Improvement Of Hyperuricemia In Obese Patients Undergoing Bariatric Surgery

Objective:The purpose of this study includes:(1)To analyze the prevalence of hyperuricemia in patients undergoing obesity surgery;(2)To analyze the changes of serum uric acid after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y-gastric bypass surgery;(3)Analysis of hyperuricemia risk factors and predictors of serum uric acid improvement.Methods:A retrospective review of a prospectively collected database was conducted in the patients undergoing RYGB and LSG in our hospital between January 2016 and December 2017.An physical examination data and blood biochemistry data were collected before surgery,at 3 months postoperatively,at 6 months postoperatively and at 12 months postoperatively.Preoperatively,3 months postoperatively,6 months postoperatively and 12 months postoperatively,SUA and relevant metabolic parameters were compared.Statistical analysis was carried by using SPSS23.0 software,stratified analysis was performed by surgical methods,t text,Wilcoxon text and chi-square test were used for comparison between groups,Pearson’s or Spearman’s correlation analysis was used to assess the correlation between SUA and clinical biochemical indexes.Results:(1)This study enrolled 329 patients(109 RYGB,220 SG),including 106 men and 223 women.The prevalence of HUA was 69.6%,the prevalence of gout was 7.9%,the prevalence of hyperlipidemia was 61.4%,and the prevalence of T2 DM was 26.4%.(2)The number of cases involving multivariate logistic regression analysis was 279.Among the analysis,Statistically significant indicators include age,gout prevalence,waist circumference,Cr,BUN,and γ-GT(P<0.05).The risk factors of HUA may be gout,hip circumference,Cr and γ-GT(OR>1).the protective factors of HUA may be age and BUN(OR<1).(3)The SUA at 3 months postoperatively was slightly higher than that before surgery,and the SUA level was significantly decreased at 6 months postoperatively and at 12 months postoperatively.(4)Correlation analysis showed that changes of BMI level and changes of Cr level was correlated with changes of SUA level(P<0.05).The correlation coefficient between ΔBMI and ΔSUA is-0.386,and the correlation coefficient between ΔCr and ΔSUA is 0.45.(5)Predictive factor analysis showed that changes of SUA level was closely related to SUA baseline value,BMI baseline value,body fat percentage,Cys-C,waist circumference,and FPG(P<0.05).According to the model,the multiple linear regression equation can be established as: ΔSUA=245.496-0.743(SUA)-14.297(body fat percentage)+23.989(BMI)+89.143(CysC)-3.471(waist circumference)+5.142(FPG).Conclusions:(1)Both LRYGB and LSG can significantly improve the SUA level in obese patients,and the degree of improvement in SUA levels is similar between the two procedures.(2)Risk factors for HUA include waist circumference,Cr and γ-GT.Not only obesity patients,but also the general population should control the waist circumference to help prevent HUA.In addition to measuring uric acid indicators,HUA patients should also pay attention to changes in Cr and γ-GT indicators.(3)Patients should actively lose weight and reduce the BMI baseline value before surgery.Patients with T2 DM also need to actively control blood glucose before surgery.Because patients with lower BMI and FPG baseline values may get better SUA improvement after surgery.(4)Patients with gout or chronic HUA should actively reduce uric acid and be given low purine diet during perioperative period to prevent postoperative acute gout attacks and accelerating postoperative recovery.