Weight and Metabolic Outcomes 12 Years after Gastric Bypass.
Weight and Metabolic Outcomes 12 Years after Gastric Bypass.
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DOI：
10.1056/nejmoa1700459
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发表时间：
2017-09-21
期刊：
影响因子：
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通讯作者：
Hunt SC
中科院分区：
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作者：
Adams TD;Davidson LE;Litwin SE;Kim J;Kolotkin RL;Nanjee MN;Gutierrez JM;Frogley SJ;Ibele AR;Brinton EA;Hopkins PN;McKinlay R;Simper SC;Hunt SC
到目前为止，几乎没有关于减肥手术的长期或对照研究。我们报道了在美国进行的一项观察性前瞻性Roux-en-Y胃分流术研究的12年随访结果。共有1156名严重肥胖患者分为三组：418名寻求并接受Roux-en-Y胃分流术的患者(手术组)，417名寻求但没有接受手术(主要是出于保险原因)的患者(非手术组1)，以及321名没有寻求手术的患者(非手术组2)。我们在基线、2年、6年和12年进行临床检查，以确定是否存在2型糖尿病、高血压和血脂异常。术后12年随访率超过90%。2年时，手术组调整后体重较基线平均变化为−45.0 kg(95%可信区间，−47.2to−42.9；平均百分比变化，−35.0)，6年时−36.3 kg(95%CI，−39.0至−33.5；平均百分比变化，−28.0)，12年时−35.0 kg(95%CI，−38.4至−31.7；平均百分比变化，−26.9)；非手术组1 12年后平均变化−2.9 kg(95%CI，−6.9~1.0；平均百分比变化，−2.0)；非手术组2 12年平均变化0 kg(95%CI，−3.5~3.5；平均百分比变化，−0.9)。在基线为2型糖尿病的手术组患者中，88名患者中有66名(75%)在2年后缓解，87名患者中有54名(62%)在6年后缓解，84名患者中有43名(51%)在12年后缓解。手术组与非手术组12年后发生2型糖尿病的优势比分别为0.08(95%CI，0.03~0.24)和0.09(95%CI，0.03~0.29)(P<；0.001)。与非手术组1相比，手术组有更高的缓解率和更低的高血压和血脂异常发生率(P<；0.05)。这项研究表明，Roux-en-Y胃旁路手术后，体重减轻和有效缓解和预防2型糖尿病、高血压和血脂异常的效果是长期的。(由国家糖尿病、消化和肾脏疾病研究所等资助。)
Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (non-surgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)