单吻合口胃旁路术对于肥胖及糖尿病患者心脑血管风险的影响  

Effects of OAGB surgery on cardiovascular and cerebrovascular risk in patients with obesity and diabetes mellitus

作　　者：秦晓光 毛忠琦 周晓庆[1] 谢尔凡 吴国强[1] 张敏 李威杰[1] Qin Xiaoguang;Mao Zhongqi;Zhou Xiaoqing;Xie Erfan;Wu Guoqiang;Zhang Min;Lee Weijie(Department of Bariatric/Metabolic Surgical Center,Suzhou BenQ Medical Center,The Affiliated BenQ Hospital of Nanjing Medical University,Suzhou 215010,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]南京医科大学附属明基医院苏州院区代谢与减重医学中心,苏州215010 [2]苏州大学附属第一医院胃肠外科,苏州215000

出　　处：《中华肥胖与代谢病电子杂志》2023年第2期120-125,共6页Chinese Journal Of Obesity and Metabolic Diseases：Electronic Edition

摘　　要：目的探讨分析肥胖及糖尿病患者单吻合口胃旁路术(OAGB)手术前后英国糖尿病心血管疾病风险因子(UKPDS)的变化,从而客观评估患者术后远期冠心病及脑卒中发生风险的获益。方法回顾性分析2019年9月至2020年6月在苏州明基医院代谢与减重医学中心接受减重手术的30名肥胖及糖尿病患者的临床资料,其中2型糖尿病(T2DM)组及单纯性肥胖组各15例,使用UKPDS评估手术前后心血管风险因子改变,所有手术病人年龄在18~60岁,均为肥胖症患者(BMI>32.5 kg/m^(2)),手术方式为腹腔镜OAGB,其中术后患者的数据为术后6个月随访数据,使用SPSS 25进行数据统计。结果术后6个月,两组患者冠心病(CHD)及脑卒中(stroke)的风险均有下降(P<0.05),手术后对于患者CHD、致命性冠心病(Fatal CHD)、Stroke以及致命性脑卒中(Fatal Stroke)的发生率有一定改善(两组患者术后P<0.05)。其中单纯性肥胖组手术前后Fatal CHD(0.8±1.2 vs.0.4±0.9,P=0.008)及Fatal Stroke(0.1±0.2 vs.0.05±0.13,P=0.027)下降明显,而糖尿病组中手术前后CHD(8.28±5.28 vs.4.07±2.86,P<0.001)和致命性CHD(3.5±2.79 vs.1.28±1.18,P=0.001)下降更明显。结论OAGB可有效降低肥胖及糖尿病患者术后远期心脑血管疾病的发病风险,其中肥胖伴T2DM的患者获益更多,因此对于肥胖伴T2DM的患者更推荐早期行OAGB手术治疗。Objective In order to objectively evaluate the benefits of long-term coronary heart disease(CHD)and stroke in obese and diabetic patients,the changes of UK diabetes cardiovascular disease risk factors(UKPDS)before and after One-anastomosis gastric bypass were investigated.Methods Data of this study are obtained from the bariatric/metabolic surgical center of Suzhou Benq Hospital.A total of 30 patients with obesity and diabetes,including 15 patients in type 2 diabetic mellitus(T2DM)group and 15 patients in obesity group,were enrolled from September 2019 to june 2020.UKPDS was used to assess changes in cardiovascular risk factors before and after surgery.All patients aged 18 to 60 years were obese(BMI>32.5 kg/m^(2)),and metabolic surgery was performed by laparoscopic one single anastomotic gastric bypass(OAGB).SPSS 25 was used for statistical analysis.Results 6 months after surgery,the risks of coronary heart disease(CHD)and Stroke were decreased in both groups(P<0.05).There was some improvement in the incidence of CHD,Fatal CHD,Stroke,and Fatal Stroke after surgery(P<0.05 in both groups).Fatal CHD and Fatal Stroke decreased significantly in the obesity group(0.8±1.2 vs.0.4±0.9;P=0.008 and 0.1±0.2 vs.0.05±0.13,P=0.027),while CHD and Fatal CHD decreased more significantly in the diabetic group(8.28±5.28 vs.4.07±2.86,P<0.001 and 3.5±2.79 vs.1.28±1.18,P=0.001),Conclusions Metabolic surgery can effectively reduce the risk of long-term cardiovascular and cerebrovascular diseases in obese and diabetic patients,and obese patients with T2DM have more benefits,so early metabolic surgery is recommended for obese patients with T2DM.

关 键 词：减重代谢外科 单吻合口胃旁路术 英国糖尿病心血管疾病风险因子 2型糖尿病 肥胖 

分 类 号：R54[医药卫生—心血管疾病]