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目的研究内镜下胃壁注射A型肉毒毒素(BTX-A)治疗单纯性肥胖的有效性和安全性。方法10例单纯性肥胖患者为解放军总医院消化内科2008年12月至2009年3月收治患者,体重指数(BMI)28.6～46.41,随机分为2组,200U组内镜下胃窦、胃体、胃底共注射BTX-A200U,300U组胃窦、胃体、胃底共注射BTX-A300U。治疗前和治疗后1周、4周、12周分别对进食量、体重、BMI、胃半排空时间等进行随访。结果所有患者治疗后进食量较治疗前明显减少(P<0.05),至12周时仍较为明显;治疗后胃固体半排空时间均延长,且较治疗前差异有统计学意义(P<0.05);治疗后体重和BMI呈下降趋势,12周时体重减轻3～10kg,平均体重由(96.85±26.70)kg降至(91.10±26.15)kg(P<0.05),BMI由35.42±6.9降至33.31±6.92(P<0.05)。300U组BMI减少较200U组明显(P<0.05),但其余指标两组间相比差异无统计学意义。无明显不良反应发生。结论内镜下注射BTX-A能减慢胃排空、减少进食量,减轻体重,有望成为减肥治疗新手段。
Objective To study the efficacy and safety of endoscopic injection of botulinum toxin type A (BTX-A) in the treatment of simple obesity. Methods Ten patients with simple obesity were admitted to the Department of Gastroenterology, PLA General Hospital from December 2008 to March 2009. The body mass index (BMI) ranged from 28.6 to 46.41, and were randomly divided into 2 groups. The gastric antrum , Co-injection of BTX-A200U in the stomach fundus, group 300U gastric antrum, gastric body, gastric co-injection of BTX-A300U. Before treatment and after treatment, 1 week, 4 weeks, 12 weeks, respectively, intake, weight, BMI, gastric emptying time were followed up. Results All patients’ food intake after treatment was significantly lower than that before treatment (P <0.05), and remained obvious at 12 weeks. The half-emptying time of gastric solid was prolonged after treatment, and the difference was statistically significant (P <0.05) (P <0.05). The mean body weight decreased from (96.85 ± 26.70) kg to (91.10 ± 26.15) kg (P <0.05), and the BMI decreased from 35.42 ± 6.9 to 33.31 ± 6.92 (P <0.05). The decrease of BMI in 300U group was more obvious than that in 200U group (P <0.05), but there was no significant difference between the two groups in other indexes. No significant adverse reactions occurred. Conclusion Endoscopic injection of BTX-A can slow down gastric emptying, reduce food intake and reduce body weight, which is expected to be a new treatment for weight loss.