Palmisano Silvia, Silvestri Marta, Giuricin Michela, Baldini Edoardo, Albertario Simone, Capelli Patrizio, Marzano Bernardo, Fanti Giovanni, Zompicchiatti Aron, Millo Paolo, Fabozzi Massimiliano, Brachet Contul Riccardo, Ponte Elisa, Allieta Rosaldo, de Manzini Nicolò
Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
Obes Surg. 2015 Nov;25(11):2040-6. doi: 10.1007/s11695-015-1662-2.
Gastric bypass (GBP) is one of the most effective surgical procedures to treat morbid obesity and the related comorbidities. This study aimed at identifying preoperative predictors of successful weight loss and type 2 diabetes mellitus (T2DM) remission 1 year after GBP.
Prospective longitudinal study of 771 patients who underwent GBP was performed at four Italian centres between November 2011 and May 2013 with 1-year follow-up. Preoperative anthropometric, metabolic and social parameters, the surgical technique and the previous failed bariatric procedures were analyzed. Weight, the body mass index (BMI), the percentage of excess weight lost (% EWL), the percentage of excess BMI lost (% BMIL) and glycated haemoglobin (HbA1c) were recorded at follow-up.
Univariate and multivariate analysis showed that BMI <50 kg/m(2) (p = 0.006) and dyslipidaemia (p = 0.05) were predictive factors of successful weight loss. Multivariate analysis of surgical technique showed significant weight loss in patients with a small gastric pouch (p < 0.001); the lengths of alimentary and biliary loops showed no statistical significance. All diabetic patients had a significant reduction of HbA1c (p < 0.001) after surgery. BMI ≥ 50 kg/m(2) (p = 0.02) and low level of preoperative HbA1c (p < 0.01) were independent risk factors of T2DM remission after surgery.
This study provides a useful tool for making more accurate predictions of best results in terms of weight loss and metabolic improvement.
胃旁路手术（GBP）是治疗病态肥胖及其相关合并症最有效的外科手术之一。本研究旨在确定胃旁路手术后1年体重成功减轻及2型糖尿病（T2DM）缓解的术前预测因素。
2011年11月至2013年5月期间，在意大利的四个中心对771例行胃旁路手术的患者进行了前瞻性纵向研究，并进行了1年的随访。分析术前人体测量、代谢和社会参数、手术技术以及先前失败的减肥手术。随访时记录体重、体重指数（BMI）、超重减轻百分比（%EWL）、超重BMI减轻百分比（%BMIL）和糖化血红蛋白（HbA1c）。
单因素和多因素分析表明，BMI<50 kg/m²（p = 0.006）和血脂异常（p = 0.05）是体重成功减轻的预测因素。手术技术的多因素分析显示，胃小囊患者体重显著减轻（p<0.001）；消化道和胆肠袢长度无统计学意义。所有糖尿病患者术后HbA1c均显著降低（p<0.001）。BMI≥50 kg/m²（p = 0.02）和术前HbA1c水平低（p<0.01）是术后T2DM缓解的独立危险因素。
本研究为更准确预测减肥和代谢改善方面的最佳结果提供了有用的工具。
