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[肥胖症患者减重手术后代谢参数及肾小球滤过率的变化]

[Changes in metabolic parameters and glomerular filtration rate in patients with morbid obesity after bariatric surgery].

作者信息

Gussaova S S, Bobkova I N, Yashkov Y I, Bordan N S, Stavrovskaya E V, Bekuzarov D K, Evdoshenko V V, Fedenko V V, Malykhina A I, Struve A V

机构信息

Sechenov First Moscow State Medical University (Sechenov University).

Center for Endosurgery and Lithotripsy.

出版信息

Ter Arkh. 2020 Jul 9;92(6):53-59. doi: 10.26442/00403660.2020.06.000674.

Abstract

AIM

To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity.

MATERIALS AND METHODS

We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared.

RESULTS

In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed.

CONCLUSION

Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.

摘要

目的

研究减重手术(BO)后短期内体重减轻对病态肥胖患者代谢参数和肾小球滤过率(GFR)的影响。

材料与方法

我们研究了40例接受减重手术的成年(18岁以上)病态肥胖患者。比较了减重手术前后患者的代谢指标以及根据CKD-EPI公式计算的GFR。

结果

在整个手术患者组中,术后平均体重指数(BMI)从45.8降至30.5kg/m²。11例(92%)碳水化合物代谢受损的患者实现了糖尿病缓解并停用了降糖药物。术后基线GFR<90ml/min/1.73m²的患者中,GFR有下降趋势,可能是由于超滤减少。术后基线GFR≥90ml/min/1.73m²的患者中,GFR水平有统计学意义的升高。联合手术(迷你胃旁路术、胆胰分流术)在纠正碳水化合物和脂肪代谢方面具有更大的代谢效果。

结论

肥胖是肾功能下降和慢性肾脏病进展的一个可改变的危险因素。减重手术是治疗病态肥胖的有效方法。该研究证明了BO后体重减轻对肾功能的积极影响,包括改善与肥胖相关的疾病进程。

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