腹腔镜袖状胃切除术与腹腔镜Roux-en-Y胃旁路术对肥胖性高血压的近期疗效对比研究
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摘要
目的比较腹腔镜袖状胃切除术(LSG)和腹腔镜Roux-en-Y胃旁路术(LRYGB)治疗肥胖性高血压的疗效。方法回顾性分析2015年11月至2017年6月吉林大学中日联谊医院减重代谢外科收治的46例肥胖合并高血压患者的临床资料。根据手术方式的不同将患者分为LSG组和LRYGB组。其中LSG组32例,男9例,女23例,平均年龄(40.09±12.22)岁。LRYGB组14例,男9例,女5例,平均年龄(42.07±13.51)岁。比较两组患者术前和术后3个月的血压、心率、体重、体质量指数(BMI)、腰围、空腹血糖、糖化血红蛋白、空腹胰岛素、空腹C肽、尿酸、甘油三酯和总胆固醇水平。结果 46例患者均顺利完成减重手术,并完成术后随访。术后3个月,LSG组与LRYGB组患者的收缩压、舒张压、心率、体重、BMI、腰围、空腹血糖、糖化血红蛋白、空腹胰岛素、空腹C肽、甘油三酯、尿酸水平均较术前显著下降(除胆固醇外),差异均有统计学意义(P<0.05);LSG组与LRYGB组行组间比较,手术时间与心率具有统计学意义(P<0.05),其它指标均无统计学意义(P>0.05)。结论 LSG和LRYGB均能在短期内显著改善血压水平及代谢指标(胆固醇除外),但两者的疗效差异(心率除外)均无统计学意义,还有待于延长随访时间、增加样本例数来进一步明确。
Objective To compare the ef?cacy of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric Bypass in the treatment of obesity-associated hypertension. Methods The clinical data of 46 patients with obesity-associated hypertension who were admitted to the China-Japan Union hospital of JiLin university from November 2015 to June 2017 were retrospectively analyzed. They were divided into LSG group and LRYG group according to the different surgical methods. Among the 32 cases of LSG group,9 cases were male and 23 cases were female with an average age of(40.09±12.22) years old. Among the 14 patients of LRYGB group, 9 cases were male and 5 cases were female with an average age of(40.09±12.22)years old. Blood pressure, heart rate, body weight, body mass index, waist circumference, fasting blood glucose, glycosylated hemoglobinAlc,fasting blood insulin, fasting plasma C-peptide, triglyceride, total cholesterol and uric acid levels were compared between two groups. Results All patients were treated successfully by bariatric surgery and followed up after operation. At postoperative 3 months, both LSG group and LRYGB group, their systolic blood pressure, diastolic blood pressure, heart rate, body weight,BMI, waist circumference, fasting blood glucose, glycosylated hemoglobin Alc, fasting blood insulin, fasting C-peptide,triglyceride, cholesterol and uric acid levels were decreased signi?cantly except for cholesterol. The operation time and heart rate were statistically significant between LSG group and LGBP group, but there was no significant difference in other indexes. Conclusions LSG and LRYGB can both significantly improve blood pressure and other metabolic diseases except for cholesterol in a short time, but there is no signi?cant difference between the two groups except for heart rate, the difference between their curative effect remains to be de?ned by extending follow-up time and increasing sample sizes.
Objective To compare the ef?cacy of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric Bypass in the treatment of obesity-associated hypertension. Methods The clinical data of 46 patients with obesity-associated hypertension who were admitted to the China-Japan Union hospital of JiLin university from November 2015 to June 2017 were retrospectively analyzed. They were divided into LSG group and LRYG group according to the different surgical methods. Among the 32 cases of LSG group,9 cases were male and 23 cases were female with an average age of(40.09±12.22) years old. Among the 14 patients of LRYGB group, 9 cases were male and 5 cases were female with an average age of(40.09±12.22)years old. Blood pressure, heart rate, body weight, body mass index, waist circumference, fasting blood glucose, glycosylated hemoglobinAlc,fasting blood insulin, fasting plasma C-peptide, triglyceride, total cholesterol and uric acid levels were compared between two groups. Results All patients were treated successfully by bariatric surgery and followed up after operation. At postoperative 3 months, both LSG group and LRYGB group, their systolic blood pressure, diastolic blood pressure, heart rate, body weight,BMI, waist circumference, fasting blood glucose, glycosylated hemoglobin Alc, fasting blood insulin, fasting C-peptide,triglyceride, cholesterol and uric acid levels were decreased signi?cantly except for cholesterol. The operation time and heart rate were statistically significant between LSG group and LGBP group, but there was no significant difference in other indexes. Conclusions LSG and LRYGB can both significantly improve blood pressure and other metabolic diseases except for cholesterol in a short time, but there is no signi?cant difference between the two groups except for heart rate, the difference between their curative effect remains to be de?ned by extending follow-up time and increasing sample sizes.
引文
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[13]Kotzampassi K,Shrewsbury AD,Papakostas P,et al.Looking into the profile of those who succeed in losing weight with an intragastric balloon[J].J Laparoendosc Adv Surg Tech A,2014,24(5):295-301.
[14]Buchwald H,Avidor Y,Braunwald E,et al.Bariatric Surgery:A Systematic Review and Meta-analysis[J].Acc Current Journal Review,2004,14(1):13.
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[17]Vollenmeider P,Tappy L,Randin D,et al.Differential effects of hyperinsulinemia and carbohydrate metabolism on sympathetic nerve activity and muscle blood flows in humans[J].J Clin Invest,1993,92(1):147-154.
[18]Lim K,Burke SL,Head GA.Obesity-related hypertension and the Role of insulin and leptin in high-fat-fed rabbits[J].Hypertension,2013,61(3):628-630.
[19]Haynes WG,Sivitz WI,Morgan DA,et al.Sympatheticand car diorenal actions of leptin[J].Hypertension,1997,30(3Pt2):619-623.
[20]Shek EW,Brands MW,Hall JE.Chronic leptin infusion increases arterial pressure[J].Hypertension,1998,31(1 Pt 2):409-414.
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[24]Cassis LA,Police SB,Yiannikouris F,et al.Local adipose tissue renin-angiotensin system[J].Curr Hypertens Rep,2008,10(2):93-98.
[25]Yasue S,Masuzaki H,Okada S,et al.Adipose tissue-specific regulation of angiotensinogen in obese humans and mice:impact of nutritional status and adipocyte hypertrophy[J].Am J Hypertens,2010,23(4):425-431.
[26]Yiannikouris F,Gupte M,Putnam K,et al.Adipocyte deficiency of angiotensinogen prevents obesity-induced hypertension in male mice[J].Hypertension,2012,60(6):1524-1530.
[27]Bentley-Lewis R,Adler GK,Perlstein T,et al.Body mass index predicts aldosterone production in normotensive adults on a high-salt diet[J].J Clin Endocrinol Metab,2007,92(11):4472-4475.
[28]Goodfriend TL,Kelley DE,Goodpaster BH,et al.Visceral obesity and insulin resistance are associated with plasma aldosterone levels in women[J].Obes Res,1999,7(4):355-362.
[29]Ehrhart-Bornstein M,Lamounier-Zepter V,Schraven A,et al.Human adipocytes secrete mineralocorticoid-releasing factors[J].Proc Natl Acad Sci USA,2003,100(24):14211-14216.
[30]Shibata S,Mu S,Kawarazaki H,et al.Rac1 GTPase in rodent kidneys is essential for salt-sensitive hypertension via a mineralocorticoid receptor-dependent pathway[J].J Clin Invest,2011,121(8):3233-3243.
[2]Wickelgren I.Obesity:how big a problem?[J].Science,1998,280(5368):1364-1367.
[3]Flores L,Vidal J,Canivell S,et al.Hypertension remission 1 year after bariatric surgery:predictive factors[J].Surg Obes Relat Dis,2014,10(4):661-665.
[4]刘轶群,莫朝晖.代谢综合征外科手术治疗的研究进展[J].北方药学,2012,9(4):26-28.
[5]Brancatisano A,Wahlroos S,Matthews S,et al.Gastric banding for the treatment of type 2 diabetes mellitus in morbidly obese[J].Surg Obes Relat Dis,2008,4(3):423-429.
[6]谢晓峰,张文亮,李倩,等.外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析[J].中国循证医学杂志,2013,13(6):728-734.
[7]中用高血压防治指南修订委员会.中国血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.
[8]Movahed MR,Lee JZ,LimIM WY,et al.Strong independent association between obesity and essential hypertension[J].Clin Obess,2016,6(3):189-192.
[9]Bastien M,Poirier P,Lemieux I,et al.Overview of epidcmiology and contribution of obesity to cardiovascular disease[J].Prog Cardiovasc Dis,2014,56(4):369-381.
[10]Grassi G.Sympathetic neural activity in hypertension and related diseases[J].Am J Hypertens,2010,23(10):1052-1060.
[11]Armitage JA,Burke SL,Prior LJ,et al.Rapid onset of renal sympathetic nerve activation in rabbits fed a high-fat diet[J].Hypertension,2012,60(1):163-171.
[12]Sarkhosh K,Birch DW,Shi X,et al.The impact of sleeve gastrectomy on hypertension:a systematic review[J].Obes Surg,2012,22(5):832-837.
[13]Kotzampassi K,Shrewsbury AD,Papakostas P,et al.Looking into the profile of those who succeed in losing weight with an intragastric balloon[J].J Laparoendosc Adv Surg Tech A,2014,24(5):295-301.
[14]Buchwald H,Avidor Y,Braunwald E,et al.Bariatric Surgery:A Systematic Review and Meta-analysis[J].Acc Current Journal Review,2004,14(1):13.
[15]Mingrone G,Panunzi S,Gactano DA,et al.Bariatric surgery versus conventional medical therapy for type 2 diabetes[J].The New England journal of medicine,2012,366:1577-1585.
[16]Ahmed AR,Rickards G,Coniglio D,et al.Laparscopic RouX-en-Y gastric bypass and its early effect on blood pressure[J].Obesity surgery,2009,19(7):845-849.
[17]Vollenmeider P,Tappy L,Randin D,et al.Differential effects of hyperinsulinemia and carbohydrate metabolism on sympathetic nerve activity and muscle blood flows in humans[J].J Clin Invest,1993,92(1):147-154.
[18]Lim K,Burke SL,Head GA.Obesity-related hypertension and the Role of insulin and leptin in high-fat-fed rabbits[J].Hypertension,2013,61(3):628-630.
[19]Haynes WG,Sivitz WI,Morgan DA,et al.Sympatheticand car diorenal actions of leptin[J].Hypertension,1997,30(3Pt2):619-623.
[20]Shek EW,Brands MW,Hall JE.Chronic leptin infusion increases arterial pressure[J].Hypertension,1998,31(1 Pt 2):409-414.
[21]Narkiewicz K,van de Borne PJH,Cooley RL,et al.Sympathetic activity in obese subjects with and without obstructive sleep apnoea[J].Circulation,1998,98(8):772-776.
[22]Somers VK,Dyken ME,Clary MP,et al.Sympathetic neural mechanisms in obstructive sleep apnea[J].J Clin Invest,1995,96(4):1897-1904.
[23]Grassi G,Facchini A,Trevano FQ,et al.Obstructive sleep apneadependent and independent adrenergic activation in obesity[J].Hypertension,2005,46(2):321-325.
[24]Cassis LA,Police SB,Yiannikouris F,et al.Local adipose tissue renin-angiotensin system[J].Curr Hypertens Rep,2008,10(2):93-98.
[25]Yasue S,Masuzaki H,Okada S,et al.Adipose tissue-specific regulation of angiotensinogen in obese humans and mice:impact of nutritional status and adipocyte hypertrophy[J].Am J Hypertens,2010,23(4):425-431.
[26]Yiannikouris F,Gupte M,Putnam K,et al.Adipocyte deficiency of angiotensinogen prevents obesity-induced hypertension in male mice[J].Hypertension,2012,60(6):1524-1530.
[27]Bentley-Lewis R,Adler GK,Perlstein T,et al.Body mass index predicts aldosterone production in normotensive adults on a high-salt diet[J].J Clin Endocrinol Metab,2007,92(11):4472-4475.
[28]Goodfriend TL,Kelley DE,Goodpaster BH,et al.Visceral obesity and insulin resistance are associated with plasma aldosterone levels in women[J].Obes Res,1999,7(4):355-362.
[29]Ehrhart-Bornstein M,Lamounier-Zepter V,Schraven A,et al.Human adipocytes secrete mineralocorticoid-releasing factors[J].Proc Natl Acad Sci USA,2003,100(24):14211-14216.
[30]Shibata S,Mu S,Kawarazaki H,et al.Rac1 GTPase in rodent kidneys is essential for salt-sensitive hypertension via a mineralocorticoid receptor-dependent pathway[J].J Clin Invest,2011,121(8):3233-3243.
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