代谢手术在心脏移植领域中的应用现状与展望  

Application status and prospect of metabolic surgery in the field of heart transplantation

作　　者：王伦 王泽雨 王金发[1] 于洋[1] 姜涛[1] Wang Lun;Wang Zeyu;Wang Jinfa;Yu Yang;Jiang Tao(Department of Bariatric and Metabolic Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院减重与代谢外科,长春130033

出　　处：《中华胸心血管外科杂志》2022年第11期699-704,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：肥胖不仅导致非酒精性脂肪肝、高血压、高血脂、糖尿病、心血管疾病等多种代谢性疾病,还与心力衰竭的发生发展密切相关。心脏移植是心力衰竭患者的终极治疗方法,合并肥胖的心力衰竭却通常排除在外,肥胖症被认为是心脏移植的禁忌证。传统的降低体质量方法包括生活方式干预和药物减肥,疗效有限且耗时久,而且减肥药因影响免疫抑制剂吸收而被禁用于心脏移植中。目前,代谢手术已成为肥胖及其合并症的最有效治疗方式,并逐渐应用于心脏移植领域。术后大部分患者可达到心脏移植标准,移植率大大提高;肥胖及其代谢病、心功能得到显著改善,部分心力衰竭患者甚至不再需要进行心脏移植。然而,代谢手术在心脏移植领域中的应用尚未形成共识,本文就其在心脏移植领域的应用现状及展望进行综述,以期为临床提供参考。Obesity can not only lead to various metabolic diseases such as non-alcoholic fatty liver,hypertension,hyperlipidemia,diabetes,and cardiovascular disease,it is also closely related to the occurrence and development of heart failure.Heart transplantation is the ultimate treatment for patients with heart failure.However,heart failure patients with obesity are usually excluded from the list of heart transplants.That is to say,obesity is considered a contraindication for heart transplantation.The traditional weight loss methods,including lifestyle interventions and medications,can not effectively alleviate obesity and its comorbidities because of their limited effect and time-consuming.In addition,weight-loss drugs cannot be used in heart transplantation because they can affect the absorption of immunosuppressive drugs.At present,metabolic surgery has become the most effective method for the treatment of obesity and its comorbidities,and is now gradually applied in the field of heart transplantation most of the heart failure patients with obesity meet the standards of heart transplantation after metabolic surgery,greatly increasing the transplantation rate as well as obesity,obesity-related metabolic diseases,and cardiac function were significantly improved,even some patients with heart failure no longer need heart transplantation after their cardiac function has been significantly improved.However,the application of metabolic surgery in the field of heart transplantation has not yet reached a consensus,and only a few reviews on this topic have been published.In this article,the application status and prospects of metabolic surgery in the field of heart transplantation are reviewed so as to provided reference for clinical practice.

关 键 词：代谢手术 心脏移植 生活方式干预 心血管疾病 非酒精性脂肪肝 代谢性疾病 免疫抑制剂 心力衰竭 

分 类 号：R654.2[医药卫生—外科学] R656.61[医药卫生—临床医学]