Department of Surgery, Medical College of Wisconsin, 8900 W Doyne Ave, Milwaukee, WI, 53226, USA.
Surg Endosc. 2019 Dec;33(12):3984-3989. doi: 10.1007/s00464-019-06687-0. Epub 2019 Feb 7.
Recent studies have suggested that potential aberrant alterations in the gastrointestinal microbiome contribute to the development of cardiovascular disease, specifically hypertension. Bariatric surgery produces significant sustained weight loss and hypertension resolution likely through multiple mechanisms which includes beneficial changes in the gut microbiome. We hypothesized that the type of prophylactic antibiotic given for bariatric surgery could impact the resolution rate of hypertension by altering the post-operative gastrointestinal microflora.
A retrospective analysis of adult bariatric patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2012 and 2016 was conducted. The standard antibiotic prophylaxis was cefazolin, or clindamycin in patients with a penicillin allergy. Univariate analyses were performed comparing the differing peri-operative antibiotic treatments with resolution of hypertension at 2-week (± 1 week), 6-week (± 2 weeks), 3-month (± 2 weeks), 6-month (± 6 weeks), and 1-year (± 2 months) follow-up appointments. The criterion for resolution of hypertension was no longer requiring medication at time of follow-up.
In total, 123 RYGB and 88 SG patients were included. No significant differences were found between cefazolin and clindamycin regarding hypertension resolution rates after SG. However, patients who underwent RYGB and received clindamycin had a significantly higher rate of hypertension resolution compared to cefazolin. This effect started at 2 weeks post-operatively (52.4% vs. 23.5% respectively, p = 0.008) and persisted up to the 1-year (57.9% vs. 44.0% respectively, p = 0.05).
Prophylactic peri-operative, intravenous clindamycin was associated with significantly increased resolution of post-operative hypertension compared to cefazolin. This finding was not observed in SG patients. Future studies are needed to confirm the mechanism of action for this novel finding is due to the differing modifications of the gastrointestinal microflora after RYGB resulting from the specific peri-operative antibiotic administered.
最近的研究表明，胃肠道微生物组的潜在异常改变可能导致心血管疾病的发生，特别是高血压。减重手术可显著持续地减轻体重并解决高血压问题，其机制可能包括肠道微生物组的有益改变。我们假设，减重手术中预防性使用的抗生素类型可能会通过改变术后胃肠道微生物群来影响高血压的缓解率。
对 2012 年至 2016 年间接受 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）的成年减重患者进行回顾性分析。标准抗生素预防是头孢唑林，如果患者对青霉素过敏，则使用克林霉素。对不同围手术期抗生素治疗与术后 2 周（±1 周）、6 周（±2 周）、3 个月（±2 周）、6 个月（±6 周）和 1 年（±2 个月）随访时高血压缓解情况进行单因素分析。高血压缓解的标准是在随访时不再需要药物治疗。
共纳入 123 例 RYGB 和 88 例 SG 患者。SG 后，头孢唑林和克林霉素在高血压缓解率方面无显著差异。然而，接受 RYGB 并接受克林霉素治疗的患者高血压缓解率明显高于头孢唑林。这种影响在术后 2 周开始（分别为 52.4%和 23.5%，p=0.008），并持续至 1 年（分别为 57.9%和 44.0%，p=0.05）。
与头孢唑林相比，围手术期预防性静脉注射克林霉素与术后高血压缓解率显著增加相关。在 SG 患者中未观察到这种现象。需要进一步的研究来证实这一新发现的作用机制，即由于 RYGB 后特定围手术期抗生素的使用导致胃肠道微生物群的不同改变。
