胃切除不同消化道重建方式术后叶酸、维生素B12及铁蛋白水平的随访研究

Follow-up Study on the Levels of Folate, Vitamin B12 and Ferritin after Gastric Resection with Different Methods of Digestive Tract Reconstruction

目的:探究胃切除不同消化道重建方式术后叶酸、维生素B12及铁蛋白水平的变化规律及其影响因素。方法:100例外科手术治疗患者,根据胃切除范围和消化道重建方式分,分为A组(远端胃切除后行毕Ⅰ式重建)33例、B组(远端胃切除后行毕II式重建)34例、C组(全胃切除术后行Roux-en-Y重建)33例,检测三组手术前后叶酸、维生素B12及铁蛋白水平并比较,分析各组手术前后三项指标的变化。根据术后是否发生叶酸、维生素B12及铁蛋白缺乏分为缺乏组48例和未缺乏组52例,对两组各影响因素进行分析,对缺乏组的临床因素行Logistic多因素回归分析。结果:(1)叶酸、维生素B12、铁蛋白水平组内比较分析:A组、B组、C组术后各时间点均低于术前,差异有统计学意义(P<0.05);A组术后1~3月内水平降低,术后6月逐渐回升并趋于稳定;B、C组术后各时间点水平呈逐渐下降趋势。(2)叶酸、维生素B12、铁蛋白水平组间比较分析:三组术前比较差异无统计学意义(P>0.05);术后各时间点水平比较A组>B组>C组,其中术后6个月、9个月和12个月时,A组与B组、C组差异有统计学意义(P<0.05)。(3)缺乏组和未缺乏组单因素分析:年龄、性别、胃切除范围、术前血液学指标差异有统计学意义(P<0.05)。(4)Logistic多因素回归分析:年龄、胃切除范围、术前血液学指标是叶酸、维生素B12及铁蛋白缺乏的危险因素。结论:胃切除不同消化道重建方式术后叶酸、维生素B12及铁蛋白水平均有所下降,但相较于远端胃切除后行毕II式重建和全胃切除术后行Roux-en-Y重建、远端胃切除后行毕Ⅰ式重建影响比较小。叶酸、维生素B12及铁蛋白缺乏的危险因素主要有年龄、胃切除范围、术前血液学指标,临床应针对性加强防治。

Objective:to investigate the changes in the levels of folate,vitamin B12 and ferritin after gastric resection with different digestive tract reconstruction and the influencing factors.Methods:100 patients with surgical treatment,according to the scope of the gastric resection and the way of digestive tract reconstruction,were divided into group A(33 cases,tyope I reconstruction after distal gastric resection)and group B(34 cases,type II reconstruction after distal gastric resection),and group C(33 cases,Roux en-Y reconstruction after total gastrectomy),with folate,vitamin B12 and ferritin in the three groups detected and their levels compared among the three groups before and after operation,and with the changes in the three indicators before and after the operation analyzd in each group.According to whether folate,vitamin B12 and ferritin deficiency would occurr after the operation,all the patients were further divided into the deficiency group(48 cases)and the non-deficiency group(52 cases),with the influencing factors in the two groups analyzed,and with the clinical factors of the deficiency group analyzed by Logistic multivariate regression.Results:(1)comparison and analysis of folate,vitamin B12 and ferritin levels in each group:The levels of folate,vitamin B12 and ferritin at each time point in group A,group B,and group C were lower after operation than those before the operation(P<0.05).The levels of folate,vitamin B12 and ferritin in the group A decreased 1-3 months after the operation,and gradually recovered and stabilized 6 months after operation,and there was a gradually decreasing trend in the levels of folate,vitamin B12 and ferritin at each time point after operation in group B and C.(2)comparison and analysis of folate,vitamin B12 and ferritin levels among the three groups:There was no significant difference in the levels of folate,vitamin B12 and ferritin before operation among the three groups(P>0.05).There were significant differences in the levels of folate,vitamin B12 and ferritin at each time point between group A and group B and group C 6,9 and 12 months after the operation(P<0.05).(3)Univariate comparison and analysis between the deficiency group and the non-deficiency group:There were significant differences in age,gender,gastric resection range and preoperative hematological indexes between the two groups(P<0.05).Logistic multivariate regression analysis showed that age,gastrectomy range and preoperative hematology were risk factors for the deficiency of folate,vitamin B12 and ferritin.Conclusion:The levels of folate,vitamin B12 and ferritin decreased after the Gastric resection with different ways of the digestive tract reconstruction.Compared with type II reconstruction after distal gastric resection and Roux en-Y reconstruction after total gastrectomy,tyope I reconstruction after distal gastric resection can bring about little adverse effect on the levels of folate,vitamin B12 and ferritin.The risk factors for folate,vitamin B12 and ferritin deficiency mainly include age,range of gastric resection and preoperative hematological indexes,to which much attention should be paid in the clinical treatment and prevetion.