Subramaniam Suresh, Fletcher William A
Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
J Neuroophthalmol. 2017 Jun;37(2):197-205. doi: 10.1097/WNO.0000000000000448.
Most patients with idiopathic intracranial hypertension (IIH) are obese. Weight loss is felt to be an important factor in improving IIH. The mechanism by which weight loss leads to a reduction in elevated intracranial pressure is unclear. Evidence from prospective studies evaluating the role of weight loss in IIH is lacking.
We performed a detailed review of the published literature regarding the association of IIH and obesity, including proposed pathogenetic mechanisms, and the effect of weight loss and weight-loss interventions in IIH. References were identified by searching PubMed with the terms idiopathic intracranial hypertension and weight loss. Additional citations were found in the identified references.
Over 90% of IIH patients are obese or overweight. The risk of IIH increases as a function of body mass index (BMI) and weight gain over the preceding year. The risk of IIH-induced vision loss also increases with increasing BMI, especially with BMI >40 kg/m. Several mechanisms have been proposed linking obesity to the development of IIH but the pathophysiology remains unknown. Published studies and clinical observations strongly support weight loss as an effective treatment, although there are no prospective controlled trials. Weight loss in the range of 6%-10% often leads to IIH remission. Weight loss of ≥5% at 1 year is achieved in roughly 50%-70% of patients if they are enrolled in a high-intensity lifestyle modification program and in 20%-35% of patients if they direct their own weight loss. Weight is typically regained over 1-3 years but about a third of patients maintain ≥5% weight loss over the long term. Patients treated initially with lifestyle modification therapy show a modest persisting benefit over self-directed patients. Selected commercial weight loss programs also may improve long-term maintenance of weight loss. New antiobesity drugs significantly improve the proportion of obese patients who have ≥5% loss of weight at 1 year.
Obesity is an important contributing factor for the development of IIH, although the pathophysiological mechanism linking obesity to IIH is unknown. The risk of developing IIH and associated visual loss increases with increasing BMI. Weight loss is an effective treatment for IIH. Long-term maintenance of initial weight loss is helped modestly by lifestyle modification programs and possibly by selected commercial weight loss programs. New antiobesity drugs may provide further options for IIH therapy in the future.
大多数特发性颅内高压（IIH）患者肥胖。体重减轻被认为是改善IIH的一个重要因素。体重减轻导致颅内压升高降低的机制尚不清楚。缺乏评估体重减轻在IIH中作用的前瞻性研究证据。
我们对已发表的关于IIH与肥胖关联的文献进行了详细综述，包括提出的发病机制，以及体重减轻和减肥干预措施对IIH的影响。通过在PubMed上搜索“特发性颅内高压”和“体重减轻”等关键词来确定参考文献。在已确定的参考文献中发现了其他引用文献。
超过90%的IIH患者肥胖或超重。IIH的风险随着体重指数（BMI）以及前一年体重增加而增加。IIH导致视力丧失的风险也随着BMI增加而增加，尤其是BMI>40kg/m²时。已经提出了几种将肥胖与IIH发生联系起来的机制，但病理生理学仍不清楚。已发表的研究和临床观察强烈支持体重减轻是一种有效的治疗方法，尽管没有前瞻性对照试验。6%-10%的体重减轻通常会导致IIH缓解。如果参加高强度生活方式改变计划，约50%-70%的患者在1年内体重减轻≥5%；如果自行减肥，这一比例为20%-35%。体重通常在1-3年内恢复，但约三分之一的患者长期保持≥5%的体重减轻。最初接受生活方式改变疗法治疗的患者比自行减肥的患者有适度的持续获益。选定的商业减肥计划也可能改善体重减轻的长期维持情况。新型抗肥胖药物显著提高了肥胖患者在1年内体重减轻≥5%的比例。
肥胖是IIH发生的一个重要促成因素，尽管将肥胖与IIH联系起来的病理生理机制尚不清楚。发生IIH及相关视力丧失的风险随着BMI增加而增加。体重减轻是IIH的有效治疗方法。生活方式改变计划以及可能选定的商业减肥计划对初始体重减轻的长期维持有一定帮助。新型抗肥胖药物未来可能为IIH治疗提供更多选择。
