减重手术对肥胖患者心脏形态与功能的影响

Effect of bariatric surgery on cardiac morphology and function in obese patients

目的:探究减重术后肥胖患者心脏形态与心功能的变化情况。方法:回顾性分析2018年1月—2021年12月于首都医科大学附属北京友谊医院接受减重手术(包括胃袖状切除术和胃旁路术)并进行术后复查的100例患者的临床资料。其中女性67例,男性33例,年龄18~65岁,平均年龄(36.7±9.5)岁,采用SPSS 26.0软件对数据进行统计分析,将患者减重手术前及术后1年的指标进行单因素与Logistic回归分析,并绘制ROC曲线,以确定减重手术术后心脏形态及心功能的变化。结果:与术前相比,患者接受减重手术后1年体重[(112.20±30.20)kg比(80.70±23.00)kg,P<0.001]及体重指数[(38.77±8.26)kg/m^(2)比(27.98±6.54)kg/m^(2),P<0.001]均显著下降,同时收缩压和舒张压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、血尿酸、静息心率也显著降低(P<0.05),心脏射血分数显著改善[(65.5±5.9)%比(67.9±4.7)%,P<0.001],室间隔、左室后壁、左房内径、左室收缩及舒张末期内径显著降低(P<0.05),而升主动脉内径无显著变化[(3.14±0.39)cm比(3.09±0.38)cm,P=0.125]。此外,胃旁路术与胃袖状切除术相比,心脏形态的各项指标无明显差异。Logistic回归分析结果显示,减重术前体重指数值、术后体重指数降低值、是否患高血压、升主动脉内径是否增宽是减重手术后射血分数是否改善的重要影响因素(P<0.05)。对射血分数是否改善的预测ROC曲线下面积为0.772(95%CI:0.669~0.875),特异度85%,敏感度66%,最佳截断点为0.545。结论:肥胖患者接受减重手术后1年,心脏射血分数显著改善,室间隔、左室后壁、左房内径、左室收缩及舒张末期内径较术前显著降低。胃袖状切除术与胃旁路术对心功能的改善及对心脏形态的影响无明显差异。术前体重指数值、术后1年体重指数降低值、是否患高血压、升主动脉内径是否增宽等指标构成的联合预测模型对减重患者术后1年射血分数是否改善具有良好的预测价值。

ObjectiveTo investigate the changes of cardiac morphology and function in obese patients after bariatric surgery.MethodsThe clinical data of 100 patients who underwent bariatric surgery,including gastric sleeve resection and gastric bypass in Beijing Friendship Hospital,Capital Medical University from January 2018 to December 2021 were selected for retrospective analysis,including 67 females and 33 males,aged from 18 to 65 years,with average of(36.7±9.5)years.The sofware of SPSS 26.0 was used to conduct data analysis.Univariate and Logistic regression analysis was performed on the indicators of patients before bariatric surgery and 1 year after surgery,and ROC curves were drawn to determine the changes of cardiac morphology and cardiac function after bariatric surgery.ResultsCompared with preoperative,one year after bariatric surgery,patients'body weight[(112.2±30.2)kg us(80.7±23)kg,P<0.001]and body mass indes[(38.77±8.26)kg/m^(2)us(27.98±6.54)kg/m^(2),P<0.001]were significantly decreased,and systolic and diastolic blood pressure,lowdensity lipoprotein cholesterol,high-density lipoprotein cholesterol,triglyceride,blood uric acid,and resting heart rate were also significantly decreased(P<0.05),cardiac ejection fraction was significantly improved[(65.5±5.9)%us(67.9±4.7)%,P<0.001],ventricular septum,left ventricular posterior wall,left atrial diameter,left ventricular systolic and end-diastolic diameter were significantly reduced(P<0.05),while the inner diameter of the ascending aorta was not significantly changed[(3.14±0.39)cm us(3.09±0.38)cm,P=0.125].In addition,there were no significant differences in cardiac morphology between gastric bypass and gastric sleeve resection.Logistic regression analysis showed that pre-bariatric BMI value,postoperative BMI reduction value,whether suffering from hypertension,and whether the inner diameter of the ascending aorta was widened were the important influencing factors for the improvement of ejection fraction after bariatric surgery(P<0.05).The area under the R0C curve for predicting the improvement of ejection fraction was 0.772(95%CI:0.669-0.875),the specificity was 85%,the sensitivity was 66%,and the best cut-off point was 0.545.ConclusionssOneyearafter bariatric surgery in obese patients,cardiac ejection fraction was significantly improved,and ventricular septum,left ventricular posterior wall,left atrial diameter,left ventricular systolic and end-diastolic diameter were significantly reduced compared with those before surgery.There was no significant difference between gastric sleeve resection and gastric bypass in the improvement of cardiac function and the effect on cardiac morphology.The combined prediction model composed of preoperative body mass index value,decreased body mass index value at 1 year after operation,whether suffering from hypertension,whether the inner diameter of the ascending aorta is widened and other indicators has a good predictive value for the improvement of ejection fraction in bariatric patients at 1 year after operation.