代谢手术前后肥胖患者25羟基维生素D与甲状旁腺激素的变化

Postoperative changes in 25-hydroxy vitamin D and parathyroid hormone levels in obese patients

目的观察对比代谢手术前后肥胖患者25羟基维生素D[25-(OH)D]、甲状旁腺激素(PTH)等相关指标的变化情况,分析术后近期(3~6个月)及术后远期(12~24个月)这一动态平衡的改变。方法选取2018年1月至2020年1月在中日友好医院代谢减重中心接受过代谢手术并在术后24个月进行过复查的肥胖患者,收集患者身高、体重、三围等体成分相关资料及空腹血糖、糖化血红蛋白、25-(OH)D、PTH、血清总钙、血清无机磷等实验室指标。并计算体重指数、腰臀比等。采用重复测量方差分析比较不同时间点患者的人体测量学指标变化情况。采用独立样本t检验比较两组间的参数差异。根据正态性采用单因素方差分析或Kruskal-Wallis检验比较多组间的参数差异。结果共纳入96例患者(男性33例,女性63例),其中合并糖尿病患者49例。76例(79.17%)术前存在25-(OH)D缺乏(<20μg/L),16例(16.67%)患者存在25-(OH)D不足(≥20μg/L且<30μg/L);23例(23.96%)患者存在术前PTH水平升高(>70 ng/L)。手术后,术后近期25-(OH)D水平较基线期上升(P=0.001),但在远期较近期(P<0.01)及术前下降(P=0.023);术后远期的PTH水平较近期有所上升(P=0.012),术后远期,11例患者的PTH水平高于正常值(>70 ng/L);术后血清无机磷水平在近、远期均较术前有所升高(均为P<0.01)。结论代谢手术患者术前的25-(OH)D水平总体不足,尽管在术后短期内有所上升,远期依然低于术前水平。部分患者在术后远期存在PTH继发性升高。代谢手术后的患者需要长期的术后营养补充和全面综合的营养管理。

Objective To investigate the postoperative changes in levels of 25-hydroxy vitamin D(25-[OH]D),parathyroid hormone(PTH)and other relevant biomarkers in obese patients receiving metabolic surgery and analyze the dynamic changes in relevant biomarkers in the short term(after 3-6 months)and the long term(after 12-24 months).Methods A total of 96 obese patients who underwent metabolic surgery and received follow-up examinations from January 2018 to January 2020 were included.Baseline and postoperative data were collected,including anthropometric data(height,weight,neck circumference,waistline and hipline)and laboratory test results(fasting glucose,glycated hemoglobin,25-[OH]D,PTH,serum calcium and serum phosphorus).Body mass index(BMI)and waist-hip ratio were calculated.The anthropometric data were analyzed by repeated measures analysis of variance and laboratory data were compared between groups using t test and Kruskal-Wallis test.Results 96 patients(33 males and 63 females)were included,of whom 49 were complicated with diabetes.Prior to surgery,79(79.17%)of the patients had 25-(OH)D deficiency(<20μg/L),16(16.67%)had 25-(OH)D insufficiency(≥20μg/L and<30μg/L)and 23(23.96%)had high PTH levels(>70 ng/L).After the surgery,25-(OH)D level was transiently increased in the short term(P=0.01)but declined thereafter in the long term(P<0.01)to levels lower than baseline(P=0.023).Long-term PTH level was higher than baseline(P=0.012),with 11 patients showing PTH levels higher than normal(>70 ng/L).Serum phosphorus level was increased in both the short term and the long term(P<0.01).Conclusions Obese patients have 25-(OH)D deficiency/insufficiency before metabolic surgery and experience further decrease in the long term after surgery,despite a transient increase.Secondary increase in PTH level occurs in some of the patients after surgery.Long-term nutritional supplements and comprehensive nutritional management play important roles in postoperative management of obese patient.