| 摘要: | 背景：
肥胖會提高冠狀動脈心臟病的罹病率，而且容易發生心血管疾病的相關併發症，甚至導致猝死。目前討論腹腔鏡袖狀胃切除手術在改善病態性肥胖產生的代謝症候群後，對於冠狀動脈心臟病長期風險影響的資料仍然不足。
目的：
評估接受腹腔鏡袖狀胃切除手術的病態性肥胖患者，術前、術後 6 個月和術後 12個月體重、血壓、血糖與血脂之變化，以及佛萊明漢危險預估評分表預測的冠狀動脈心臟病長期風險下降趨勢。藉此找出高危險族群的相關因子，可以早期發現、早期治療。
方法：
從 2007 年 6 月至 2014 年 6 月，總共 870 位病態性肥胖患者於臺北醫學大學附設醫院體重管理中心接受腹腔鏡袖狀胃切除手術，分別就術前、術後 6 個月和術後12 個月體重、血壓、血糖與血脂之資料進行回溯性研究，並以佛萊明漢危險預估評分表估算研究個案之冠狀動脈心臟病長期風險。
研究之連續變項以平均值 ± 標準偏差表示，類別變項則以百分比表示。術前和術後的檢查結果由麥內瑪檢驗或單變數重複測量變異數分析進行檢定，各組間平均值的差異比較使用曼恩-惠特尼 U 檢定或魏克生檢定，變項之間的相關性由皮爾森和斯皮爾曼相關係數進行分析，各變項和冠狀動脈心臟病長期風險之間的關聯則以邏輯斯回歸進行分析。雙尾檢定之 P 值若小於 0.05，有統計學上的顯著差異。結果：
男性和女性的身體質量指數（BMI），從術前 43.3 ± 6.9 公斤/平方公尺和 39.2 ± 6.0 公斤/平方公尺，術後 6 個月下降至 32.9 ± 6.7 公斤/平方公尺和 31.0 ± 5.2 公斤/平方公尺，術後 12 個月則下降至 30.4 ± 5.6 公斤/平方公尺和 28.2 ± 4.7 公斤/平方公尺。而接受腹腔鏡袖狀胃切除手術後，病態性肥胖患者的高血脂有顯著改善（總膽固醇、低密度脂蛋白膽固醇、三酸甘油酯減少，並增加高密度脂蛋白膽固醇），糖尿病、高血壓與抽菸的盛行率亦顯著降低。男性和女性的糖尿病比例從 30.1％和 19.0％，術後 6 個月降低至 0.8％和 2.0%，術後 12 個月則下降至 1.1％和 1.0％；男性和女性的高血壓比例從 52.6％和 41.9％，術後 6 個月降低至 28.6％和 16.7%，術後 12 個月則下降至 16.9％和 9.8％；男性和女性的吸菸比例從術前的 13.5％和 7.5％，術後降低至 8.6％和 3.6%。男性和女性的冠狀動脈心臟病長期風險≧10％的百分比，從 10.2％和 1.0％，術後 6 個月降低至 6.1％和 0%，術後 12 個月則下降至 5.3％和 0.3％。
結論：
腹腔鏡袖狀胃切除手術不僅改善了病態性肥胖與其相關的合併症，而且可以降低日後發生冠狀動脈心臟病之風險。對於高危險族群應及早介入治療。
Background:
Obesity is associated with high prevalence of coronary heart disease (CHD) and long term increased cardiovascular morbidity as well as mortality. There are few data regarding the effect of laparoscopic sleeve gastrectomy (LSG) on long-term CHD risk after improving metabolic syndrome resulted from morbid obesity.
Purpose:
To assess the decreasing trend of 6 and 12 months of Framingham risk score in morbidly obese patients with LSG. According to the association with risk factors, early detection, evaluation, and treatment are available for high-risk patients.
Methods:
870 morbid obesity patients received laparoscopic sleeve gastrectomy in Taipei Medical University Hospital from June 2007 to June 2014 were retrospectively studied preoperatively, 6 and 12 months after surgery. The coronary heart disease risk was
calculated using Framingham risk score.
Data are expressed as means ± standard deviation (SD) for continuous variables and as percentages for categorical variables. Findings at the pre- and post-operative examinations were compared by McNemar test, or One-way repeated measures
ANOVA, as appropriate. The differences in the mean values between groups were compared using Mann-Whitney U or Wilcoxon test, as appropriate. The significance of the association between variables was determined by Pearson and Spearman correlation. Logistic regression assessed the association between variables and CHD risk. A probability value of p < 0.05 was considered significant, and two tailed p values were used for all statistics.
Results:
The body mass index (BMI) in men and women decreased from 43.3 ± 6.9 kg/m 2 , 39.2 ± 6.0 kg/m 2 preoperatively to 32.9 ± 6.7 kg/m 2 , 31.0 ± 5.2 kg/m 2 and to 30.4 ± 5.6 kg/m 2 , 28.2 ± 4.7 kg/m 2 , respectively, at 6 and 12 months after surgery. At 6 and 12 months after LSG, there was a marked improvement of lipid profile (decrease of total cholesterol, LDL-cholesterol, triglycerides, and an increase of HDL-cholesterol) and a significant decrease in the prevalence of diabetes mellitus, systemic hypertension and smoking. The prevalence of diabetes mellitus in men and women reduced from 30.1%, 19.0% preoperatively to 0.8%, 2.0% and 1.1%, 1.0%, respectively, at 6 and 12 months after surgery. The prevalence of hypertension in men and women reduced from 52.6%, 41.9% preoperatively to 28.6%, 16.7% and 16.9%, 9.8%, respectively, at 6 and 12 months after surgery. The prevalence of smoking in men and women reduced from 13.5%, 7.5% preoperatively to 8.6%, 3.6% postoperatively. The percentage of CHD Framingham, risk ≧ 10% in men and women, reduced from 10.2%, 1.0%
preoperatively to 6.1%, 0% and 5.3%, 0.3%, respectively, at 6 and 12 months after surgery.
Conclusions:
Laparoscopic sleeve gastrectomy is efficient not only in the reduction of obesity and its related comorbidities but also in decreasing the long-term coronary event risk. Early intervention for the high-risk group is strongly recommended. |
