亚临床甲状腺功能减退对胃袖状切除术后早期临床结局影响研究

Weight loss and subclinical hypothyroidism in obese patients with sleeve gastrectomy

目的探讨术前存在亚临床甲状腺功能减退对减重术后体重改善的影响。方法回顾性分析2020年复旦大学附属华山医院减重代谢外科进行腹腔镜下胃袖状切除术的病人资料。根据其术前是否合并亚临床甲状腺功能减退分为亚临床甲状腺功能减退组(研究组)和正常组(对照组),研究组均未在术前干预其甲状腺功能。分析比较两组病人的基线特征、术后体重变化等指标,评估亚临床甲状腺功能减退是否会对减重手术的体重改善产生影响。结果共纳入197例病人,研究组35例,基线促甲状腺激素(TSH)水平(5.77±1.05)mU/L,对照组162例,基线TSH水平(2.31±0.91)mU/L(P<0.0001)。基线水平上两组体重、体重指数(BMI)、腰臀比、血压、血糖及胰岛素水平、血脂水平、总三碘甲状腺原氨酸(TT3)及游离三碘甲状腺原氨酸(FT3)、总甲状腺(TT4)及游离甲状腺激素(FT4)差异无统计学意义。经过平均(6.69±0.42)个月随访,研究组的总体重减轻百分比(TWL%)为(26.95±6.93)%,对照组为(26.22±5.80)%,两组之间差异无统计学意义;临床甲状腺功能减退组的额外体重减轻百分比(EWL%)为(78.05±29.15)%,对照组为(77.29±28.28)%,两组之间差异无统计学意义。结论减重手术前病人是否合并亚临床甲状腺功能减退状态,并不影响减重手术对于体重的效果,术前合并亚临床甲状腺功能减退不应成为影响病人手术的条件之一。

Objective Subclinical hypothyroidism is one of the endocrine disorders commonly associated with obese patients.However,there was no consensus on the necessity of medical intervention before operation and corresponding ef⁃fects on surgical prognosis.Objective To analyze the effect of preoperative sub-clinical hypothyroidism on postoperative weight change after bariatric surgery.Methods According to the inclusion criteria,patients undergoing laparoscopic sleeve gastrectomy in the Division of Bariatric and Metabolic Surgery of Huashan Hospital Affiliated to Fudan University in 2020 were included in this retrospective analysis.Patients with subclinical hypothyroidism were divided into subclini⁃cal hypothyroidism group(the study group)and normal group(the control group)according to their preoperative thyroid functions.None of the study group were intervened in their thyroid function before surgery.The baseline characteristics,postoperative weight changes and other indicators of patients in the two groups were compared to evaluate whether sub⁃clinical hypothyroidism would have an impact on weight loss after bariatric surgery.Results A total of 197 patients were enrolled in this study,including 35 patients in the subclinical hypothyroidism group with baseline TSH level of(5.77±1.05)mU/L and 162 patients in the normal control group with baseline TSH level of(2.31±0.91)mU/L(P<0.0001).There were no significant differences at baseline in body weight,BMI,waistto-hip ratio,blood pressure,fasting plasma glucose and insulin levels,plasma lipid levels,TT3 and FT3,TT4 and FT4.After a mean follow-up of(6.69±0.42)months,the total weight loss percentage(TWL%)was(26.95±6.93)%in the subclinical hypothyroidism group and(26.22±5.80)%in the normal control group,with no significant difference between groups.The percentage of excess weight loss(EWL%)was(78.05±29.15)%in the clinical hypothyroidism group and(77.29±28.28)%in the normal control group,with no significant difference between groups.Conclusion The existence of subclinical hypothyroidism before bariatric surgery does not affect the weight loss after bariatric surgery.And preoperative subclinical hypothyroidism should not be one of the conditions affecting pa⁃tients'surgery decision.