性别因素对胃袖状切除术治疗肥胖及相关疾病临床结局的影响

Impact of gender on clinical outcomes of laparoscopic sleeve gastrectomy in obese patients

目的探求不同性别的肥胖病人在接受减重与代谢手术后是否存在临床结局的差异。方法回顾性研究了2013年5月至2018年1月连续113例接受腹腔镜胃袖状切除术、并按计划完成术后1、3、6、12个月完整随访的肥胖病人,其中女性73例(64.6%),男性40例(35.4%)。对不同性别的两组病人的术前一般情况、术前及术后各时间点的体重相关临床指标和代谢相关临床指标进行组间对比分析。结果术前女性组和男性组年龄中位数分别为31岁和29岁(P>0.05),体重指数(body mass index,BMI)平均数分别为37.2 kg/m^(2)和40.2 kg/m^(2)(P<0.05),基线空腹血糖水平、糖化血红蛋白(HbA 1 c)、血脂水平和动脉血压平均值组间比较差异均无统计学意义(均P>0.05)。其中女性和男性病人HbA 1 c>6.5%的占比分别为47.9%和60.0%(P>0.05),空腹血糖>7 mmol/L占比分别为35.6%和35.0%(P>0.05)。术后12个月时,女性组和男性组总体重减少百分比(percentage of total weight loss,%TWL)分别为(29.6±7.0)%和(31.8±8.7)%,组间差异无统计学意义(P>0.05);男性组病人的BMI减少量显著多于女性组,分别为(13.0±5.1)kg/m^(2)和(10.9±3.1)kg/m^(2)(P<0.001),两组在术后12个月时实际BMI差异无统计学意义(P>0.05)。女性组和男性组的空腹血糖[(5.27±0.62)mmol/L比(5.48±1.24)mmol/L,P>0.05]和HbA 1 c[(5.69±0.49)%比(5.71±1.00)%,P>0.05]差异均无统计学意义。术前空腹血糖>7 mmol/L的病人当中,术后12个月分别有84.6%(女性)和85.7%(男性)降低在7 mmol/L以下;术前HbA 1 c>6.5%的病人中,80.0%(女性)和79.2%(男性)降低在6.5%以下,组间均差异无统计学意义(P>0.05)。术前和术后各时间点的三酰甘油水平、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平及动脉收缩压组间差异均无统计学意义(均P>0.05);但女性病人组术后12个月动脉舒张压显著低于男性组(73.4 mmHg比79.4 mmHg,P<0.001,1 mmHg=0.133 kPa)。结论接受胃袖状切除术的男性和女性病人年龄及肥胖相关疾病相似,术后均获得良好的减重效果和代谢紊乱的缓解;尽管男性术前BMI高于女性,但男性病人减重量大于女性,使得术后1年实际BMI无性别差异。血糖和血脂紊乱的改善无性别差异,然而女性病人动脉舒张压改善更佳,值得对其机制进行进一步研究。

Objective To explore the disparity of clinical outcome in patients with obesity after sleeve gastrectomy(SG)by gender.Methods Between May 2013 and January 2018,retrospective review was conducted for 113 consecutive patients undergoing SG.There were 73 female and 40 males.Follow-ups were performed at Month 1/3/6/12 post-operation.Demographics,obesity and comorbidities at baseline and all follow-up timepoints were compared by gender.Results This cohort had 73 females(64.6%)and 40 males(35.4%)with a median age of(31 vs.29 year,P>0.05)and a mean body mass index(BMI)of(37.2 vs.40.2 kg/m^(2),P<0.05).The baseline levels of fasting plasma glucose(FPG),HbA 1c,lipid panel and blood pressure showed no significant difference between two genders.The proportions of female/male were HbA 1 c>6.5%(47.9%vs.60.0%,P>0.05)and FPG>7 mmol/L(35.6%vs.35.0%,P>0.05).At Month 12 post-SG,percentage of total weight loss(%TWL)had no difference[(29.6±7.0)%in female vs.(31.8±8.7)%in male,P>0.05].Males had a greater reduction of BMI than females[(13.0±5.1)vs.(10.9±3.1)kg/m^(2),P<0.001].Mean FPG was[(5.27±0.62)vs.(5.48±1.24)mmol/L,P>0.05]and HbA 1 c[(5.69±0.49)%vs.(5.71±1.00)%,P>0.05].In individuals with FPG>7 mmol/L at baseline,84.6%(female)and 85.7%(male)achieved FPG<7 mmol/L(P>0.05).In patients with HbA 1 c>6.5%,80.0%(female)and 79.2%(male)decreased to<6.5%(P>0.05).No significant inter-group differences existed in triglyceride,low/high-density lipoprotein cholesterol or systolic blood pressure(SBP).However,females had lower SBP than males at Month 12 post-SG(73.4 vs.79.4 mmHg,P<0.001).Conclusion With comparable age and comorbidities at baseline,BMI is higher in males.Both genders achieve drastic and equivalent weight loss.However,males have a greater reduction of BMI post-SG.Both genders also have equivalent improvements in hyperglycemia and dyslipidemia.However,there is a larger decline of DBP in females.Further researches are warranted for elucidating the underlying mechanism.