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# 【学术2015-340】减重手术或可降低T2DM、MI和高血压

记者： 时间：2015-12-29 19:19　　来源：
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2015 年 12 月 22 日，PLOS 在线发表一项英国研究结果显示，减重手术可大幅减轻体重，并且至少可在术后持续 4 年。体重减轻还伴随着此前就存在的 2 型糖尿病（T2DM）及高血压的明显改善，此外 T2DM、高血压、心绞痛、心梗（MI）和阻塞性睡眠呼吸暂停（OSA）的发生危险也随之下降。扩大减重手术的使用范围可能带给许多病态肥胖者明显的健康益处。

减重手术已越来越广泛地用于肥胖症的治疗，但目前还缺乏这种手术在日常临床实践中用于大型人群的长期疗效证据。这项观察性回顾队列研究采用英国临床实践研究数据链的数据，对截至 2014 年 12 月 31 日接受减重手术的所有 3882 例患者进行评估，目的是衡量减重手术、BMI 和肥胖症相关合并症之间的相关性。主要转归是 4 年间的体重及 BMI 变化，T2DM、高血压、心绞痛、MI、卒中、骨折和 OSA 及癌症的诊断，死亡率，以及高血压及 T2DM 的缓解情况。

结果显示，在术后 1~4 个月，5~12 个月以及 13~48 个月期间分别有 3847 例、2884 例和 2258 例患者提供了体重测量数据。减重手术患者术后最初 4 个月的体重迅速减轻，减重速度达到 4.98 kg/mo。截至 4 年结束时较缓慢的体重减轻得以维持。胃旁路术（6.56 kg/mo）和袖状胃切除术（6.29 kg/mo）的初始体重降幅大于胃束带术（2.77 kg/mo）。减重手术对 T2DM、高血压、心绞痛、MI 和 OSA 的保护性风险比（HR）分别为 0.68、0.35、0.59、0.28 和 0.55。研究发现减重手术与 T2DM（HR:9.29）和高血压（HR:5.64）的缓解强相关。研究未检出减重手术与骨折、癌症或卒中之间具有相关性。此外研究也未发现总体上减重手术对死亡具有保护作用（HR:0.97）。

（英文原文）Bariatric Surgery in the United Kingdom: ACohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

Background Bariatric surgery is becoming a morewidespread treatment for obesity. Comprehensive evidence of the long-termeffects of contemporary surgery on a broad range of clinical outcomes in largepopulations treated in routine clinical practice is lacking. The objective ofthis study was to measure the association between bariatric surgery, weight,body mass index, and obesity-related co-morbidities.

Methods and Findings This was an observational retrospective cohort studyusing data from the United Kingdom Clinical Practice Research Datalink. All3,882 patients registered in the database and with bariatric surgery on orbefore 31 December 2014 were included and matched by propensity score to 3,882obese patients without surgery. The main outcome measures were change in weightand body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus(T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures,obstructive sleep apnoea, and cancer; mortality; and resolution of hypertensionand T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo,2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mopost-procedure. Bariatric surgery patients exhibited rapid weight loss for thefirst four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08).Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo)and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weightreduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs)were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83);hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28(95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87).Strong associations were found between bariatric surgery and the resolution ofT2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery andthe resolution of hypertension, with a HR of 5.64 (95% CI 2.65–11.99). Noassociation was detected between bariatric surgery and fractures, cancer, orstroke. Effect estimates for mortality found no protective association withbariatric surgery overall, with a HR of 0.97 (95% CI 0.66–1.43). The data usedwere recorded for the management of patients in primary care and may be subjectto inaccuracy, which would tend to lead to underestimates of true relativeeffect sizes.

Conclusions Bariatric surgery as delivered in the UKhealthcare system is associated with dramatic weight loss, sustained at least 4y after surgery. This weight loss is accompanied by substantial improvements inpre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM,hypertension, angina, MI, and obstructive sleep apnoea. Widening theavailability of bariatric surgery could lead to substantial health benefits formany people who are morbidly obese.

来源：ACC CV News Digest（December 22，2015）

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