Borzì Antonio Maria, Buscemi Carola, Corleo Davide, Randazzo Cristiana, Rosafio Giuseppe, Pantuso Gianni, Buscemi Silvio
Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy.
Specialization School in Geriatrics, Catania, Italy.
Diabetes Metab Syndr Obes. 2020 Feb 4;13:247-256. doi: 10.2147/DMSO.S230684. eCollection 2020.
Bariatric surgery (BS) is becoming an increasingly frequent treatment option especially in people with morbid obesity, demonstrating that it is able to reduce total mortality and cardiovascular (CV) risk. Despite endothelial dysfunction is an essential requisite contributing to atherosclerosis and predicting CV events, only some studies have investigated the effects of BS on endothelial function with controversial results. In this study, the effects of weight loss on endothelial function were investigated in obese patients after BS and compared with patients after medical nutrition treatment (MNT).
Seventeen obese patients who underwent BS procedures (9 adjustable gastric bands, 3 gastric by-passes and 5 biliopancreatic diversions) were included in the study and compared with 18 obese individuals who underwent MNT. Endothelial function was investigated by flow-mediated dilation (FMD) of the brachial artery. Also, carotid intima-media thickness (c-IMT) was measured as a marker of subclinical atherosclerosis.
At the end of follow-up, the mean weight loss was 18.8% in the BS group and 7.0% in the MNT group. After treatment, FMD significantly decreased in the BS group (mean ± SD before: 9.0 ± 4.7; after: 6.1 ± 2.9%; P= 0.04); however, no significant change was observed in the MNT group (before: 9.4 ± 5.8; after: 8.3 ± 5.3; P= 0.41). The modification of endothelial function was negatively correlated with c-IMT change in the BS group (r= -0.63; P <0.007).
A significant endothelial dysfunction occurred following BS but not after MNT. Furthermore, the decline of endothelial function observed in the BS group might have contributed to atherosclerosis.
减重手术（BS）正成为一种越来越常见的治疗选择，尤其是在病态肥胖人群中，这表明它能够降低总死亡率和心血管（CV）风险。尽管内皮功能障碍是导致动脉粥样硬化和预测心血管事件的重要因素，但只有一些研究调查了减重手术对内皮功能的影响，结果存在争议。在本研究中，我们调查了减重手术后肥胖患者体重减轻对内皮功能的影响，并与接受医学营养治疗（MNT）后的患者进行了比较。
本研究纳入了17例接受减重手术的肥胖患者（9例可调式胃束带术、3例胃旁路术和5例胆胰转流术），并与18例接受医学营养治疗的肥胖个体进行比较。通过肱动脉血流介导的血管舒张（FMD）来研究内皮功能。此外，测量颈动脉内膜中层厚度（c-IMT）作为亚临床动脉粥样硬化的标志物。
随访结束时，减重手术组的平均体重减轻了18.8%，医学营养治疗组为7.0%。治疗后，减重手术组的FMD显著降低（术前平均值±标准差：9.0±4.7；术后：6.1±2.9%；P = 0.04）；然而，医学营养治疗组未观察到显著变化（术前：9.4±5.8；术后：8.3±5.3；P = 0.41）。减重手术组内皮功能的改变与c-IMT的变化呈负相关（r = -0.63；P <0.007）。
减重手术后出现了明显的内皮功能障碍，而医学营养治疗后未出现。此外，减重手术组观察到的内皮功能下降可能促成了动脉粥样硬化。
