摘要

研究背景

近幾年，減重手術被發現對於肥胖第二型糖尿病(身體質量指數>35)有治療效果，並且可以降低心血管疾病危險及死亡率。然而，對於非肥胖糖尿病患者(身體質量指數<35)降低心血管疾病危險的效果尚待證實。

研究目的

評估第二型糖尿病患者接受代謝手術後心血管疾病危險使用英國預測糖尿病研究分數。

研究方法

本研究一共收集了392位第二型糖尿病患者 (235位女性 147位男性)接受胃袖狀切除手術有87位，接受胃繞道手術有305位，術後ㄧ年追蹤資料。前瞻性研究，腦部及冠心病危險性用英國預測糖尿病研究風險引擎作為評估。結果由不同術式做為分組。

研究結果

手術後ㄧ年，多數患者糖尿病部分緩解或完全緩解。10年冠心病危險以及致命性冠心病危險分別由8.8%降至4.6%以及4.6%降至2.1%，顯著減少風險。在肥胖或非肥胖的第二型糖尿病患者有相似的降低心血管疾病危險性。多變數分析證實胃袖狀切除手術對於降低心血管疾病危險是負面預測因子。

結論

此研究證實第二型糖尿病患者接受代謝手術ㄧ年後可降低心血管疾病危險達50%以上。胃繞道手術較胃袖狀切除手術更為顯著。

摘錄原文如下

Metabolic surgery ameliorates cardiovascular risk in obese diabetic patients: Influence of different surgical procedures

DOI: https://doi.org/10.1016/j.soard.2018.08.026

The current study confirms the significant reduction of the CVD risk of up to 50% after one year of surgery.

Metabolic surgery confirms the well remission of type 2 diabetes mellitus after one year of surgery.

The sleeve gastrectomy before surgery was the independent predictor of CVD risk reduction after MS.

Gastric bypass surgery carries a higher power on CVD risk reduction than SG.

Abstract

Background

In recent years, bariatric surgery was found to have therapeutic potential for the treatment of type 2 diabetes (T2D) in severely obese patients (body mass index [BMI] ≥35 kg/m2) and to reduce cardiovascular disease (CVD) risk and mortality. However, the benefit of CVD risk reduction after metabolic surgery in nonseverely obese T2D patients (BMI <35 kg/m2) remained to be proven.

Objective

To evaluate the CVD risk after metabolic surgery in T2D patients using The UK Prospective Diabetes Study score.

Setting

Tertiary referral general hospital, Taiwan, Republic of China.

Methods

Outcomes of 392 patients (235 women and 147 men) who had undergone sleeve gastrectomy (87) or gastric bypass (305) for treatment of T2D with 1-year follow-up were assessed. Data were prospectively collected for study, and cerebral and coronary heart disease risk was calculated by using The UK Prospective Diabetes Study risk engine. Outcomes of patients who had undergone different surgical procedures were assessed.

Results

One year after surgery, weight and glycemic control with complete and partial remission of T2D were significant in most of the patients. The 10-year coronary heart disease risk and fatal coronary heart disease risk were also reduced from 8.8% to 4.6% and from 4.6% to 2.1%, respectively (both P < .001). Similar CVD risk reduction was seen in both patients with BMI ≥35 and BMI <35. Multivariable analysis confirmed that surgical procedure of sleeve gastrectomy was a negative independent predictor of CVD risk reduction after metabolic surgery.

Conclusion

The present study confirms the efficacy of metabolic surgery for the T2D treatment and reduction of CVD risk up to 50% 1 year after surgery. Gastric bypass surgery has more power on CVD risk reduction than sleeve gastrectomy.

Keywords:

Bariatric surgery, Metabolic surgery, Sleeve gastrectomy, Gastric bypass surgery, Roux-en-Y gastric bypass surgery, T2D, UKPDS risk score