减重手术已更名为代谢手术!阜外医院学者发文称,减肥是治疗冠心病、肥胖伴糖尿病的基础

2020-02-14 李晓玲,陈燕燕 中国循环杂志

肥胖患者发生糖尿病及冠心病的风险显着升高。而对于肥胖伴糖尿病的冠心病患者,其治疗更具挑战性。

肥胖患者发生糖尿病及冠心病的风险显着升高。而对于肥胖伴糖尿病的冠心病患者,其治疗更具挑战性。

阜外医院陈燕燕、李晓玲在本刊发文指出,胰岛素抵抗是肥胖、糖尿病及冠心病的共同病理生理基础,脂肪组织分布及功能改变、氧化应激、炎症反应及代谢异常共同作用导致胰岛素抵抗。

因此,减轻体重,改善胰岛素敏感性,是肥胖伴糖尿病及冠心病治疗的基础。

Look AHEAD 研究证明,超重/肥胖的糖尿病患者体重下降5%~10%,即可获得明显获益,包括血压、血糖、低密度脂蛋白胆固醇、甘油三酯降低及高密度脂蛋白胆固醇升高,患者心血管风险下降。

减重的方式包括三种:生活方式干预、药物治疗及外科手术。

生活方式干预

生活方式干预是目前最有效、最安全的治疗方式,其中营养治疗是基础。

而运动干预的效果受运动方式、强度及总量的影响。

动物实验表明,饭吃八成饱可改善胰岛素敏感性,减轻氧化应激损伤。

运动能明显减轻胰岛素抵抗,并改善冠心病患者的心肺功能及心血管结构,降低患者心血管风险。

药物减重

据2015 年美国内分泌学会、欧洲内分泌协会及美国肥胖协会制定的《减肥药物临床实践指南》,体重指数(BMI)≥30的患者或BMI≥27伴有其他疾病的患者应选用药物治疗。

目前,美国食品药品监督管理局(FDA)共批准5 类减肥药物,包括包括芬特明托吡酯、利拉鲁肽、纳曲酮- 安非他酮、氯卡色林及奥利司他,其中胰高血糖素样肽-1(GLP-1)类似物因其降糖及心血管保护作用获得广泛关注。

手术减重

《中国超重/ 肥胖医学营养治疗专家共识(2016年版)》提出,对于BMI ≥ 35,存在危险因素或严重肥胖相关并发症即可进行手术治疗。

2016 年美国临床内分泌医师学会(AACE)/ACE 提出,肥胖(BMI ≥ 30)和糖尿病患者在生活方式及药物治疗效果不理想时,可考虑手术治疗。

目前临床上常用的减重术式主要有4 种:可调节绑带术、旁路术、袖套样胃减容术、胆胰旷置术与十二指肠转位术。

其中,袖套样胃减容术是肥胖合并中重度2型糖尿病的首选术式,胃旁路术适用于体重基数大、糖尿病病程长的患者。

美国糖尿病学会发布的2017年版糖尿病医学诊疗标准将“减重手术”更名为“代谢手术”,进一步突出手术对于肥胖患者异常代谢的改善作用。

作者表示,通过生活方式干预、药物治疗及外科手术等方式减重后,肥胖合并糖尿病及冠心病患者能获得明显的代谢及心血管收益,但如何对患者进行科学的个体化的体重管理仍然是临床上亟待解决的问题。

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    2020-02-15 shalley69
  5. [GetPortalCommentsPageByObjectIdResponse(id=1816153, encodeId=40f9181615346, content=<a href='/topic/show?id=fc4e9e348b6' target=_blank style='color:#2F92EE;'>#阜外医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97348, encryptionId=fc4e9e348b6, topicName=阜外医)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Tue Aug 11 11:48:00 CST 2020, time=2020-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1634667, encodeId=f167163466e8b, content=<a href='/topic/show?id=5fa02543864' target=_blank style='color:#2F92EE;'>#代谢手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25438, encryptionId=5fa02543864, topicName=代谢手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d4d422235205, createdName=贵阳, createdTime=Tue Apr 07 09:48:00 CST 2020, time=2020-04-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1293748, encodeId=e7d61293e48a8, content=<a href='/topic/show?id=4c6e9e34931' target=_blank style='color:#2F92EE;'>#阜外医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97349, encryptionId=4c6e9e34931, topicName=阜外医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Sat Feb 15 16:48:00 CST 2020, time=2020-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497536, encodeId=2bd3149e53640, content=<a href='/topic/show?id=21146026446' target=_blank style='color:#2F92EE;'>#更名#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60264, encryptionId=21146026446, topicName=更名)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d5619335471, createdName=shalley69, createdTime=Sat Feb 15 16:48:00 CST 2020, time=2020-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=379220, encodeId=db1e3e92206f, content=学习了学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJm4xPKAf4u6XWj35VVrjsS7zV0iceXLnUFyPcpCEs1Zws5knTcAxG7qOtflUuDHnbmVwUSbawnTUw/132, createdBy=4bea5277230, createdName=lian6388, createdTime=Fri Feb 14 08:33:42 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=379216, encodeId=79193e921690, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Feb 14 04:49:08 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042975, encodeId=402410429e591, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Fri Feb 14 04:48:00 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048295, encodeId=8e001048295d5, content=什么时候有懒人用的减肥神药?, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Fri Feb 14 04:48:00 CST 2020, time=2020-02-14, status=1, ipAttribution=)]
    2020-02-14 lian6388

    学习了学习了

    0

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    2020-02-14 phoebeyan520

    学习了

    0

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    2020-02-14 misszhang

    谢谢MedSci提供最新的资讯

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1816153, encodeId=40f9181615346, content=<a href='/topic/show?id=fc4e9e348b6' target=_blank style='color:#2F92EE;'>#阜外医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97348, encryptionId=fc4e9e348b6, topicName=阜外医)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Tue Aug 11 11:48:00 CST 2020, time=2020-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1634667, encodeId=f167163466e8b, content=<a href='/topic/show?id=5fa02543864' target=_blank style='color:#2F92EE;'>#代谢手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25438, encryptionId=5fa02543864, topicName=代谢手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d4d422235205, createdName=贵阳, createdTime=Tue Apr 07 09:48:00 CST 2020, time=2020-04-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1293748, encodeId=e7d61293e48a8, content=<a href='/topic/show?id=4c6e9e34931' target=_blank style='color:#2F92EE;'>#阜外医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97349, encryptionId=4c6e9e34931, topicName=阜外医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Sat Feb 15 16:48:00 CST 2020, time=2020-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497536, encodeId=2bd3149e53640, content=<a href='/topic/show?id=21146026446' target=_blank style='color:#2F92EE;'>#更名#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60264, encryptionId=21146026446, topicName=更名)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d5619335471, createdName=shalley69, createdTime=Sat Feb 15 16:48:00 CST 2020, time=2020-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=379220, encodeId=db1e3e92206f, content=学习了学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJm4xPKAf4u6XWj35VVrjsS7zV0iceXLnUFyPcpCEs1Zws5knTcAxG7qOtflUuDHnbmVwUSbawnTUw/132, createdBy=4bea5277230, createdName=lian6388, createdTime=Fri Feb 14 08:33:42 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=379216, encodeId=79193e921690, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Feb 14 04:49:08 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042975, encodeId=402410429e591, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Fri Feb 14 04:48:00 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048295, encodeId=8e001048295d5, content=什么时候有懒人用的减肥神药?, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Fri Feb 14 04:48:00 CST 2020, time=2020-02-14, status=1, ipAttribution=)]
    2020-02-14 CHANGE

    什么时候有懒人用的减肥神药?

    0

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2018年9月,《JAMA》杂志在线发表了美国预防服务工作组(USPSTF)近期对减肥以预防肥胖相关疾病的最新声明,明确指出不推荐使用减肥药物。 该声明建议,临床医生应向肥胖(体重指数≥30 kg / m2)的成年人推荐强化的行为干预措施。

病例分享:改善胰岛功能、减重是肥胖合并2型糖尿病的重要治疗目标!

患者,男性,42岁。2016年3月,患者因“口干、多饮、多尿、多食8年,双眼视物模糊半年,加重4天”入院。患者于8年前明确诊断为2型糖尿病,不规律用药,二甲双胍 500 mg tid +地特胰岛素 16 u QN。

CNS Drugs:抗精神病药增加儿童和青少年体重 “神药”二甲双胍能减重吗?

体重增加是第二代抗精神病药(SGAs)的一个潜在顾虑的不良反应。二甲双胍,一种具有降糖作用的双胍类药物,被用于管理使用SGAs进行治疗的成人的体重。2018年9月,发表在《CNS Drugs》的一项系统评价和荟萃分析调查了二甲双胍对SGAs治疗儿童和青少年体重增加的影响。