Department of Surgery, University of California, Davis, California.
Department of Surgery, University of California, Davis, California; Center for Alimentary and Metabolic Science, University of California, Davis, California.
Surg Obes Relat Dis. 2024 Dec;20(12):1343-1350. doi: 10.1016/j.soard.2024.08.022. Epub 2024 Aug 17.
Severity stratification and longitudinal evaluation of metabolic conditions in response to Roux-en-Y gastric bypass (RYGB) are not standardized. Our Assessment of Obesity-related Metabolic Comorbidities (AOMC) scoring tool combines pharmacotherapy and biochemical data to objectively define type 2 diabetes (T2D), hypertension (HTN), and dyslipidemia (DYS) severity. We previously showed that AOMC more accurately describes disease severity than clinical history alone.
We aimed to show that AOMC more precisely and reproducibly measures metabolic disease response to RYGB and preoperative disease severity influences remission rates.
University hospital, United States.
AOMC scores for T2D, DYS, and HTN were calculated preoperatively and postoperatively (1-, 2-, and 5-years) for patients who underwent RYGB over 14 years. Generalized linear mixed-effect models were used to evaluate AOMC score trends and remission over time.
Of 351 patients, 214, 188, and 303, presented with any T2D, DYS, or HTN respectively. One-year remission rates were: T2D 57.1%, DYS 59.7%, and HTN 29.3%. Over 5 years post-RYGB, remission rates declined for T2D (P < .05) and DYS (P < .05) but remained steady for HTN (P > .05). Remission was associated with preoperative disease severity: those with premetabolic disease had the highest remission rates (i.e., 1-year: pre-T2D 81.4%, pre-DYS 91.4%, pre-HTN 53.5%, all P < .05), while those with most severe scores preoperatively (untreated/uncontrolled) had the lowest remission rates.
AOMC allows precise assessment of comorbidity severity and disease-specific postoperative quantification of comorbidity responses and remission rates. These findings can guide preoperative metabolic disease optimization and postoperative metabolic recovery expectations and standardize communication regarding comorbidity severity.
罗伊氏胃旁路术（RYGB）后代谢状况的严重程度分层和纵向评估尚未标准化。我们的肥胖相关代谢合并症评估（AOMC）评分工具结合了药物治疗和生化数据，客观地定义了 2 型糖尿病（T2D）、高血压（HTN）和血脂异常（DYS）的严重程度。我们之前表明，AOMC 比仅基于临床病史更准确地描述疾病严重程度。
我们旨在表明 AOMC 更准确和可重复地测量 RYGB 后代谢疾病的反应，并且术前疾病严重程度影响缓解率。
美国大学医院。
对 14 年来接受 RYGB 的患者术前和术后（1、2 和 5 年）的 T2D、DYS 和 HTN 的 AOMC 评分进行计算。使用广义线性混合效应模型评估 AOMC 评分趋势和随时间的缓解情况。
在 351 名患者中，分别有 214 名、188 名和 303 名患有任何 T2D、DYS 或 HTN。1 年缓解率分别为：T2D 57.1%、DYS 59.7%和 HTN 29.3%。在 RYGB 后 5 年，T2D（P<.05）和 DYS（P<.05）的缓解率下降，但 HTN （P>.05）仍保持稳定。缓解与术前疾病严重程度相关：患有前期代谢疾病的患者缓解率最高（即 1 年：前期 T2D 81.4%、前期 DYS 91.4%、前期 HTN 53.5%，均 P<.05），而术前评分最严重（未经治疗/未控制）的患者缓解率最低。
AOMC 允许对合并症严重程度进行精确评估，并对术后特定合并症的反应和缓解率进行定量评估。这些发现可以指导术前代谢疾病的优化和术后代谢恢复的预期，并标准化关于合并症严重程度的沟通。
