Gjevestad Espen, Hjelmesaeth Jøran, Sandbu Rune, Nordstrand Njord
Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway; Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.
Obesity (Silver Spring). 2015 Jan;23(1):37-45. doi: 10.1002/oby.20880. Epub 2014 Aug 30.
To compare the long-term effects of Roux-en-Y gastric bypass (GBS) and intensive lifestyle intervention (ILI) on aortic stiffness.
Nonrandomized clinical trial. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cf PWV) using high-fidelity applanation tonometry.
A total of 159 treatment-seeking morbidly obese patients were included, 82 (54 females) in the GBS-group and 77 (48 females) in the ILI-group. Participants in the GBS-group were younger (42.0 ± 9.9 vs. 46.4 ± 10.5 years), heavier (BMI 45.7 ± 5.3 vs. 42.0 ± 4.9 kg/m(2) ), and had lower systolic pressure (137 ± 19 vs. 145 ± 18 mm Hg) and pulse pressure (57 ± 16 vs. 65 ± 17 mm Hg), all P ≤ 0.006. Mean (SD) cf PWV at baseline was 8.6 ± 1.7 m/s in the GBS-group and 8.6 ± 1.9 m/s in the ILI-group, P = 0.959. At follow-up, mean (95% CI) weight loss was larger in the GBS-group than in the ILI-group -43.3 (-46.0 to -40.7) vs. -12.1 (-14.6 to -9.6) kg, P < 0.001. The mean change in cf PWV was -0.02 (-0.31 to 0.27) m/s in the GBS-group and 0.03 (-0.28 to 0.33) m/s in the ILI-group, both P ≥ 0.412; adjusted between-group difference (ANCOVA) 0.05 (-0.40 to 0.49) m/s, P = 0.836. The adjusted regression analysis showed that weight loss was associated with increased cf PWV in the GBS-group.
GBS and ILI had no significant long-term effects on aortic stiffness in treatment-seeking morbidly obese individuals.
比较Roux-en-Y胃旁路术（GBS）和强化生活方式干预（ILI）对主动脉僵硬度的长期影响。
非随机临床试验。使用高保真压平式眼压计通过颈股脉搏波速度（cf PWV）评估主动脉僵硬度。
共纳入159例寻求治疗的病态肥胖患者，GBS组82例（54例女性），ILI组77例（48例女性）。GBS组参与者更年轻（42.0±9.9岁对46.4±10.5岁），体重更重（BMI 45.7±5.3对42.0±4.9kg/m²），收缩压更低（137±19对145±18mmHg），脉压更低（57±16对65±17mmHg），所有P≤0.006。GBS组基线时平均（标准差）cf PWV为8.6±1.7m/s，ILI组为8.6±1.9m/s，P = 0.959。随访时，GBS组平均（95%CI）体重减轻大于ILI组，分别为-43.3（-46.0至-40.7）kg对-12.1（-14.6至-9.6）kg，P < 0.001。GBS组cf PWV的平均变化为-0.02（-0.31至0.27）m/s，ILI组为0.03（-0.28至0.33）m/s，两者P≥0.412；调整后的组间差异（协方差分析）为0.05（-0.40至0.49）m/s，P = 0.836。调整后的回归分析表明，GBS组体重减轻与cf PWV增加相关。
GBS和ILI对寻求治疗的病态肥胖个体的主动脉僵硬度无显著长期影响。
