*Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden †Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ‡Department of Surgery, Lycksele Hospital, Lycksele, Sweden §Department of Surgery, Ersta Hospital, Stockholm, Sweden ¶Aleris Obesity & Clinical Sciences, Lund University, Lund, Sweden ||Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg, Sweden **Österlenskirurgin, Simrishamn Hospital, Simrishamn, Sweden ††Department of Surgery, Kalmar County Hospital, Kalmar, Sweden ‡‡Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Ann Surg. 2017 Jun;265(6):1166-1171. doi: 10.1097/SLA.0000000000001920.
To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort.
The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few.
Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases.
BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%-5.9%), hypertension (29.7%-19.5%), dyslipidemia (14.0%-6.8%), and sleep apnea (9.6%-2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%-27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively.
In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation.
在一个大型全国性队列中评估肥胖症相关共病和体重减轻对 Roux-en-Y 胃旁路手术（RYGB）治疗病态肥胖 5 年后的影响。
接受手术治疗肥胖和肥胖相关疾病的患者人数正在增加。然而，基于人群的长期结果研究很少。
收集了 2007 年 5 月 1 日至 2012 年 6 月 30 日期间在瑞典 2 个质量登记处（斯堪的纳维亚肥胖手术登记处和处方药物登记处）接受原发性 RYGB 的 26119 名个体（75.8%女性，41.0 岁，体重指数（BMI）42.8kg/m）的数据。研究体重、2 型糖尿病、高血压、血脂异常、抑郁症和睡眠呼吸暂停的缓解情况以及相应的实验室数据变化。共病的 5 年随访率为 100%（9774 名符合条件的个体）。
BMI 从 42.8±5.5kg/m 下降到 5 年后的 31.2±5.5kg/m，总体重减轻 27.7%。2 型糖尿病（15.5%-5.9%）、高血压（29.7%-19.5%）、血脂异常（14.0%-6.8%）和睡眠呼吸暂停（9.6%-2.6%）的患病率降低。体重减轻越多是一个积极的预后因素，而基线时年龄或 BMI 越大则是缓解的负面预后因素。抗抑郁药的使用增加（24.1%-27.5%）。实验室状态得到改善，例如空腹血糖和糖化血红蛋白分别从 6.1mmol/mol 降至 5.4mmol/mol，从 41.8%降至 37.7%。
在这项全国性研究中，胃旁路术在 5 年内显著改善了肥胖相关的共病，并持续减轻体重。抗抑郁药使用增加需要进一步研究。
