腹腔镜袖状胃切除术后早期减重效果的预测因素

Predictive Factors of Early Weight Loss after Laparoscopic Sleeve Gastrectomy

目的探讨腹腔镜袖状胃切除术(LSG)术后早期减重效果的预测因素。方法回顾性分析2015年8月至2018年1月在北京协和医院基本外科行LSG的64例肥胖患者的临床资料,采用相关系分析探讨不同临床指标与减重效果的关系,Logistic模型得到独立危险因素,受试者工作特征曲线评估其检验效能。结果相关性分析结果显示,患者术前的体质量指数(P=0.000,P=0.000,P=0.000)、腰围(P=0.000,P=0.000,P=0.000)、全身脂肪体积(P=0.000,P=0.006,P=0.003)、胰岛素抵抗指数(HOMA-IR)(P=0.000,P=0.000,P=0.002)和超敏C反应蛋白(hsCRP)(P=0.004,P=0.002,P=0.025)与患者术后3、6个月及1年的多余体质量减少百分比(EWL%)呈显著负相关,术后6个月的hsCRP与术后1年的EWL%呈显著负相关(P=0.029)。Logistic二元回归分析结果显示,腰围是早期减重效果的独立预测因素(P=0.018)。腰围142.5cm为最佳截断值时,Youden指数为最大值,敏感度为80%,特异度为87%。根据该值将患者分为高腰围组和低腰围组,结果显示,低腰围组患者术后3个月(t=6.677,P=0.000)、6个月(t=6.157,P=0.000)和1年(t=4.006,P=0.000)的EWL%明显高于高腰围组;术后6个月的hsCRP明显低于高腰围组(z=-3.510,P=0.000);术后HOMA-IR与高腰围组差异无统计学意义(z=-0.821,P=0.412)。结论腰围是LSG术后早期减重效果的独立预测指标,低腰围组患者的减重效果更好。

Objective To explore the clinical factors that can be used to predict the early weight loss after laparoscopic sleeve gastrectomy(LSG). Methods The clinical data of 64 obese patients undergoing LSG in Peking Union Medical College Hospital from August 2015 to January 2018 were retrospectively analyzed.We analyzed the relationship between different clinical factors and early weight loss,determined the independent predictors based on Logistic models,and estimated their test power by using the receiver operating characteristic(ROC)curves. Results Correlation analysis indicated that preoperative body mass index( P =0.000, P =0.000, P =0.000),waist circumference(WC)( P =0.000, P =0.000, P =0.000), whole body fat volume( P =0.000, P =0.006, P =0.003), homeostatic model assessment for insulin resistance(HOMA-IR)( P =0.000, P =0.000, P =0.002),and hypersensitive C-reactive protein(hsCRP)( P =0.004, P = 0.002, P =0.025)were negatively correlated with excess weight loss percentage(EWL %) after 3,6 and 12 months.Also,hsCRP after 6 months showed negative correlation with EWL % after 1 year( P =0.029).Binary Logistic regression analysis showed that WC was an independent predictor of early weight loss( P =0.018).ROC analysis showed that when the optimal cutoff value is 142.5 cm for WC, Youden index was highest,with a sensitivity of 80% and a specificity of 87%.Patients were further divided into low WC group and high WC group based on this optimal cutoff value.The low WC group had significantly higher EWL% than the high WC group 3 months( t =6.677, P =0.000),6 months( t =6.157, P =0.000),and 1 year( t =4.006, P =0.000)after surgery.The low WC group also had significantly lower hsCRP than high WC group 6 months after surgery( z =-3.510 , P =0.000). HOMA-IR showed no significant difference between these two groups( z =-0.821, P =0.412). Conclusions WC is an independent predictor of weight loss early after LSG.The patients with low WC have better weight loss effectiveness.