Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, Sakura-shi, Japan,
Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, Sakura-shi, Japan.
Obes Facts. 2021;14(6):613-621. doi: 10.1159/000519156. Epub 2021 Oct 14.
In patients with severe obesity, albuminuria can be improved by both conventional medical therapy and bariatric surgery. The purpose of this study was to compare the impact of weight loss achieved through conventional medical therapy or laparoscopic sleeve gastrectomy (LSG) on albuminuria in Japanese subjects with severe obesity and identify the factors involved.
We retrospectively evaluated the clinical characteristics including the urinary albumin/creatinine ratio (UACR) of 340 consecutive subjects with a body mass index ≥35 who received LSG (n = 242) or medical therapy (n = 98) between 2010 and 2018 and were followed for at least 12 months.
The baseline of the UACR was not different between the 2 groups. At the 12-month follow-up, total weight loss (TWL) and decreases in glycosylated hemoglobin (HbA1c) and loge UACR were greater in the LSG group than in the medical therapy group (body weight; -35.7 kg vs. -8.0 kg, p < 0.001, HbA1c; -1.4% vs. -0.7%, p < 0.001, loge UACR; -0.3 vs. 0.9, p < 0.001). The rate of complete remission of diabetes was significantly higher in the LSG group than in the medical therapy group. At 12 and 36 months (n = 111 in the medical therapy group, n = 56 in the LSG group at 36 months), loge UACR increased in the medical therapy group, while it remained unchanged or decreased in the LSG group. In subjects with microalbuminuria and macroalbuminuria, changes in the loge UACR correlated with percent total body weight loss (%TWL) in both groups at 12 months. Percent TWL contributed independently to the change in the loge UACR, irrespective of whether LSG was performed. In receiver-operating characteristic analysis, a weight loss of 7.8% predicted a decrease in the UACR (∆UACR <0 at 12 months).
Our analysis suggests that albuminuria may increase over time if only medical therapy is continued. To improve albuminuria, weight loss may be more important than whether LSG is performed.
在重度肥胖患者中，常规药物治疗和减重手术均可改善白蛋白尿。本研究旨在比较通过常规药物治疗或腹腔镜袖状胃切除术（LSG）减轻体重对日本重度肥胖患者白蛋白尿的影响，并确定相关因素。
我们回顾性评估了 2010 年至 2018 年间连续 340 例 BMI≥35 的患者的临床特征，包括尿白蛋白/肌酐比值（UACR），其中 242 例行 LSG，98 例行药物治疗，并至少随访 12 个月。
两组患者的 UACR 基线无差异。在 12 个月的随访中，LSG 组的总体重减轻（TWL）和糖化血红蛋白（HbA1c）及对数 UACR 下降幅度均大于药物治疗组（体重：-35.7kg 比-8.0kg，p<0.001，HbA1c：-1.4%比-0.7%，p<0.001，对数 UACR：-0.3 比 0.9，p<0.001）。LSG 组糖尿病完全缓解率明显高于药物治疗组。在 12 个月和 36 个月（药物治疗组 n=111，LSG 组 n=36 个月）时，药物治疗组的对数 UACR 升高，而 LSG 组则保持不变或降低。在微量白蛋白尿和大量白蛋白尿患者中，两组在 12 个月时，对数 UACR 的变化与总体重减轻百分比（%TWL）相关。%TWL 与 LSG 无关，是对数 UACR 变化的独立因素。在受试者工作特征分析中，体重减轻 7.8%可预测 UACR 降低（12 个月时∆UACR<0）。
我们的分析表明，如果仅进行药物治疗，白蛋白尿可能会随时间而增加。为改善白蛋白尿，减轻体重可能比是否行 LSG 更重要。
