做了胃旁路手术的患者
减肥手术可降低心脏病和中风的风险及由此导致的死亡风险。瑞典哥德堡大学医院的研究者发现，在中位数随访14.7年的一项研究中，与非减肥手术患者相比，减肥手术后心血管死亡患者减少53%。该研究发表在近期《美国医学会杂志》上。
该研究指出，减肥尤其是减肥手术可降低心血管死亡和心血管事件的发生率。而在以前的研究中，即使随访20年，生活方式和药物干预都没有阻止心血管事件的发生。手术组2010名患者首次发生心肌梗死或卒中的199名，死亡28名，在常规治疗肥胖的对照组2034名患者中为234名，死亡49名。手术组当中，13.2％的患者进行了胃旁路手术，18.7％的患者进行了胃束带手术。大部分患者（68.1％）的垂直带状胃减肥手术目前已经很少用。研究人员指出，由于20世纪80年代高手术死亡率，研究伦理上的原因，患者不能被随机分组。进一步分析显示，较高的基线血浆胰岛素水平可预测减肥手术心血管获益。
有专家评论认为：“由于预期的健康获益不超过减肥手术的风险，肥胖患者如果没有其他与体重相关的并发症，一般不应该接受减肥手术。”
Bariatric Surgery and Long-term Cardiovascular Events
Lars Sjöström, MD, PhD; Markku Peltonen, PhD; Peter Jacobson, MD, PhD; C. David Sjöström, MD, PhD; Kristjan Karason, MD, PhD; Hans Wedel, PhD; Sofie Ahlin, MD; Åsa Anveden, MD; Calle Bengtsson, MD, PhD; Gerd Bergmark, BMA; Claude Bouchard, PhD; Björn Carlsson, MD, PhD; Sven Dahlgren, MD, PhD; Jan Karlsson, PhD; Anna-Karin Lindroos, PhD; Hans Lönroth, MD, PhD; Kristina Narbro, PhD; Ingmar Näslund, MD, PhD; Torsten Olbers, MD, PhD; Per-Arne Svensson, PhD; Lena M. S. Carlsson, MD, PhD
Context Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking.
Objective To study the association between bariatric surgery, weight loss, and cardiovascular events.
Design, Setting, and Participants The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals.
Main Outcome Measures The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined.
Results Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001).
Conclusion Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
文献链接：https://jama.ama-assn.org/content/307/1/56.full?sid=8afb8f9e-3bcf-4bd5-bf10-bb4df84dd727
