多学科减重联合门诊对中国肥胖患者减重效果的研究

Multi-disciplinary team based obesity treatment in Chinese obese patients

目的探讨多学科联合减重门诊对肥胖的减重效果及减重成功率的影响因素。方法多学科减重门诊团队由2名内分泌科医师、2名营养师、2名康复科运动指导师、1名普外科医师、1名中医科医师以及多名健康教育护士组成。本团队自2015年6月至2017年6月共纳入在北京大学第一医院多学科减重门诊就诊的患者445例,平均年龄(37.6±12.5)岁,其中女性293例(65.8%),男性152例(34.2%)。在首诊后的3、6、12、18和24个月进行复诊,同时随访其体重及异常的代谢指标,并应用Logistic回归分析和χ2检验分析影响减重成功率的因素。结果多学科减重门诊患者每次随访体重均较基线体重显著下降(P<0.01)。此外,随访第6和12个月时的体重均较上一次随访体重显著下降[6个月比3个月:(87.2±20.2)比(87.8±19.8)kg,P<0.01;12个月比6个月:(86.7±19.0)比(87.2±20.2)kg,P<0.01]。定义体重较基线下降超过5%为减重成功时,多学科减重门诊患者中减重成功率达40.9%(179/438)~50.9%(110/216)。定义体重较基线下降超过10%为减重成功时,减重成功率逐渐由13.2%(58/438)升高至26.9%(14/52)。女性性别、基线体质指数(BMI)、腰围和减重治疗早期体重下降与减重成功率有关(P<0.01或P<0.05),应用二甲双胍与减重成功率无关(P>0.05)。结论多学科减重团队对肥胖患者的减重治疗具有显著效果。女性性别、基线BMI、腰围和减重治疗早期体重出现下降与减重成功率有关。

Objective To investigate the effect and associated factors of multi-disciplinary team approach on weight loss in Chinese obese patients.Methods The multi-disciplinary team for obesity in Peking University First Hospital consists of 2 endocrinologists,2 dieticians,2 exercise therapists,a bariatric surgeon,an acupuncturist and several health educators.A total of 445 patients treated by multi-disciplinary team were recruited from June 2015 to June 2017,the mean age was(37.6±12.5)years old,with 293 females(65.8%)and 152 males(34.2%).Patients were followed up at 3,6,12,18 and 24 months after their first visit.We analyzed body weight changes overs follow-up and factors that affected the successful rate in weight reduction using Logistic regression or chi-square analysis.Results Body weight declined significantly at each follow-up visit compared with baseline(P<0.01),and the reduction at 6 months and 12 months of follow-up were significant compared with corresponding former visit[6 months vs 3 months:(87.2±20.2)vs(87.8±19.8)kg,P<0.01;12 months vs 6 months:(86.7±19.0)vs(87.2±20.2)kg,P<0.01].Defining body weight reduction over 5%as success,the rate of success was as high as 40.9%-50.9%during visits.Defining the reduction of body weight over 10%as success,the successful rate gradually increased from 13.2%to 26.9%during visits.Female,baseline body mass index,waist circumference and weight reduction in early treatment phase were associated with weight-loss success rate(all P<0.01).There was no correlation between the use of metformin and weight-loss success rate(P>0.05).Conclusions A multi-disciplinary approach to manage obesity could significantly achieve the goal of body weight reduction.Female,baseline body mass index,waist circumference and weight reduction in early treatment phase are associated with successful weight control.