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腹腔镜袖状胃切除术对肥胖患者肾功能的影响。

Effect of laparoscopic sleeve gastrectomy on renal function in obese patients.

作者信息

Cao Feng, Cao Pengwei, Liu Yanwei, Wang Song, He Yan, Xu Yanyan, Wang Yong

机构信息

Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.

出版信息

ANZ J Surg. 2020 Apr;90(4):514-520. doi: 10.1111/ans.15767. Epub 2020 Mar 2.

Abstract

BACKGROUND

To investigate the clinical efficacy and mechanism of laparoscopic sleeve gastrectomy (LSG) in improving renal function in obese patients.

METHODS

We retrospectively reviewed the anthropometric indices (waist circumference, hip circumference and body mass index (BMI)), renal function indices (serum creatinine, urea and urinary albumin:creatinine ratio (UACR)), serum inflammatory indices (C-reactive protein, interleukin-6 and tumour necrosis factor-α) and an adipose factor (leptin) in 50 patients with obesity (BMI ≥32.5 kg/m ) who underwent LSG in our hospital from January 2018 to January 2019.

RESULTS

Patients constituted 23 men and 27 women, with an average age of 32.5 ± 8.7 years and BMI of 43.99 ± 8.29 kg/m . Body weight and BMI 1 month post-operatively were significantly lower than preoperatively (P < 0.05), and the renal function indices serum creatinine, urea and UACR, improved significantly 3 months post-operatively (P < 0.05). C-reactive protein, interleukin-6 and tumour necrosis factor-α levels improved significantly 3 months post-operatively (P < 0.05), while leptin levels decreased significantly 1 month post-operatively (P < 0.05). Six months post-operatively, the remission rates for type 2 diabetes mellitus, sleep apnoea syndrome and hypertension were 83.8%, 92.9% and 88.6%, respectively.

CONCLUSIONS

LSG led to body weight loss and significantly improved serum creatinine, urea and UACR values in patients with obesity, which may be related to changes in adipocytokines and inflammatory factors, post-operatively. LSG is expected to become a new treatment to prevent or treat renal insufficiency caused by obesity.

摘要

背景

探讨腹腔镜袖状胃切除术(LSG)改善肥胖患者肾功能的临床疗效及机制。

方法

回顾性分析2018年1月至2019年1月在我院接受LSG的50例肥胖患者(BMI≥32.5 kg/m²)的人体测量指标(腰围、臀围和体重指数(BMI))、肾功能指标(血清肌酐、尿素和尿白蛋白:肌酐比值(UACR))、血清炎症指标(C反应蛋白、白细胞介素-6和肿瘤坏死因子-α)及一种脂肪因子(瘦素)。

结果

患者中男性23例,女性27例,平均年龄32.5±8.7岁,BMI为43.99±8.29 kg/m²。术后1个月体重和BMI显著低于术前(P<0.05),术后3个月肾功能指标血清肌酐、尿素和UACR显著改善(P<0.05)。术后3个月C反应蛋白、白细胞介素-6和肿瘤坏死因子-α水平显著改善(P<0.05),而瘦素水平在术后1个月显著降低(P<0.05)。术后6个月,2型糖尿病、睡眠呼吸暂停综合征和高血压的缓解率分别为83.8%、92.9%和88.6%。

结论

LSG导致肥胖患者体重减轻,并显著改善血清肌酐、尿素和UACR值,这可能与术后脂肪细胞因子和炎症因子的变化有关。LSG有望成为预防或治疗肥胖所致肾功能不全的新疗法。

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