Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy
Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy
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DOI：
10.1001/jamasurg.2015.2202
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发表时间：
2015-11-01
期刊：
影响因子：
16.9
通讯作者：
Keidar, Andrei
中科院分区：
文献类型：
--
作者：
Golomb, Inbal;Ben David, Matan;Keidar, Andrei
腹腔镜袖状胃切除术（LSG）的流行率正在增加，但其对肥胖相关合并症的长期影响的数据很少。由于肥胖患者的人口是年轻的，长期的结果，这些合并症是高度relevant.Objective调查的长期影响LSG对体重减轻，糖尿病，高血压，血脂异常，高尿酸血症。设计，设置，和参与者队列研究采用回顾性分析的前瞻性队列在一所大学医院。从2006年4月1日至2013年2月28日期间由同一团队进行LSG的所有患者收集数据，包括人口统计学细节、体重随访、血液检查结果以及药物和合并症的信息。结果共进行了443例LSG。1年随访时，443例患者中有241例（54.4%）、3年随访时，259例患者中有128例（49.4%）、5年随访时，56例患者中有39例（69.6%）的完整数据可用。过量失重率分别为76.8%、69.7%和56.1%。糖尿病完全缓解率分别为50.7%、38.2%和20.0%，高血压缓解率分别为46.3%、48.0%和45.5%。高密度脂蛋白胆固醇水平的变化（术前和1年、3年和5年时的平均[SD]水平分别为46.7 [15.8]、52.8 [13.6]、56.8 [16.0]和52.4 [13.8] mg/dL）和甘油三酯水平（术前和1年、3年和5年时的平均[SD]水平分别为155.2 [86.1]、106.3 [45.3]、107.2 [53.4]和126.4 [59.7] mg/dL，与术前和术后测量值相比，差异有统计学意义（P < .001）。低密度脂蛋白胆固醇水平仅在1年（P = .04）和3年（P = .04）时显著降低（术前和1年、3年和5年时的平均[SD]水平分别为115.8 [33.2]、110.8 [32.0]、105.7 [25.9]和110.6 [28.3] mg/dL）。总胆固醇水平的变化未达到统计学显著性（术前和1年、3年和5年时的平均[SD]水平分别为189.5 [38.2]、184.0 [35.4]、183.4 [31.2]和188.1 [35.7] mg/dL）。合并症状态的变化与术前超重无关。高脂血症是唯一的合并症，其缓解率在1年的后续行动（部分/完全，80.6%;完全，72.2%）与过度减肥的百分比（76.8%）（P = 0.005）。结论和相关性进行LSG诱导有效的体重减轻和肥胖相关的合并症的重大改善，大多数没有相关性的百分比过度减肥。随着时间的推移，体重显著回升，糖尿病缓解率下降，其他合并症缓解率下降程度较小。
IMPORTANCE The prevalence of laparoscopic sleeve gastrectomy (LSG) is increasing, but data on its long-term effect on obesity-related comorbidities are scarce. Because the population of bariatric patients is young, long-term results of those comorbidities are highly relevant.OBJECTIVE To investigate the long-term effects of LSG on weight loss, diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia.DESIGN, SETTING, AND PARTICIPANTS Cohort study using a retrospective analysis of a prospective cohort at a university hospital. Data were collected from all patients undergoing LSGs performed by the same team between April 1, 2006, and February 28, 2013, including demographic details, weight follow-up, blood test results, and information on medications and comorbidities.MAIN OUTCOMES AND MEASURES Excess weight loss, obesity-related comorbidities, and partial and complete remission at 1, 3, and 5 years of follow-up.RESULTS A total of 443 LSGs were performed. Complete data were available for 241 of the 443 patients (54.4%) at the 1-year follow-up, for 128 of 259 patients (49.4%) at the 3-year follow-up, and for 39 of 56 patients (69.6%) at the 5-year follow-up. The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively. Complete remission of diabetes was maintained in 50.7%, 38.2%, and 20.0%, respectively, and remission of hypertension was maintained in 46.3%, 48.0%, and 45.5%, respectively. Changes in high-density lipoprotein cholesterol level (mean [SD] level preoperatively and at 1, 3, and 5 years, 46.7 [15.8], 52.8 [13.6], 56.8 [16.0], and 52.4 [13.8] mg/dL, respectively) and triglyceride level (mean [SD] level preoperatively and at 1, 3, and 5 years, 155.2 [86.1], 106.3 [45.3], 107.2 [53.4], and 126.4 [59.7] mg/dL, respectively) were significant compared with preoperative and postoperative measurements (P < .001). The decrease of low-density lipoprotein cholesterol level was significant only at 1 year (P = .04) and 3 years (P = .04) (mean [SD] level preoperatively and at 1, 3, and 5 years, 115.8 [33.2], 110.8 [32.0], 105.7 [25.9], and 110.6 [28.3] mg/dL, respectively). The changes in total cholesterol level did not reach statistical significance (mean [SD] level preoperatively and at 1, 3, and 5 years, 189.5 [38.2], 184.0 [35.4], 183.4 [31.2], and 188.1 [35.7] mg/dL, respectively). No changes in comorbidity status correlated with preoperative excess weight. Hypertriglyceridemia was the only comorbidity whose remission rates at 1 year of follow-up (partial/complete, 80.6%; complete, 72.2%) correlated with percentage of excess weight loss (76.8%) (P = .005).CONCLUSIONS AND RELEVANCE Undergoing LSG induced efficient weight loss and a major improvement in obesity-related comorbidities, with mostly no correlation to percentage of excess weight loss. There was a significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other comorbidities over time.