年龄因素对胃袖状切除术后患者临床结局的影响

Impact of age on the clinical outcome of sleeve gastrectomy

目的:比较不同年龄段肥胖症患者接受腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)的临床治疗结局。方法:选取2013—2018年在复旦大学附属浦东医院因肥胖合并代谢紊乱而接受LSG手术治疗且年龄介于16~65岁,并按要求完成术后第1、3、6、12个月随访的109例患者资料,按照年龄分为3组,分别为16~30岁组(56例)、31~45岁组(32例)和46~65岁组(21例),回顾性分析并比较3组患者在术后1、3、6和12个月体重相关指标、血糖代谢相关指标、血脂和血压的变化情况。计量资料采用重复测量方差分析,并以Bonferroni法对P值进行校正;分类变量使用χ2检验。结果:术前基线数据显示随着年龄增加,体重指数呈逐步降低趋势,16~30岁组、31~45岁组和46~65岁组分别为(40.1±5.9)、(37.1±6.6)、(35.3±7.4)kg/m 2,其余基线指标各组间差异无统计学意义(均P>0.05)。术后12个月时,各组患者体重减轻绝对数差异无统计学意义,但总体重减轻百分比(%TWL)和BMI减轻百分比(%TBMIL)随着年龄增加而显著性降低,其中16~30岁组、31~45岁组和46~65岁组%TBMIL分别为(32.3±7.5)%、(28.4±8.4)%(与16~30岁组相比P<0.05)和(25.7±8.2)%(与16~30岁组相比P<0.001)。在术前HbA1c>7%的患者中,术后12个月3组HbA1c下降绝对值依次为3.20%、2.64%和1.34%,46~65岁组显著低于16~30岁组(P<0.001)和31~45岁组(P<0.05),HbA1c<6.5%的患者占比分别为95.8%、88.9%和50.0%。3组患者低密度脂蛋白胆固醇、甘油三酯、和动脉血压均在术后3个月内快速下降,高密度脂蛋白胆固醇快速上升,但组间差异无统计学意义。结论:46~65岁组患者在LSG术后血糖代谢改善情况差于年轻患者,年轻患者所合并的2型糖尿病(T2DM)在LSG术后更易于获得临床缓解;在体重减轻方面,随着年龄的增长,%TWL和%TBMIL也呈现减低趋势。然而,术后血脂和血压的改善情况并不受患者年龄影响。本研究提示符合减重与代谢手术指征的患者,为了获得更优的临床结局,建议尽早接受手术治疗。

Objective To compare the effect of age on clinical outcome of laparoscopic sleeve gastrectomy(LSG)in the obese patients.Methods A total of 113 patients who underwent LSG due to obesity and metabolic disorders between 2013 and 2018 at Fudan University Pudong Hospital,and completed the scheduled follow-up(1,3,6,and 12 months after surgery)were included for the retrospective analysis.The patients were divided into three groups based upon pre-operative age,including 15 to 30 year-old group(n=58),31 to 45 year-old group(n=32),and 45 to 65 year-old group(n=23).The body weight related parameters,glycemic and metabolic related parameters,lipid panel as well as arterial blood pressure were compared at pre-operative baseline,1,3,6,and 12 months after surgery.The quantitative data were analyzed by repeated measurement ANOVA,and the P value was corrected by Bonferroni method.And the categorical variables were analyzed by chi square test.Results The preoperative baseline data showed that with the increase of age,the preoperative body mass index gradually decreased,which were(40.1±5.9)kg/m2,(37.1±6.6)kg/m2 and(35.3±7.4)kg/m2 in 16 to 30,31 to 45 and 46 to 65 year-old groups,respectively.Otherwise,other metabolic related parameters were comparable.At 12 months after LSG,there was no significant difference in the amount of weight loss among the groups,but the percentage of total weight loss(%TWL)and the percentage of total BMI loss(%TBMIL)decreased significantly with age increasing.The%TBMIL in 16 to 30,31 to 45 and 46 to 65 year-old groups were 32.3±7.5%,28.4±8.4%(P<005 compared with 16 to 30 year-old group)and 25.7±8.2%(compared with 16 to 30 year-old group P<0.001),respectively.In the patients with preoperative HbA1c>7%,HbA1c reduction in the three groups at 12 months after operation were 3.20%(compared with 46-65 year-old group P<0.001),2.64%(compared with 46-65 year-old group P<0.05)and 1.34%,respectively.The proportions of patients with HbA1c<6.5%were 95.8%,88.9%and 50.0%,respectively.LDL,triglyceride and arterial blood pressure in all groups decreased and HDL increased rapidly within 3 months after operation,but there was no significant difference among the three groups.Conclusions The improvement of blood glucose metabolism and the remission rate of type 2 diabetes mellitus(T2DM)in the patients with older age were worse than those in the younger patients,and the T2DM in the younger patients tends to obtain better clinical remission after LSG;in terms of weight loss,with the increase of age,%TWL and%TBMIL also showed a decreasing trend;however,the improvement of blood lipid and blood pressure after LSG was not affected by the factor of age.This study implies that patients who meet the indications of metabolic and bariatric surgery should be suggested to receive surgical treatment early in order to achieve better clinical outcomes.