术前体重对腹腔镜胃袖状切除术后临床疗效影响研究

The effect of pre-operative body weight on the clinical outcome of laparospic sleeve gastrectomy

目的比较腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)治疗高BMI与低BMI肥胖症合并代谢紊乱病人的临床疗效。方法回顾性分析2013—2018年复旦大学附属浦东医院收治的因肥胖症或肥胖合并2型糖尿病(T2DM)等代谢紊乱而接受LSG的113例病人的临床资料,按术前BMI值将病人分为低BMI组(BMI≤35,38例)和高BMI组(BMI>35,75例),术后1、3、6和12个月进行随访,比较两组病人体重、血糖代谢、血脂和血压等相关指标的改善情况。结果 LSG术后高BMI组较低BMI组体重下降更为明显,12个月时,平均总体重减轻百分比(%TWL)分别为32.6%和26.1%(P<0.001),低BMI组的平均BMI降至23.3,而高BMI组则为28.3(P<0.001)。术后,高BMI组比低BMI组有更多病人的空腹血糖(FPG)和糖化血红蛋白A1c(HbA1c)下降至理想水平,两组在术前和术后12个月时,FPG>7 mmol/L的病例数占比分别为33.3%和2.7%、44.7%和15.8%(P均<0.05),HbA1c> 6.5%的病例数占比分别为48.0%和57.9%、2.7%和26.3%(P均<0.05)。两组病人术后甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-c)水平下降以及血压变化差异无统计学意义,但低BMI组病人高密度脂蛋白胆固醇(HDL-c)的上升幅度较高BMI组更加显著(P<0.05)。结论 LSG术后,高BMI病人体重减轻更多,所合并的T2DM有更大可能获得临床缓解,但低BMI病人术后体重有较大可能降低为正常体重水平,且血脂的改善优于高BMI病人。

Objective To compare the clinical outcome of laparoscopic sleeve gastrectomy(LSG) in the metabolic disordered patients with high body mass index(BMI) versus low BMI obesity.Methods A total of 113 patients who underwent LSG due to obesity and metabolic disorders in Fudan University Pudong Hospital between 2013 and 2018 were divided into low BMI(BMI ≤ 35,n=38) and high BMI groups(BMI > 35,n=75) for the retrospective analysis. The body weight related parameters,glycemic 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.ResultsHigh BMI patients had better weight loss than low BMI patients after surgery. At 12 months after surgery, percentage of total weight loss(%TWL) in high BMI and low BMI groups were 32.6% and 26.1%, respectively(P<0.001). However,mean BMI of low BMI group achieved 23.3 which was within the normal range,while high BMI group still had 28.29(P<0.001). In addition,high BMI group had more patients achieved ideal fasting plasma glucose(FPG) and hemoglobin A1c(HbA1c) levels. The ratios of patients with FPG >7 mmol/L preoperatively and 12 months after LSG in high and low BMI groups were 33.3% vs 44.7% and 2.7% vs 15.8%,and the ratios of patients with HbA1c > 6.5%were 48.0% vs 57.9% and 2.7% vs 26.3%,respectively(P<0.05). Although there was not any significant difference between two groups in triglyceride(TG), low density lipoprotein cholesterol(LDL-c),or arterial blood pressure, the escalation of high density lipoprotein cholesterol(HDL-c) were more favorable in the low BMI group.Conclusion Although more weight loss and higher remission rate of type 2 diabetes mellitus(T2DM) are achieved if preoperative BMI is high,the body weight in low BMI patients has a higher chance to return back to normal range. The qualities of plasma lipid panel improvements are more favorable in the low BMI patients.