重度肥胖患者內臟脂肪和逆流性食道炎之關係

The Relationship Between Visceral Adiposity and the Risk of Erosive Esophagitis in Severely Obese Patients

戴啟明(Chi-Ming Tai)

指導教授 ： 王文明

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00066

摘要

研究背景:肥胖患者比非肥胖患者有較高逆流性食道炎的盛行率; 然而，仍然令人不解的是，在肥胖患者中，一些患者會得到逆流性食道炎但其他人卻不會。因此，在這個研究中，我們想要探討重度肥胖華人得到逆流性食道炎的危險因子。

研究方法:這個橫斷面研究包含從2007年6月到2009年1月之間，共260名接受減重手術的重度肥胖患者。所有患者接受術前內視鏡檢查並評估是否出現逆流性食道炎並評估其嚴重程度。我們測量人口統計學的因子、人體測量學的因子和代謝因子並利用多重邏輯迴歸分析來探討造成重度肥胖患者逆流性食道炎的危險因子。在部分患者身上，我們也用電腦斷層來測量其內臟脂肪並分析其和逆流性食道炎危險因子是否相關。

結果:在260位重度肥胖患者中，有84位有逆流性食道炎，其盛行率為32.3%。多重邏輯迴歸分析顯示較大的腹圍(odds ratio = 1.03， 95%信賴區間= 1.01到1.04)，較高的胰島素抗性(odds ratio = 1.57， 95%信賴區間= 1.06到2.31)以及出現食道逆流症狀 (odds ratio = 2.40，95%信赖區間= 1.22到4.74)是逆流性食道炎的獨立危險因子。在17位接受電腦斷層患者中，相關分析(Pearson’s correlation coefficients)發現內臟脂肪和腹圍(r = 0.71, P < 0.01)和胰島素抗性(r = 0.59, P = 0.01)有明顯相關。

結論:總而言之，在重度肥胖患者中，較大的腹圍和較高的胰島素抗性是逆流性食道炎的危險因子，這顯示內臟脂肪和逆流性食道炎的發生扮演相當重要的角色。

關鍵字

肥胖 ； 內臟脂肪 ； 胰島素抗性 ； 逆流性食道炎

並列摘要

Background: A higher prevalence of erosive esophagitis is found in obese than in non-obese patients; however, it remains unclear why some obese patients develop this disease, but others do not. Accordingly, we elucidated the risk factors associated with erosive esophagitis in severely obese patients.

Method: Between June 2007 and January 2009, a total of 260 Chinese patients with severe obesity referred for bariatric surgery were enrolled in this cross-sectional study. All patients received preoperative endoscopy for evaluation of the presence and severity of erosive esophagitis. Demographic variables, anthropometric measurements, and metabolic factors were included in a logistic regression model to identify the factors predictive of erosive esophagitis. Computed tomography further correlated significant risk factors with visceral adipose tissue in a subset of patients.

Result: The prevalence of erosive esophagitis was 32.3%. Multiple logistic regression showed that increased waist circumference (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01 to 1.04), increased insulin resistance (OR = 1.57, 95% CI = 1.06 to 2.31) and presence of reflux symptoms (OR = 2.40, 95% CI = 1.22 to 4.74) were independent risk factors associated with erosive esophagitis. Pearson’s correlation coefficients showed waist circumference (r = 0.71, P < 0.01) and HOMA (r = 0.59, P = 0.01) were significantly correlated with visceral adipose tissue in the interpretation of computed tomography in 17 patients.

Conclusion: Among patients with severe obesity, increased waist circumference and insulin resistance were risk factors for erosive esophagitis, which highlights the critical role of visceral adiposity in the pathogenesis of erosive esophagitis.

並列關鍵字

obesity ； visceral adiposity ； insulin resistance ； erosive esophagitis

參考文獻

1. Vakil N, Van Zanten SV, Kahrilas P et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence based consensus. Am J Gastroenterol 2006; 101: 1900–20.

2. Johnson DA , Fennerty MB. Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 2004; 126: 660–4.

3. Ronkainen J, Aro P, Storskrubb T et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixandra study report. Scand J Gastroenterol 2005; 40: 275–85.

4. Labenz J & Malfertheiner P. Helicobacter pylori in gastro-oesophageal reflux disease: causal agent, independent or protective factor? Gut 1997; 41: 277–80.

5. Pandolfino JE, Kwiatek MA, Kahrilas PJ. The pathophysiologic basis for epidemiologic trends in gastroesophageal reflux disease. Gastroenterol Clin North Am 2008;37:827-43, viii.