单纯性肥胖的外科手术治疗

随着我国人民生活水平的不断提高,人们的营养物质摄入不断增加,肥胖症已在我国普遍存在,因肥胖而导致的如高血压、心脏病、脂肪肝、糖尿病、中风等疾病有明显地上升趋势。直接影响着人们的健康安全,怎样有效地扼制肥胖已成为医学界研究的重要课题。以往的方法,如药物减肥,虽然能达到一定的疗效、但不能持久,且易反弹,达不到永久治疗肥胖的目的。自1996年6月～2003年6月,我们通过外科手术的方式治疗单纯性肥胖的患者共12例,收到良好的临床效果。现总结报告如下：     

肥胖治疗的新进展

南非荒芜的喀拉哈里沙漠，几乎没有任何食物。极少数生命力顽强的植物能够在那儿生存，其中之一便是叫作xhoba或hoodia的绿色的仙人掌。当地人外出在沙漠中时便以hoodia仙人掌为食，因为hoodia不仅仅含有基本的营养。在贫瘠的沙漠里很难想像找出治疗肥胖的药物，然而hoodia似乎正有此作用。     

肥胖的外科治疗方法比较

随着人们生活水平的提高,肥胖已经成为影响人类健康的重要问题,肥胖所带来的三高（高血压、高脂血症、高血糖）、非酒精性脂肪肝病、高尿酸血症、糖耐量异常、代谢综合征等一系列并发症,给患者身心健康带来了严重损害。巨额的医疗费用,严重制约着社会、经济的发展。目前,肥胖的主要传统治疗措施包括：限制摄入量、加强有氧运动、行为的纠正、某些严重的患者需要药物治疗,但由于上述措施自身的缺点、医疗费用的高昂、以及患者自身行为习惯难以改变且需长期坚持,导致病人依从性较差,往往导致治疗失败或体重减轻一段时间后很快出现反弹。上世纪50年代,欧洲首先提出了采用手术治疗肥胖的方法,尤其是北欧,该地区由于国家的富裕,人们日常饮食多以高热量、高脂肪、高蛋白质食物为主,且具有完善的社会保障体系,所以肥胖患者较多。目前临床上流行的减肥手术主要由两大类组成,分别为吸收不良型和限制型。     

肥胖外科治疗研究进展

肥胖已于1997年被世界卫生组织列为全球性流行病,不管是从生理上还是从心理上,它都容易引发一系列疾病,给肥胖患者带来莫大的压力与痛苦。一些简单保守的减肥方法已无法达到预期效果,减肥手术已然成为了治疗肥胖病的有效方法。从传统的吸收不良型手术到胃内水球术、腹腔镜可调节胃束带手术,肥胖外科的发展日新月异,广大肥胖患者将会有更加健康的明天。     

瑞格列奈治疗肥胖及非肥胖2型糖尿病80例

目的 :观察瑞格列奈对肥胖及非肥胖 2型糖尿病患者的降糖效应 ,并与格列吡嗪进行比较。方法 :12 0例 2型糖尿病患者入选 ,按体重指数 (BMI)≥ 2 5和≤ 2 4分为DM1和DM 2两组 ,每组各 6 0例。 2组均有 4 0例用瑞格列奈 0 .5～ 1mg ,tid ,2 0例用格列吡嗪 5～ 10mg ,tid ,疗程 12周 ,比较两药对空腹血糖 (FBS)、餐后 2h血糖(PBS)、糖基化血红蛋白 (HbA1C)及BMI的影响。结果 :经 12周治疗后 ,在DM 1组接受瑞格列奈治疗的患者的FBS ,PBS ,HbA1C和BMI值较格列吡嗪治疗的患者显著降低 (P <0 .0 5和P <0 .0 1) ;在DM2组仅PBS水平瑞格列奈组明显低于格列吡嗪组 (P <0 .0 5 )。DM 2组BMI均有上升趋势 ,但 2组比较差异无显著性。消化道不良反应及低血糖的发生率瑞格列奈低于格列吡嗪。结论 :对于 2型糖尿病患者瑞格列奈的疗效优于格列吡嗪。     

痛风发病机理及其药物治疗现状和展望

目的探讨痛风的中西医发病机理,及其药物治疗情况的研究概况。方法参阅近年来国内外文献资料,并进行整理、综述。结果分别归纳分析了痛风的中医发病机理与人体肝、脾、胃、肾的关系,痛风的西医发病机理与人体尿酸排泄减少和尿酸生成过多的关系。同时,分别总结分析了中、西药物治疗痛风的进展。结论在此基础上,认为结合痛风的中医发病机理,从调节肝、肾、脾、胃功能入手,从中医药和天然药中寻找并开发出疗效明确、毒副反应少的抗痛风和高尿酸血症药物,尤其是治疗慢性痛风的中成药,对痛风药物的发展具有重要意义。     

药物治疗肥胖的现状及展望

肥胖是当今医学界的一个热门话题,这是因为肥胖与许多疾病有密切关系,在世界范围内,肥胖发病率很高,且有不断上升的趋势。早在1948年,肥胖就被定义为一种疾病,直到1980年才引起医学界的重视。许多国家相继宣称进入或将进入老龄化社会,中国在2000年进入老龄化社会,即60岁以上人口占总人口数的10％。影响人类社会的重大因素也许并不是老龄化本身,而是老龄化后群体的健康问题。当今危害人类健康的重要因素之一肥胖,在新世纪将显得更加突出。目前肥胖的发病状况是:在欧美国家现有1/3的人属肥胖,有1/2的人属超重,在40岁以上的人群     

Restraint and age at onset of obesity

Dietary restraint in 30 obese females was examined in relation to age at onset of obesity. Juvenile-onset obese individuals were found to experience significantly more restraint in their eating behavior than adult-onset obese individuals, based on responses to Herman's revised Restraint Questionnaire. Restraint score was significantly correlated with both age at onset and duration of obesity, but not with weight, percent overweight, or present age. Possible biological and psychosocial contributors to the age at onset effect are discussed, as are implications of restraint differences for treatment.     

Age of onset and body dissatisfaction in obesity

This study investigated variation in body dissatisfaction among obese women in relation to age of onset of obesity, and evaluated the contribution of teasing about weight and self-esteem as possible causes of higher body dissatisfaction in the early-onset group. One hundred and five obese women (body mass index [BMI] > or =30), recruited from clinical settings in England, completed a mailed questionnaire. The early-onset group (by age 16) had a higher BMI, greater body dissatisfaction, and lower self-esteem. Predictably, they also reported more childhood teasing. Path analyses confirmed our expectation that early onset of obesity has an adverse effect on body image, which is independent of current BMI. Regression analyses failed to support the hypothesized mediating role of either childhood teasing or lower self-esteem. The possible direction of causal effects between body dissatisfaction and self-esteem is discussed, with the suggestion that early onset of obesity increases the risk of body dissatisfaction, which in turn impairs self-esteem.     

Methodological issues related to age of onset of obesity

Research related to age of onset of obesity may be hampered by two methodological problems: (a) inconsistencies across studies in the criteria used to define early-onset and maturity-onset obesity and (b) the failure to control for other differences between early-onset and maturity-onset obese patients. Analyzing data from 178 applicants to a behavioral weight control program, this study found that almost twice many patients were classified as early-onset obese when the division was based on their answer to the question, “Were you overweight as a child or teenager?” than when the division was based on self-reported weight at age 21. Moreover, early-onset obese patients were younger and heavier than those with maturity-onset obesity. Further studies are needed to determine the most reliable and valid means of classifying patients as early- or maturity-onset obese.     

Medical therapy for obesity

Obesity results from a prolonged small positive energy imbalance, and treatment needs to reverse this imbalance. Many different diets have been tried to treat obesity, and weight loss occurs with all of them. There is currently no evidence that supports the superiority of one macronutrient composition for diets over any other. The principal effect seems to be the degree of adherence to the prescribed calorie reduction. Obesity drugs have been developed that tap brain mechanisms for controlling feeding and the gastrointestinal tract and its peptides. Orlistat blocks intestinal lipase and produces modest weight loss. Sibutramine is a serotonin-norepinephrine reuptake inhibitor that has a warning on its label from the US Food and Drug Administration because of cardiovascular risk. Its marketing has been suspended in Europe. Several drug combinations are on the horizon for treatment of obesity.