Newsletter No. 294

第二九四期 二零零七年三月十九日 No. 294 19 March 2007 5 手術有助治療嚴重肥胖代謝綜合症 Bariatric Surgery Offers Effective Treatment to Metabolic Syndrome in Severely Obese 醫 學院外科學系及內科及藥物治療學系,自二零 零二年起跟進了患代謝綜合症人士接受減肥手 術後的情況,發現逾九成九患者的病況有明顯改善。外 科學系和內科及藥物治療學系分析了五百零二名肥胖症 患者,當中四百一十二人(八成二)被介定為嚴重肥胖 (即體重指數超過三十)。在這群嚴重肥胖症患者中, 結果發現有二百七十六人(六成七)患有代謝綜合症 (發病率是一般人口的四倍)。其中一百一十六名患有 代謝綜合症的嚴重肥胖症人士進行了不同的減肥手術, 包括胃內水球手術、腹腔鏡束胃帶手術及腹腔鏡胃繞道 手術。手術後,九成九患者的代謝綜合症的情況有明顯 改善,而其中六成一患者的代謝綜合症情況則完全根 治。手術以微創技術來進行,只有少數人士出現併發 症。 代謝綜合症是導致心臟病、中風及糖尿病的高風險因 素,甚至加速死亡。本港一項最新的研究發現,本港華 人患上代謝綜合症的發病率約為一成七。根據國際糖尿 聯盟的標準,華裔男性和女性腰圍相等於或超過九十厘 米及八十厘米,西方男性和女性腰圍相等於或超過九十 四厘米及八十厘米,即屬中央肥胖人士,若他們的高密 度膽固醇、三酸甘油酯濃度、血壓和血糖濃度,有兩項 超標者,則已是患上代謝綜合症。 調節生活及作息時間、進 行適量運動、改善飲食習 慣及藥物治療可控制輕微 肥胖患者的代謝綜合症。 但對部分嚴重肥胖症者則 未必有效,減肥手術為目 前最有效及持久的體重及 改善代謝綜合症控制法。 R apid growth and development in the economy of Hong Kong and the Mainland brings about dietary changes and sedentary lifestyles. Obesity and its associated metabolic syndrome (MES) are increasingly becoming a health and social burden to the region. MES is a collection of heart disease risk factors that increase the chances of heart disease, stroke, and diabetes. It is also associated with premature mortality. A recent study estimates the prevalence of MES in Hong Kong’s Chinese population to be around 17%. While life-style modification, exercise, dietary training and medical therapy may be effective in controlling MES in slightly overweight people, these simple measures usually fail with the severely obese. Bariatric surgery has been proven to be the most effective and long-lastingmeasure in themanagement of such a condition. In recent years, it has become one of the most common operations in the Western world and is gaining popularity in Asia. The Department of Surgery and the Department of Medicine and Therapeutics of the Faculty of Medicine recently completed a study on the prevalence of MES in patients seeking bariatric surgery. A total of 502 patients were prospectively evaluated since 2002. About 82% were classified as severely obese with body mass index (BMI) of over 30. Study results discovered that the prevalence of MES in this group of patients was 67% — four times that of the normal population. A total of 116 severely obese patients (BMI > 30) with MES were treated with various bariatric procedures, including intragastric balloon, laparoscopic adjustable gastric banding and laparoscopic gastric bypass operation. After surgery, 99.1% showed significant improvement of MES and 61.2% of them were completely cured. All procedures were carried out by a minimally invasive approach. There was zero mortality and minimal complication. The results confirmed the feasibility and efficacy of bariatric surgery in treating MES among severely obese Chinese patients. 空氣污染嚴重 肺病患者入院率增 Air Pollution Increases Hospital Admissions of Pulmonary Disease Sufferers 慢 性阻塞性肺病(簡稱 慢阻肺病)是本港第 五號殺手,占二零零三年公 立醫院急症入院率的百分之 四以上。慢阻肺病為本港長 者(七十歲或以上)常見的疾 病,估計本港長者人口百分 之九是慢阻肺病患者。過往 的研究指出,病患者病發會 嚴重影響其肺功能及生活素 質。 內科及藥物治療學系和社區 及家庭醫學系合作研究空氣 中的污染物濃度與慢阻肺病 患者入院率的關係,研究結 果剛於 THORAX 醫學期刊 公布。 研究分析了二零零零年一月 至二零零四年十二月的有關數據,包括全港十五間主 要醫院慢阻肺病者入院數字、空氣污染物的濃度資料 (二氧化硫、二氧化氮、臭氧、十微米或以下的懸浮 粒子和二點五微米或以下的懸浮粒子)及其他有關的氣 象數據。 研究結果顯示,慢阻肺病患者入院數字與空氣污染物 濃度息息相關。每立方米的空氣污染物濃度上升十微 克—二氧化硫、二氧化氮、臭氧、十微米或以下的懸 浮粒子及二點五微米或以下的懸浮粒子,並分別增加慢 阻肺病患者入院率百分之零點七、二點六、三點四、二 點四及三點一。臭氧濃度對病患者入院率影響最大。與 天氣較和暖的季節比較,二氧化硫、二氧化氮及臭氧濃 度在天氣較冷季節(十二月至三月)對病患者入院率影 響較大。 總結而言,在本港,尤其在冬季,空氣污染物能增加 慢阻肺病患者的入院率,故改善空氣素質實在刻不容 緩。 I n Hong Kong, chronic obstructive pulmonary disease (COPD) was the fifth leading cause of death, and accounted for at least 4% of all public hospital acute admissions in 2003. The prevalence of COPD among elderly Chinese (age ≥ 70 years) living in Hong Kong is estimated to be 9%. Previous studies have shown that pulmonary function and quality of life among patients with COPD were adversely affected by frequent exacerbations. The Department of Medicine and Therapeutics and the Department of Community and Family Medicine of CUHK carried out a study which has just been published in the journal THORAX . The study assessed the relationship between the levels of ambient air pollutants and hospitalization rate due to COPD in Hong Kong. Data of daily emergency hospital admissions to 15 major hospitals in Hong Kong for COPD and indices of air pollutants and meteorological variables from January 2000 to December 2004 were obtained from several government departments. Significant associations were found between hospital admissions for COPD with the air pollutants, especially in the cold season. Adverse effects of ambient concentrations of air pollutants on hospitalization rates for COPD are evident. Measures to improve air quality are urgently needed.