需外科减重治疗腹型肥胖患者的病因分析

Factors analysis of the abdominal obesity patients needing bariatric surgery treatment

目的分析需外科减重治疗的腹型肥胖患者的发病因素。方法法国洛林大学附属Brabois医院内分泌外科行减重手术的腹型肥胖患者278例,体重指数(BMI)≥40 kg/m2或BMI≥35 kg/m2同时合并有肥胖相关代谢并发症(高血压、糖尿病、血脂紊乱),手术方式为腹腔镜胃袖状切除术50例,腹腔镜Roux-en-Y胃旁路术228例。观察患者的年龄、性别、BMI、腰围、臀围、胰岛素抵抗程度(HOMA-IR)、既往史和肥胖相关代谢并发症,分析与BMI和腹型肥胖程度(腰围、腰臀比)相关的因素。结果单因素分析结果表明,与不吸烟人群比较,吸烟人群的男性比例较高,体重较大,腰围较大,腰臀比较大,对数转换后HOMA-IR较高,高血压病比例较高,差异有统计学意义(P<0.05)。单因素分析结果表明,吸烟对肥胖症患者的BMI有影响(P<0.05);多因素分析中该差异显著性仍然存在(P<0.05)。单因素分析中,吸烟对腰围有显著影响(P<0.05),多因素分析模型2中吸烟对腰围有显著影响(P<0.05)。结论在腹型肥胖症患者中,吸烟可能增加BMI和腰围。

Objective To analysis of the incidence factors of abdominal obesity in patients who requiring bariatric surgery. Methods Collect data of 278 cases of abdominal obesity patients undergoing bariatric surgery in the Endocrinology Surgery Department of Brabois Hospital of Lorraine University,the surgical indications are the body mass index（ BMI） ≥40 kg/m2 or BMI≥35 kg/m2 combined with obesityrelated metabolic complications（ hypertension,diabetes,dyslipidemia）,the surgical approaches are 50 cases of Laparoscopic Sleeve Gastrectomy（ LSG） or 228 cases of Laparoscopic Roux-en-Y Gastric Bypass（ LRYGB）. To analyze the reference factor related to BMI and degree of abdominal obesity（ waist circumference waist/hip circumference ratio） by observing the patients＇ age,gender,BMI,waist circumference,hip circumference,HOMA-IR,past history and the information of obesity-related metabolic complications.Results The results of univariate analysis showed that the proportion of male smokers was higher than non-smokers,and also showed that the proportion of smoker with heavier body weight,larger waist circumference,greater waist/hip circumference ratio,and higher HOMA-IR Logarithmic conversion value,higher proportion of hypertension,these results had statistically significant differences（ P〈0. 05）. In the univariate analysis,smoking had a significant effect on the body mass index of abdominal obesity patients（ P〈0. 05）,the significant difference was still present in multivariate analysis（ P〈0. 05）. In the univariate analysis,smoking had a significant effect on the waist circumference（ P〈0. 05）,in the multivariate analysis model 2,the smoking had a significant effect on the waist circumference（ P〈0. 05）. Conclusion Among patients with morbidly obesity,smoking may increase body mass index and waist circumference.