肥胖患者行减重手术对预防 2 型糖尿病发病的效果：2008 年至 2016 年法国全国范围内对 328509 例肥胖患者进行的调查。
Preventive effect of bariatric surgery on type 2 diabetes onset in morbidly obese inpatients: a national French survey between 2008 and 2016 on 328,509 morbidly obese patients.
机构信息
Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France; Université Côte d'Azur, LAMHESS, Nice, France; Département de Santé Publique, CHU Nice, Hôpital Archet 1. Niveau1 151 Route Saint Antoine de Ginestière CS 23079, 06202, Nice Cedex 3, France.
Bariatric Surgery Excellence Center of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy.
出版信息
Surg Obes Relat Dis. 2019 Mar;15(3):478-487. doi: 10.1016/j.soard.2018.12.028. Epub 2019 Jan 8.
BACKGROUND
The association between bariatric surgery (BS) and the prevention of type 2 diabetes (T2D) and its complications in patients with obesity has been rarely addressed in large, nationwide database studies.
OBJECTIVE
To estimate the preventive effect of BS against T2D and its vascular complications in patients with obesity without co-morbidity at baseline.
SETTING
All French public and private hospitals.
METHODS
Data were extracted from the French National Health Service database between 2008 and 2016. All patients with obesity aged 18- to 60-years old, free of T2D and major co-morbidities, and with at least 1 year of follow-up were analyzed. Patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) were included in the BS group, and patients with obesity with no history of BS were considered as controls.
RESULTS
Of 328,509 patients with obesity, 102,627 had BS. Between 2009 and 2016, 9.7% (31,946/328,509) of patients had a diagnosis of T2D associated with morbid obesity, 13.2% of the control group versus 2.0% of the BS group (P < .001). BS was associated with favorable 8-year T2D event-free survival estimates of 92.3% in the BS group against 58.2% in the control group. The hazard ratio for the diagnosis of T2D was .18 (95% confidence interval, .17-.19) for the BS group versus controls, after adjustment on age, sex, body mass index, and baseline differences. A significant difference was found between the type of bariatric procedure (P < .001) with more T2D after AGB (4.5%) than after GB (1.2%) or SG (0.9%). T2D complications were more common in controls (P < .001) with multiple T2D complications occurring in 1% of patients in the control group and .1% in the BS group (P < 0.001). GB and SG were more effective than AGB.
CONCLUSIONS
This nationwide study shows that BS reduces the new onset of T2D in patients with obesity by 82%. SG and GB give comparable results and both are more effective than AGB.
背景
在肥胖患者中，减重手术（BS）与 2 型糖尿病（T2D）及其并发症的预防之间的关联在大型全国性数据库研究中很少被涉及。
目的
评估肥胖患者在基线时无合并症的情况下，BS 对 T2D 及其血管并发症的预防作用。
设置
法国所有公立和私立医院。
方法
数据来自 2008 年至 2016 年期间的法国国家卫生服务数据库。分析了所有年龄在 18 至 60 岁之间、无 T2D 和重大合并症且随访至少 1 年的肥胖患者。接受胃旁路术（GB）、袖状胃切除术（SG）或可调胃束带术（AGB）的患者被纳入 BS 组，而无 BS 史的肥胖患者被视为对照组。
结果
在 328509 名肥胖患者中，有 102627 人接受了 BS。2009 年至 2016 年间，328509 名患者中有 9.7%（31946/328509）被诊断患有与病态肥胖相关的 T2D，对照组为 13.2%，BS 组为 2.0%（P<.001）。BS 组 8 年 T2D 无事件生存估计值为 92.3%，而对照组为 58.2%（P<.001）。BS 组与对照组相比，T2D 的诊断风险比为 0.18（95%置信区间，0.17-0.19），调整了年龄、性别、体重指数和基线差异。不同减重手术类型之间存在显著差异（P<.001），AGB 后 T2D 的发生率（4.5%）高于 GB（1.2%）或 SG（0.9%）。T2D 并发症在对照组中更为常见（P<.001），对照组中有 1%的患者发生多种 T2D 并发症，BS 组为 0.1%（P<.001）。GB 和 SG 比 AGB 更有效。
结论
这项全国性研究表明，BS 可使肥胖患者新发 T2D 减少 82%。SG 和 GB 的结果相当，两者均比 AGB 更有效。
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