垂直袖状胃切除术和 Roux-en Y 胃旁路术对认知功能的短期改善：一项直接比较研究。
Short-term improvements in cognitive function following vertical sleeve gastrectomy and Roux-en Y gastric bypass: a direct comparison study.
机构信息
Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St., Phipps 316, Baltimore, MD, 21287, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Surg Endosc. 2020 May;34(5):2248-2257. doi: 10.1007/s00464-019-07015-2. Epub 2019 Jul 31.
BACKGROUND
Cognitive deficits are observed in individuals with obesity. While bariatric surgery can reverse these deficits, it remains unclear whether surgery type differentially influences cognitive outcome. We compared the extent to which vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) ameliorated cognitive impairments associated with obesity.
METHODS
Female participants approved for VSG (N = 18) or RYGB (N = 18) were administered cognitive measures spanning the domains of attention [Hopkins Verbal Learning Test (HVLT) Trial 1 and Letter Number Sequencing], processing speed [Stroop Color Trial, Symbol Digit Modalities Test, and Trail Making Part A], memory [HVLT Retained and HVLT Discrimination Index], and executive functioning (Stroop Color Word Trials and Trail Making Part B-A) prior to surgery and at 2 weeks and 3 months following surgery. Scores for each cognitive domain were calculated and compared between surgical cohorts using repeated measures analyses of variance.
RESULTS
Significant weight loss was observed 2 weeks and 3 months following RYGB and VSG and was accompanied by improvements in processing speed and executive functioning. Patients who received RYGB also experienced improved attention as early as 2 weeks, which persisted at 3 months. This was not observed in individuals who underwent VSG. No changes in memory were observed from baseline measures in either group.
CONCLUSIONS
This is the first report of cognitive improvements following VSG and the first direct comparison of cognitive improvements following RYGB and VSG. Short-term improvements in specific domains of cognitive function are observed at the beginning of the active weight loss phase following bariatric surgery that persisted to 3 months. The anatomical distinction between the two surgeries and resulting differential metabolic profiles may be responsible for the improvements in attention observed following RYGB but not following VSG.
背景
肥胖人群存在认知缺陷。减重手术可以逆转这些缺陷，但目前尚不清楚手术类型是否会对认知结果产生差异影响。我们比较了袖状胃切除术（VSG）和 Roux-en Y 胃旁路术（RYGB）在多大程度上改善了与肥胖相关的认知障碍。
方法
接受 VSG（N=18）或 RYGB（N=18）手术的女性参与者接受了认知测试，涵盖注意力领域[霍普金斯词语学习测试（HVLT）试验 1 和字母数字序列]、加工速度[Stroop 颜色试验、符号数字模态测试和连线测试 A]、记忆[HVLT 保留和 HVLT 辨别指数]和执行功能（Stroop 颜色词试验和连线测试 B-A），手术前和手术后 2 周和 3 个月进行测试。使用重复测量方差分析比较手术队列之间每个认知领域的得分。
结果
RYGB 和 VSG 手术后 2 周和 3 个月体重显著减轻，并伴有加工速度和执行功能的改善。接受 RYGB 的患者早在 2 周时就出现了注意力改善，这一改善持续到 3 个月。接受 VSG 的患者则没有观察到这种情况。两组基线测量均未观察到记忆的变化。
结论
这是 VSG 后认知改善的首次报道，也是 RYGB 和 VSG 后认知改善的首次直接比较。减重手术后主动减肥阶段早期观察到特定认知功能领域的短期改善，这种改善持续到 3 个月。两种手术之间的解剖学差异以及由此产生的不同代谢特征可能是 RYGB 术后注意力改善的原因，但不是 VSG 术后注意力改善的原因。
Zotero 插件