不同减重手术方式对血脂异常的影响：基于注册登记的分析。

Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis.

机构信息

Department of Surgery, Chaim Sheba Medical Center, Rama-Gan, Israel; Department of Surgery, Herzliya Medical Center, Herzliya, Israel.

Department of Surgery A, Emek Medical Center, Afula, Israel; affiliated with the Technion - Israel Institute of Technology, Haifa, Israel.

出版信息

Surg Obes Relat Dis. 2017 Jul;13(7):1189-1194. doi: 10.1016/j.soard.2017.03.013. Epub 2017 Mar 23.

DOI:10.1016/j.soard.2017.03.013

PMID:28456511

Abstract

BACKGROUND

The scale and variables linked to bariatric surgery's effect on dyslipidemia have not been conclusive.

OBJECTIVE

To compare the effect of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (LAGB) on dyslipidemia SETTING: National bariatric surgery registry.

METHODS

Plasma lipids and associated variables were compared at baseline and 1 year (12±4 mo) after surgery for registry patients with dyslipidemia enrolled from June 2013 to August 2014.

RESULTS

The greatest mean total-cholesterol (TC) reduction was observed post-RYGB, 226.7±26.4 to 181.3±30.9 mg/dL (19.9%, n = 208), followed by post-SG, 227.9±24.4 to 206.7±34.2 mg/dL (8.9%, n = 1515; P<.001). Normal TC levels of below 200 mg/dL were achieved by 76% post-RYGB patients compared with 43.5% post-SG patients (odds ratio [OR] = 6.24, 95% confidence interval [CI]: 3.69-10.53) and 25.6% post-LABG patients (OR = 9.66, 95% CI: 4.11-22.67; P<.01). Although equivalent patterns were observed for low-density-lipoprotein cholesterol (LDL), the levels of high-density-lipoprotein cholesterol (HDL) were most improved post-SG, reaching normal levels in 58.1% of SG male patients versus 39.5% of RYGB male patients (OR = 1.56, 95% CI: 1.04-2.35), (P = .02). The lowering of triglyceride levels by approximately 75% was comparable after SG and RYGB procedures. The type of surgery was the strongest independent predictor for all lipid level improvements or remissions. Male sex was an independent predictor for LDL normalization only (OR = 1.88, 95% CI: 1.24-2.85). Excess weight loss offered no meaningful prediction for lipid improvement (OR = 1.01-1.03).

CONCLUSION

Particular types of bariatric surgeries had different effects on dyslipidemia, independent of weight loss. Overall, the RYGB achieved the biggest reduction in plasma lipids (TC and LDL), although SG did affect HDL. Our results could aid in the decision-making process regarding the most appropriate procedure for patients with dyslipidemia.

摘要

背景

减重手术对血脂异常的影响的规模和变量尚无定论。

目的

比较 Roux-en-Y 胃旁路术（RYGB）、袖状胃切除术（SG）和可调胃束带术（LAGB）对血脂异常的影响。

设置

国家减重手术登记处。

方法

对 2013 年 6 月至 2014 年 8 月期间登记处中患有血脂异常的患者进行手术 1 年（12±4 个月）后，比较血浆脂质和相关变量。

结果

RYGB 术后总胆固醇（TC）的平均降幅最大，从 226.7±26.4 降至 181.3±30.9 mg/dL（19.9%，n=208），其次是 SG 术后，从 227.9±24.4 降至 206.7±34.2 mg/dL（8.9%，n=1515；P<.001）。RYGB 术后 76%的患者达到正常 TC 水平（<200 mg/dL），而 SG 术后为 43.5%（比值比[OR] = 6.24，95%置信区间[CI]：3.69-10.53），LAGB 术后为 25.6%（OR = 9.66，95%CI：4.11-22.67；P<.01）。尽管 LDL 水平也呈现出类似的模式，但 SG 术后 HDL 水平的改善最为显著，58.1%的 SG 男性患者达到正常水平，而 RYGB 男性患者为 39.5%（OR = 1.56，95%CI：1.04-2.35），（P =.02）。SG 和 RYGB 术后甘油三酯水平降低约 75%。手术类型是所有血脂水平改善或缓解的最强独立预测因素。男性是 LDL 正常化的独立预测因素（OR = 1.88，95%CI：1.24-2.85）。体重减轻对血脂改善没有明显预测作用（OR = 1.01-1.03）。