快速通道救援减重治疗以使危及生命的不可手术重度肥胖患者的急诊减重手术迅速达到技术可操作性-概念验证研究。

Fast-track rescue weight reduction therapy to achieve rapid technical operability for emergency bariatric surgery in patients with life-threatening inoperable severe obesity - A proof of concept study.

机构信息

Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany; Sana Obesity Center North Rhine Westphalia, Hürth, Germany; Department of General, Visceral and Transplant Surgery, University of Aachen, Germany; Division of Endocrinology and Diabetes at the Department of Internal Medicine, University of Würzburg, Germany.

Division of Endocrinology and Diabetes at the Department of Internal Medicine, University of Würzburg, Germany.

出版信息

Clin Nutr ESPEN. 2022 Aug;50:238-246. doi: 10.1016/j.clnesp.2022.05.009. Epub 2022 May 26.

DOI:10.1016/j.clnesp.2022.05.009

PMID:35871930

Abstract

BACKGROUND AND AIMS

Severe obesity (BMI ≥60 kg/m) in multimorbid patients can be acutely life-threatening. While emergency weight-loss surgery is urgently needed to preserve life, most patients are in an inoperable state. Pre-surgical bridging therapy is required to achieve technical operability through weight reduction. Standard bridging using an intragastric balloon (IB) can achieve operability in 6 months but is unsuitable for some patients in a critical condition. A non-invasive fast-track rescue therapy to achieve very rapid operability is urgently needed. We investigated whether a rescue weight reduction therapy (RWR) consisting of liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, a leucine-rich amino acid infusion and a hypocaloric diet, can accelerate readiness for emergency surgery in patients with acutely life-threatening severe obesity.

METHODS

In this proof-of-concept study, prospective data from patients treated with RWR (intervention group 1, n = 26) were mathematically matched with retrospective biometric data of 26 patients with severe obesity (historic control group 2) who underwent standard 6-month bridging with IB. A rating scale was developed to identify patients needing urgent fast-track bridging.

RESULTS

Rapid weight loss was observed in all patients on the RWR therapy. All achieved operability after a mean RWR bridging duration of 20.7 ± 6.9 days. Baseline weight was 236.3 ± 35.8 kg in group 1 compared with 230.1 ± 32.7 kg in group 2. Mean body weight loss during RWR was 27.5 ± 14.1 kg, compared with 20.9 ± 10.5 kg in group 2 (P = 0.0629).

CONCLUSIONS

Pre-operative bridging using liraglutide in combination with a leucine-rich amino acid infusion and hypocaloric diet was effective in all cases of acutely life-threatening severe obesity, achieving technical operability within only ca. 2-4 weeks. This therapy has potential as a life-saving rescue therapy for multimorbid patients with severe obesity who were previously untreatable. This study is registered at ClinicalTrials.gov (identifier: NCT02616003).

摘要

背景与目的

患有多种合并症的重度肥胖症（BMI≥60kg/m）可能会危及生命。虽然紧急减重手术是挽救生命所必需的，但大多数患者处于无法手术的状态。需要术前桥接治疗通过减重来实现技术可操作性。使用胃内球囊（IB）的标准桥接可以在 6 个月内实现可操作性，但对于一些处于危急状态的患者并不适用。迫切需要一种非侵入性的快速通道救援治疗方法来实现快速可操作性。我们研究了由利拉鲁肽、胰高血糖素样肽-1（GLP-1）受体激动剂、富含亮氨酸的氨基酸输注和低热量饮食组成的抢救减重治疗（RWR）是否可以加速患有急性危及生命的重度肥胖症的患者为紧急手术做准备。

方法

在这项概念验证研究中，接受 RWR 治疗的患者的前瞻性数据（干预组 1，n=26）与 26 例接受标准 6 个月 IB 桥接治疗的重度肥胖症患者（历史对照组 2）的回顾性生物计量数据进行了数学匹配。开发了一个评分量表来识别需要紧急快速桥接的患者。

结果

所有接受 RWR 治疗的患者体重均迅速下降。所有患者在平均 RWR 桥接持续时间 20.7±6.9 天后均达到可操作性。组 1 的基线体重为 236.3±35.8kg，而组 2 的基线体重为 230.1±32.7kg。RWR 期间的平均体重减轻为 27.5±14.1kg，而组 2 为 20.9±10.5kg（P=0.0629）。

结论

在所有患有急性危及生命的重度肥胖症的病例中，使用利拉鲁肽联合富含亮氨酸的氨基酸输注和低热量饮食进行术前桥接是有效的，仅在大约 2-4 周内即可实现技术可操作性。对于以前无法治疗的患有多种合并症的重度肥胖症患者，这种治疗方法具有作为挽救生命的抢救治疗的潜力。本研究在 ClinicalTrials.gov 注册（标识符：NCT02616003）。