CHD风险和相应的血管年龄。
体重指数（BMI）从术前的44.6±10.6kg/m²降至术后6个月时的32.2±6.9kg/m²以及术后12个月时的29.4±5.4kg/m²（均p<0.05）。术后6个月和12个月时平均超重减轻（EWL）分别为67.3±23.7%和78.3±23.4%。在LSG术后6个月和12个月时，血脂谱有显著改善（总胆固醇、低密度脂蛋白胆固醇、甘油三酯降低，高密度脂蛋白胆固醇升高），糖尿病、系统性高血压和吸烟的患病率显著降低。10年CHD风险从术前的10.1%降至术后6个月时的3.5%以及术后12个月时的2.2%（均p<0.05）。患者术前平均血管年龄为65.6岁，术后6个月降至45.8岁（p<0.05），LSG术后1年降至40.7岁（与术后6个月相比p<0.05，与实际年龄相比p=无统计学差异）。
在肥胖受试者中，CHD风险在LSG术后6个月开始早期显著降低，术后1年降低80%。尽管并非所有患者都达到了理想体重，但术后1年平均血管年龄与实际年龄相似。
