瑞典萨尔格伦斯卡大学医院Lena M.S. Carlsson团队研究了肥胖症患者减肥术后的预期寿命。2020年10月15日，该研究发表在《新英格兰医学杂志》上。

肥胖会缩短寿命。减肥手术可降低长期相对死亡风险，但对预期寿命的影响尚不清楚。

研究组进行了一项前瞻性、对照的瑞典肥胖研究（SOS），减肥手术组有2007名参与者，常规肥胖护理组有2040名参与者，从一般人群中随机抽取1135名参与者作为参考队列，对各组患者的死亡率和预期寿命进行分析。

手术组死亡率的中位随访时间为24年，对照组为22年；该研究中99.9％的患者可获得死亡数据。参考队列的中位随访时间为20年，且100％的参与者可获得死亡数据。手术组共有457例（22.8％）患者死亡，对照组有539例（26.4％），风险比为0.77。心血管疾病死亡的相应风险比为0.70，癌症死亡为0.77。手术组校正后的平均预期寿命比对照组长3.0年，但比普通人群短5.5年。90天术后死亡率为0.2％，手术组中有2.9％的患者接受了二次手术。

对于肥胖症患者，与常规肥胖治疗相比，减肥手术可显著延长预期寿命，但两组的死亡率仍高于普通人群。

附：英文原文

Title: Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study

Author: Lena M.S. Carlsson, M.D., Ph.D.,, Kajsa Sjholm, Ph.D.,, Peter Jacobson, M.D., Ph.D.,, Johanna C. Andersson-Assarsson, Ph.D.,, Per-Arne Svensson, Ph.D.,, Magdalena Taube, Ph.D.,, Bjrn Carlsson, M.D., Ph.D.,, and Markku Peltonen, Ph.D.

Issue&Volume: 2020-10-14

Abstract:

Background

Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear.

Methods

We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population.

Results

In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery.

Conclusions

Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population.

DOI: 10.1056/NEJMoa2002449

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2002449