腹腔镜袖状胃切除术治疗超级肥胖合并代谢性疾病的早期疗效及其预测因素研究

Early Efficacy and Predictive Factors of Laparoscopic Sleeve Gastrectomy for Super Obesity Combined Metabolic Diseases

目的探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)治疗超级肥胖合并代谢性疾病的早期疗效及其预测因素。方法回顾性分析2017-01/2021-04月在作者医院行LSG的50例超级肥胖患者临床资料,包括体质量、体质量指数(body mass index,BMI)、多余体质量减少率(percentage of excess weight loss,EWL)、空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、胰岛素抵抗指数(insulin resistance index,HOMA-IR)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、尿酸(uric acid,UA)等代谢指标。采用单因素分析、多因素Logistic回归分析探讨减重效果的影响因素。结果术后1年,超级肥胖患者体质量、BMI、腰围、FBG、HbAlc、TG、TC、UA,HOMA-IR均低于手术前(P<0.05)。术后1年,减重成功37例(74.00%),血糖缓解11例(84.62%),高血压缓解18例(64.29%)。单因素分析结果显示,减重成功组患者BMI、腰围、HOMA-IR低于减重无效组(P<0.05)。多因素Logistic回归分析结果显示,腰围是影响LSG治疗超级肥胖疗效的独立危险因素(P<0.05)。腰围162cm为最佳截断值,Youden指数最大,灵敏度91.18%,特异度80.00%。低腰围组术后1年体质量低于高腰围组,EWL明显高于高腰围组(P<0.05)。结论LSG治疗超级肥胖及其合并代谢性疾病早期效果显著。腰围是预测早期减重效果的独立影响因素,低腰围超级肥胖患者早期减重效果更佳。

Objective To study early efficacy and predictive factors of laparoscopic sleeve gastrectomy(LSG)in the treatment of super obesity and it′s combined metabolic disease.Methods The clinical data of 50 patients with super obesity who underwent LSG in metabolic weight loss center of affiliated hospital of Xuzhou medical university from January 2017 to April 2021 were retrospectively analyzed.The body weight,body mass index(BMI),percentage of excess weight loss(EWL),fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),total cholesterol(TC),triglyceride(TG),uric acid(UA)and other metabolic indicators were inclueded.The influencing factors of weight loss were analyzed by univariate analysis and multivariate Logistic regression.Results Body weight,BMI,waistline,FBG,HbAlc,TG,TC,UA,HOMA-IR of super obesity patients 1 year after the surgery were lower than those before(P<0.05).One year after surgery,the weight loss was successful in 37 cases(74.00%),blood glucose remission was achieved in 11 patients(84.62%),hypertension was relieved in 18 cases(64.29%).The results of univariate analysis showed that BMI,waistline and HOMA-IR in the successful weight loss group were lower than those in the ineffective weight loss group(P<0.05).Multivariate Logistic regression analysis showed that waistline was an independent risk factor affecting the efficacy of LSG in the treatment of super obesity(P<0.05).Waistline of 162cm was the best cut-off value,the Youden index was the largest,the sensitivity was 91.18%and the specificity was 80.00%.The body weight of the low waistline group was lower than that of the high waistline group 1 year after surgery,and the EWL was significantly higher than that of the high waistline group(P<0.05).Conclusion LSG has a significant early efficacy in the treatment of super obesity and its combined metabolic diseases.Waistline is an independent predictor of the early weight loss,and super obese patients with low waistline have better efficacy of early weight loss.