肥胖症手术对于超级肥胖患者的合并症治疗是否有效？

Is bariatric surgery effective for co-morbidity resolution in the super-obese patients?

机构信息

The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.

出版信息

Surg Obes Relat Dis. 2018 Sep;14(9):1261-1268. doi: 10.1016/j.soard.2018.05.015. Epub 2018 May 28.

DOI:10.1016/j.soard.2018.05.015

PMID:30001889

Abstract

BACKGROUND

Type 2 diabetes (T2D), obstructive sleep apnea (OSA), hypertension (HTN), and hyperlipidemia (HLD) are common co-morbidities that are strongly associated with obesity.

OBJECTIVE

The purpose of this study was to compare the rate of obesity-related co-morbidity remission and percent total body weight loss of super-obese patients with a body mass index (BMI) ≥50 kg/m with bariatric patients who have a BMI of 30 to 49.9 kg/m.

SETTING

Academic hospital, United States.

METHODS

A retrospective analysis of outcomes of a prospectively maintained database was done on obese patients with a diagnosis of ≥1 co-morbidity (T2D, OSA, HTN, or HLD) who at the time of initial visit had undergone either a sleeve gastrectomy or a Roux-en-Y gastric bypass at our hospital between 2011 and 2015. The patients were stratified based on their preoperative BMI class, BMI of 30 to 49.9 kg/m versus BMI ≥50 kg/m.

RESULTS

Of the 930 patients, 732 underwent sleeve gastrectomy and 198 underwent Roux-en-Y gastric bypass. The 6-month follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m (n = 759) versus super-obese patients (n = 171) were 46.0% and 36.7% (P = .348) for T2D; 75.0% and 73.2% (P = .772) for OSA; 35.0% and 22.0% (P = .142) for HTN; and 37.0% and 21.0% (P = .081) for HLD, respectively. The 1-year follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m versus super-obese patients were 54.2% and 45.5% (P = .460) for T2D; 87.0% and 89.7% (P = .649) for OSA; 37.4% and 23.9% (P = .081) for HTN; and 43.2% and 34.6% (P = .422) for HLD, respectively. Furthermore, there was no difference in the mean percent total weight loss for patients with a preoperative BMI of 30 to 49.9 kg/m versus the super-obese at the 6-month (21.4%, 20.9%, P = .612) and 1-year (28.0%, 30.7%, P = .107) follow-ups.

CONCLUSION

In our study, preoperative BMI did not have an impact on postoperative co-morbidity remission rates or percent total body weight loss. Future studies should investigate the effect of other factors, such as disease severity and duration.

摘要

背景

2 型糖尿病（T2D）、阻塞性睡眠呼吸暂停（OSA）、高血压（HTN）和高脂血症（HLD）是常见的合并症，与肥胖密切相关。

目的

本研究旨在比较超级肥胖患者（BMI≥50kg/m²）与 BMI 为 30 至 49.9kg/m²的肥胖患者接受减重手术后肥胖相关合并症缓解率和全身体重减轻百分比。

设置

美国学术医院。

方法

对 2011 年至 2015 年在我院行袖状胃切除术或 Roux-en-Y 胃旁路术的肥胖患者（至少有 1 种合并症[T2D、OSA、HTN 或 HLD]）的前瞻性数据库进行回顾性分析。根据术前 BMI 类别，将患者分为 BMI 为 30 至 49.9kg/m²与 BMI≥50kg/m²的亚组。

结果

在 930 例患者中，732 例行袖状胃切除术，198 例行 Roux-en-Y 胃旁路术。BMI 为 30 至 49.9kg/m²（n=759）和超级肥胖患者（n=171）的 6 个月随访时 T2D、OSA、HTN 和 HLD 的合并症缓解率分别为 46.0%和 36.7%（P=.348）；75.0%和 73.2%（P=.772）；35.0%和 22.0%（P=.142）；37.0%和 21.0%（P=.081）。BMI 为 30 至 49.9kg/m²和超级肥胖患者的 1 年随访时 T2D、OSA、HTN 和 HLD 的合并症缓解率分别为 54.2%和 45.5%（P=.460）；87.0%和 89.7%（P=.649）；37.4%和 23.9%（P=.081）；43.2%和 34.6%（P=.422）。此外，在 6 个月（21.4%，20.9%，P=.612）和 1 年（28.0%，30.7%，P=.107）随访时，BMI 为 30 至 49.9kg/m²和超级肥胖患者的平均全身体重减轻百分比没有差异。