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胃旁路术和袖状胃切除术前后周围性多发性神经病的患病率。

Prevalence of Peripheral Polyneuropathy Before and After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

机构信息

Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Centro de Tratamento da Obesidade, Hospital Santa Rita do Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.

出版信息

Obes Surg. 2021 Oct;31(10):4427-4435. doi: 10.1007/s11695-021-05606-4. Epub 2021 Aug 6.

DOI:10.1007/s11695-021-05606-4
PMID:34355339
Abstract

PURPOSE

Peripheral polyneuropathy (PPN) can occur in diabetes mellitus (DM), obesity, and after bariatric surgery (BS). We decided to evaluate PPN prevalence before (PreBS-PPN) and after BS (PostBS-PPN) and to look for variables that may be independently associated with both.

METHODS

In this cross-sectional study, we evaluated 1467 participants with obesity and without DM before and 10.4 ± 6.8 months after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The Michigan Neuropathy Screening Instrument and the International Physical Activity Questionnaire were used to define the presence of PPN and the Metabolic Equivalent Task (MET) spent per week, respectively. Using Poisson regression models with a robust estimator, the prevalence of PreBS-PPN and PostBS-PPN was analyzed as dependent variables.

RESULTS

Prevalence of PostBS-PPN (10.5%) was lower than PreBS-PPN (20.4%, p < 0.001), with a prevalence of 12.7% post-RYGB and 8.4% post-SG (p = 0.072). In the univariate analysis, PreBS-PPN was associated with post-menopausal status (PMS), older age, and taller height. In twelve regression models, we found an independent association of PreBS-PPN with older age, PMS, and taller height. PostBS-PPN prevalence was associated with a higher fasting glycemia and stature, and a lower MET on univariate analysis, and with higher fasting glycemia, stature and RYGB in four multivariate regression models.

CONCLUSION

PPN occurs frequently in subjects with obesity without DM and is lower after BS. SG is not likely to be harmful in the development of neuropathy. Studies of PPN incidence and persistence after BS should clarify these factors.

摘要

目的

周围性多发性神经病(PPN)可发生于糖尿病(DM)、肥胖症和减重手术后(BS)。我们决定评估 BS 前后(PreBS-PPN)的 PPN 患病率,并寻找可能与两者独立相关的变量。

方法

在这项横断面研究中,我们评估了 1467 名肥胖且无 DM 的参与者,在 Roux-en-Y 胃旁路术(RYGB)或袖状胃切除术(SG)前和 10.4±6.8 个月后。使用密歇根神经筛查工具和国际体力活动问卷分别定义 PPN 的存在和每周代谢当量任务(MET)消耗。使用具有稳健估计器的泊松回归模型,将 PreBS-PPN 和 PostBS-PPN 的患病率作为因变量进行分析。

结果

PostBS-PPN 的患病率(10.5%)低于 PreBS-PPN(20.4%,p<0.001),RYGB 术后为 12.7%,SG 术后为 8.4%(p=0.072)。在单变量分析中,PreBS-PPN 与绝经后状态(PMS)、年龄较大和身高较高相关。在 12 个回归模型中,我们发现 PreBS-PPN 与年龄较大、PMS 和身高较高独立相关。PostBS-PPN 的患病率与空腹血糖较高、身高较高和 MET 较低相关,在四个多变量回归模型中,与空腹血糖较高、身高较高和 RYGB 相关。

结论

肥胖且无 DM 的患者中 PPN 频繁发生,BS 后患病率降低。SG 不太可能导致神经病变的发生。BS 后 PPN 发生率和持续时间的研究应阐明这些因素。

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Total Weight Loss as the Outcome Measure of Choice After Roux-en-Y Gastric Bypass.Roux-en-Y胃旁路术后总体重减轻作为首选结局指标
Obes Surg. 2016 Aug;26(8):1794-8. doi: 10.1007/s11695-015-2022-y.
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Screening for alcohol abuse using CAGE scores and likelihood ratios.使用CAGE评分和似然比筛查酒精滥用情况。
Ann Intern Med. 1991 Nov 15;115(10):774-7. doi: 10.7326/0003-4819-115-10-774.