肥胖合并暴食症患者的代谢相关数据分析

Metabolism related data analysis of obesity complicated with binge eating disorder

目的研究肥胖患者中暴食症(BED)的发生率、BED对肥胖患者各项临床生化指标、肥胖相关并发症及减重手术效果的影响。方法选取四川省成都市第三人民医院肥胖与代谢中心2018年1月至2019年10月收治的236例肥胖患者为研究对象。采取问诊及填写问卷的方式进行数据收集,依据美国精神障碍诊断统计手册第五版(DSM-V)与进食障碍检测问卷(EDE-Q)对BED的评判标准分为非BED组(NBED组)和BED组,比较两组BMI、臀围等基础指标;尿酸(BUN)、三酰甘油(TG)、胆固醇(TC)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、2 h口服葡萄糖耐量试验(OGTT)血糖等临床生化指标及常见并发症;减重术后1、3个月多余体重减少百分比(EWL)值。结果肥胖伴BED者占比为25.4%(60/236)。BED组腰围高于NBED组[(123.64±13.21)cm vs.(117.15±16.84)cm],差异有统计学意义(P=0.007)。BED组尿酸[(466.50±124.55)mmol/L vs.(423.62±133.92)mmol/L,P=0.030]、TG[(2.32±1.28)mmol/L vs.(1.72±0.76)mmol/L,P<0.01]、HbA1c[(6.48±1.50)mmol/L vs.(5.77±0.83)mmol/L,P<0.01]、2 h OGTT血糖[(9.25±3.92)mmol/L vs.(7.94±2.82)mmol/L,P=0.019]水平均高于NBED组,差异有统计学意义;BED组2型糖尿病(T2DM)、高脂血症、高胰岛素血症的发生率均高于NBED组,差异有统计学意义(P<0.05);BED组减重术后1、3个月EWL值均低于NBED组,差异有统计学意义(P<0.05)。单因素logistic回归分析显示:高脂血症(P=0.035)、T2DM(P=0.02)、TG(P<0.01)、2 h OGTT血糖(P=0.019)、腹围(P=0.018)、高胰岛素血症(P=0.032)与BED有关;多因素logistic回归分析显示:高脂血症(OR=1.783,95%CI:1.015~3.216)、腹围(OR=1.022,95%CI:1.003~1.041)、TG(OR=1.722,95%CI:1.260~2.355)为BED的危险因素。结论肥胖合并BED的患者较非BED肥胖患者更易发生代谢综合征相关糖脂代谢紊乱,但在血压、睡眠呼吸暂停综合征等并发症方面无明显差异。肥胖合并BED可能会影响减重手术的效果。

Objective To study the incidence of binge eating disorder(BED)in obese patients and the influence of BED on various clinical biochemical indicators,obesity-related complications and the effect of sleeve surgery in obese patients.Methods A total of 236 obese patients admitted to the Obesity and Metabolism Center of the Third People′s Hospital of Chengdu City from January 2018 to October 2019 were selected as subjects.Data collection was conducted by means of questionnaires.Patients were divided into the non-BED groups(NBED group)and the BED group according to the criteria for BED from the DSM-V and EDE-Q.Basic indicators such as BMI and hip circumference between the two groups were compared.Triacylglycerol(TG),cholesterol(TC),glycosylated hemoglobin(HbA1c),fasting blood glucose(FPG),2 h OGTT blood glucose and other clinical biochemical indicators and common complications between the two groups were also compared.EWL values at 1 and 3 months after sleeve surgery were also compared.Results The proportion of obese patients with BED was 25.4%(60/236).The waist circumference of the BED group was higher than that of the NBED group[(123.64±13.21)cm vs.(117.15±16.84)cm],and the difference was statistically significant(P=0.007).The uric acid[(466.50±124.55)mmol/L vs.(423.62±133.92)mmol/L,P=0.030)],TG[(2.32±1.28)mmol/L vs.(1.72±0.76)mmol/L,P<0.01)],HbA1c[(6.48±1.50)mmol/L vs.(5.77±0.83)mmol/L,P<0.01)],2 h OGTT blood glucose[(9.25±3.92)mmol/L vs.(7.94±2.82)mmol/L,P=0.019)]in the BED group were higher than that of the NBED group,and the differences were statistically significant.The incidence of type 2 diabetes mellitus(T2DM),hyperlipidemia and hyperinsulinemia in the BED group were higher than that of the NBED group,and the difference were statistically significant(P<0.05).The EWL values after sleeve surgery in the BED group were lower than that of the NBED group at the time of 1 and 3 months after surgery,and the difference were statistically significant(P<0.05).Univariate logistic regression analysis showed that hyperlipidemia(P=0.035),T2DM(P=0.02),TG(P<0.01),2 h OGTT blood glucose(P=0.019),abdominal circumference(P=0.018),hyperinsulinemia(P=0.032)were related to BED;multivariate logistic regression analysis showed that hyperlipidemia(OR=1.783,95%CI:1.015-3.216),abdominal circumference(OR=1.022,95%CI:1.003-1.041),TG(OR=1.722,95%CI:1.260-2.355)were risk factors for BED.Conclusion Obese patients with BED are more likely to have metabolic syndrome-related disorders of glucose and lipid metabolism than simple obese patients,but there is no significant difference in blood pressure,the incidence of sleep apnea syndrome and other complications.Obesity patients with BED may affect the effect of weight loss surgery.