胃旁路术后12年的体重及代谢结果

Weight and Metabolic Outcomes 12 Years after Gastric Bypass.

作者信息

Adams Ted D, Davidson Lance E, Litwin Sheldon E, Kim Jaewhan, Kolotkin Ronette L, Nanjee M Nazeem, Gutierrez Jonathan M, Frogley Sara J, Ibele Anna R, Brinton Eliot A, Hopkins Paul N, McKinlay Rodrick, Simper Steven C, Hunt Steven C

机构信息

From Intermountain Live Well Center Salt Lake, Intermountain Healthcare (T.D.A.), the Division of Cardiovascular Genetics, Department of Internal Medicine (T.D.A., L.E.D., M.N.N., J.M.G., S.J.F., P.N.H., S.C.H.), Division of General Surgery, Department of Surgery (A.R.I.), and Division of Cardiovascular Medicine, Department of Internal Medicine (P.N.H.), University of Utah School of Medicine, the Department of Health, Kinesiology and Recreation, College of Health, University of Utah (J.K.), the Utah Foundation for Biomedical Research and Utah Lipid Center (E.A.B.), and Rocky Mountain Associated Physicians (R.M., S.C.S.), Salt Lake City, and the Department of Exercise Sciences, Brigham Young University, Provo (L.E.D.) - all in Utah; the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston (S.E.L.); Quality of Life Consulting, and the Department of Community and Family Medicine, Duke University Health System, Durham, NC (R.L.K.); Western Norway University of Applied Sciences, Department of Health Studies, and Førde Hospital Trust, Førde, and the Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg - all in Norway (R.L.K.); and the Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar (S.J.F., S.C.H.).

出版信息

N Engl J Med. 2017 Sep 21;377(12):1143-1155. doi: 10.1056/NEJMoa1700459.

DOI:10.1056/NEJMoa1700459

PMID:28930514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5737957/

Abstract

BACKGROUND

Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States.

METHODS

A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia.

RESULTS

The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was -45.0 kg (95% confidence interval [CI], -47.2 to -42.9; mean percent change, -35.0) at 2 years, -36.3 kg (95% CI, -39.0 to -33.5; mean percent change, -28.0) at 6 years, and -35.0 kg (95% CI, -38.4 to -31.7; mean percent change, -26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was -2.9 kg (95% CI, -6.9 to 1.0; mean percent change, -2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, -3.5 to 3.5; mean percent change, -0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons).

CONCLUSIONS

This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

摘要

背景

迄今为止，针对减肥手术的长期或对照研究较少。我们报告了在美国进行的一项关于Roux-en-Y胃旁路术的观察性前瞻性研究的12年随访结果。

方法

共有1156例重度肥胖患者分为三组：418例寻求并接受Roux-en-Y胃旁路术的患者（手术组），417例寻求但未接受手术的患者（主要因保险原因）（非手术组1），以及321例未寻求手术的患者（非手术组2）。我们在基线、2年、6年和12年进行临床检查，以确定2型糖尿病、高血压和血脂异常的存在情况。

结果

12年时随访率超过90%。手术组体重较基线的调整后平均变化在2年时为-45.0 kg（95%置信区间[CI]，-47.2至-42.9；平均百分比变化，-35.0），6年时为-36.3 kg（95%CI，-39.0至-33.5；平均百分比变化，-28.0），12年时为-35.0 kg（95%CI，-38.4至-31.7；平均百分比变化，-26.9）；非手术组1在12年时的平均变化为-2.9 kg（95%CI，-6.9至1.0；平均百分比变化，-2.0），非手术组2在12年时的平均变化为0 kg（95%CI，-3.5至3.5；平均百分比变化，-0.9）。在手术组中，基线时患有2型糖尿病的患者中，2型糖尿病在2年时88例中有66例（75%）缓解，6年时87例中有54例（62%）缓解，12年时84例中有43例（51%）缓解。手术组与非手术组1相比，12年时2型糖尿病发病率的比值比为0.08（95%CI，0.03至0.24），手术组与非手术组2相比为0.09（95%CI，0.03至0.29）（两组比较P<0.001）。手术组的缓解率更高，高血压和血脂异常的发病率低于非手术组1（所有比较P<0.05）。