Salman Ahmed Abdallah, Salman Mohamed Abdalla, Aon Mohamed H, Mahdy Reem Ezzat, Abdallah Ahmed, Shemy Gamal Galal, Hassan Ahmed M, Amin Fatema Alzahraa Samy, Labib Safa
Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Int J Gen Med. 2022 Aug 4;15:6405-6413. doi: 10.2147/IJGM.S365113. eCollection 2022.
To examine the effect of weight-loss induced bariatric procedures on albuminuria levels among diabetic patients suffering from obesity.
Adults patients who suffer from morbid obesity and type 2 diabetes mellitus (T2DM) were included in a prospective cohort study. Subjects were scheduled to undergo laparoscopic sleeve gastrectomy (LSG) or one-anastomosis gastric bypass (OAGB). The albumin-to-creatinine ratio (ACR) was adopted to assess the degree of albuminuria. Microalbuminuria was determined as a ratio of >2.5-30 mg/mmol and >3.5-30 mg/mmol for males and females, respectively, while macroalbuminuria was diagnosed when the ACR exceeded >30 mg/mmol.
The mean uACR decreased significantly from 20.95±16.89 to 9.92±12.69mg/mmol in LSG cohort (p <0.001), and from 19.52±16.65 to 9.34±11.77mg/mmol in the OAGB cohort, with no statistically considerable differences between both cohorts at the end of follow-up (p = 0.78). Twelve months after the procedures, the percentages of cases with microalbuminuria decreased significantly to 23.8% and 23.9%, respectively (p < 0.001); likewise, the percentages of cases with macroalbuminuria significantly decreased to 7.9% and 7.5% in the LSG and OAGB groups, respectively (p < 0.001). There were no statistically considerable differences between LSG and OAGB regarding the percentages of patients with micro or macroalbuminuria at the end of follow-up. Besides, there were no significant associations between the degree of weight loss and improvement (p = 0.959) or remission (p = 0.73) of microalbuminuria.
Bariatric surgery significantly reduced the severity of albuminuria 1-year after the procedure, with no preference for one procedure over the other.
研究减肥型肥胖症手术对肥胖糖尿病患者蛋白尿水平的影响。
患有病态肥胖症和2型糖尿病（T2DM）的成年患者被纳入一项前瞻性队列研究。受试者计划接受腹腔镜袖状胃切除术（LSG）或单吻合口胃旁路术（OAGB）。采用白蛋白与肌酐比值（ACR）评估蛋白尿程度。男性微量白蛋白尿定义为比值>2.5 - 30mg/mmol，女性为>3.5 - 30mg/mmol，当ACR超过>30mg/mmol时诊断为大量白蛋白尿。
LSG队列中，平均尿ACR从20.95±16.89显著降至9.92±12.69mg/mmol（p<0.001），OAGB队列中从19.52±16.65降至9.34±11.77mg/mmol，随访结束时两组间无统计学显著差异（p = 0.78）。手术后12个月，微量白蛋白尿病例百分比分别显著降至23.8%和23.9%（p<0.001）；同样，LSG组和OAGB组大量白蛋白尿病例百分比分别显著降至7.9%和7.5%（p<0.001）。随访结束时，LSG和OAGB在微量或大量白蛋白尿患者百分比方面无统计学显著差异。此外，体重减轻程度与微量白蛋白尿的改善（p = 0.959）或缓解（p = 0.73）之间无显著关联。
减肥手术在术后1年显著降低了蛋白尿的严重程度，两种手术方式无明显差异。
