背景:尽管有观察证据表明Roux-en-Y胃旁路术(RYGB)在降低低密度脂蛋白(LDL)胆固醇方面具有优越性,但腹腔镜袖状胃切除术(SG)治疗病态肥胖的应用已大大增加。主要目的是确定在为每位患者选择最合适的外科手术(RYGB或SG)时是否应考虑高LDL胆固醇水平。
方法:在这个单中心,使用意向治疗分析的随机临床试验,38例严重肥胖和LDL胆固醇水平升高的患者被随机分配接受RYGB或SG。主要结果是12个月时LDL胆固醇缓解,定义为LDL胆固醇<3.36nmol/l,不使用降脂药。次要结果包括体重变化,其他合并症,定性脂蛋白性状,胆固醇酯,糖蛋白,胆固醇吸收和合成代谢产物和并发症。
结果:意向治疗分析显示,与SG患者的27.8%相比,RYGB患者的LDL胆固醇缓解率为66.6%(p=0.019)。在完成随访的患者中,RYGB表现出优异的缓解(80.0%vs.29.4%,p=0.005)。RYGB的独家优势包括减少了大量,中等,和小LDL颗粒。胆固醇吸收标记在两种技术后显示出不同的行为:菜油甾醇(Δ-15.2µg/mg,95%CI-30.2至-0.1)在RYGB后下降,和谷甾醇(Δ21.1µg/mg,95%CI0.9至41.2),胆固醇(Δ30.6µg/mg,95%CI14.8至57.9)和菜油甾醇(Δ18.4µg/mg,95%CI4.4至32.3)在SG后增加。减肥没有差异,胆固醇酯,糖蛋白,技术间观察到胆固醇合成代谢产物或术后并发症。
结论:结论:RYGB在短期高LDL胆固醇缓解方面优于SG。此外,RYGB还导致脂蛋白参数的更大改善,从而导致动脉粥样硬化。因此,在确定每位患者的最佳减肥手术时,应考虑LDL胆固醇水平升高的情况.
背景:Clinicaltrials.gov编号,NCT03975478)。
BACKGROUND: There has been a substantial increase in the use of laparoscopic sleeve gastrectomy (SG) to treat morbid obesity despite observational evidence demonstrating the superiority of Roux-en-Y gastric bypass (RYGB) for reducing low-density lipoprotein (LDL) cholesterol. The main aim was to ascertain whether high LDL cholesterol levels should be considered when selecting the most appropriate surgical procedure for each patient (RYGB or SG).
METHODS: In this single-center, randomized clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications. Secondary outcomes included changes in weight, other comorbidities, qualitative lipoprotein traits, cholesterol esters, glycoproteins, cholesterol absorption and synthesis metabolites and complications.
RESULTS: Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6% of RYGB patients compared to 27.8% of SG patients (p = 0.019). Among patients completing follow-up, RYGB demonstrated superior remission (80.0% vs. 29.4%, p = 0.005). Exclusive benefits of RYGB included a reduction in large, medium, and small LDL particles. Cholesterol absorption markers showed differential behavior after both techniques: campesterol (Δ -15.2 µg/mg, 95% CI -30.2 to -0.1) decreased after RYGB, and sitosterol (Δ 21.1 µg/mg, 95% CI 0.9 to 41.2), cholestanol (Δ 30.6 µg/mg, 95% CI 14.8 to 57.9) and campesterol (Δ 18.4 µg/mg, 95% CI 4.4 to 32.3) increased after SG. No differences in weight loss, cholesterol esters, glycoproteins, cholesterol synthesis metabolites or postoperative complications were observed between techniques.
CONCLUSIONS: In conclusion, RYGB is superior to SG in terms of short-term of high LDL cholesterol remission. Furthermore, RYGB also led to a greater improvement in lipoprotein parameters that confer an atherogenic profile. Therefore, the presence of elevated levels of LDL cholesterol should be considered when determining the optimal bariatric surgery procedure for each patient.
BACKGROUND: Clinicaltrials.gov number, NCT03975478).