2型糖尿病患者胃转流术后营养状况调查及其影响因素分析

Nutritional status of type 2 diabetic patients after gastric bypass and its influencing factors

目的调查2型糖尿病患者胃转流术后营养状况并分析其影响因素。方法回顾性分析2018年5月至2021年4月上海市第六人民医院收治的129例行胃转流术的2型糖尿病患者的临床资料。采用控制营养状况(control the nutritional status,CONUT)评分法评估患者术后3个月的营养状况,根据患者的营养状况分为营养不良组和营养正常组,收集并比较营养不良组与营养正常组患者的临床资料,采用多因素Logistic回归分析法分析2型糖尿病患者胃转流术后3个月营养不良的影响因素。结果129例2型糖尿病患者胃转流术后3个月治愈36例(27.91%)、好转68例(52.71%)、无效25例(19.38%),总有效率为80.62%。129例2型糖尿病患者胃转流术后3个月营养正常68例(52.71%)、营养不良61例(47.29%),营养不良患者中轻度营养不良45例(73.77%)、中度营养不良13例(21.31%)、重度营养不良3例(4.92%)。营养不良组患者年龄高于营养正常组(P<0.05),病程长于营养正常组(P<0.05);营养不良组患者上臂肌围、三头肌皮褶厚度、术前血红蛋白(hemoglobin,Hb)、糖化血红蛋白、三酰甘油(triacylglycerol,TG)水平低于营养正常组(P<0.05)。多因素Logistic回归分析结果显示,年龄、病程、术前Hb、术前TG水平均为2型糖尿病患者胃转流术后3个月营养不良的影响因素(P<0.05)。结论胃转流术治疗2型糖尿病患者疗效显著,但术后营养状况仍有待改善,且年龄、病程、术前Hb、术前TG水平均会影响2型糖尿病患者胃转流术后的营养状况。

Objective To investigate the nutritional status of patients with type 2 diabetes after gastric bypass and its influencing factors.Methods The clinical data of 129 patients with type 2 diabetes who underwent gastric bypass in Shanghai Sixth People’s Hospital from May 2018 to April 2021 were retrospectively analyzed.The nutritional status of the patients was evaluated by the control the nutritional status(CONUT)scoring 3 months after surgery.According to the nutritional status,they were divided into malnutrition group and normal nutrition group.Multivariate logistic regression analysis was used to assess the influencing factors of malnutrition 3 months after gastric bypass in patients with type 2 diabetes mellitus.Results Three months after gastric bypass,36 patients(27.91%)were cured,68 patients(52.71%)were relieved,and 25 patients(19.38%)were ineffective,with a total effective rate of 80.62%.Of the 129 patients,68(52.71%)had normal nutrition and 61(47.29%)had malnutrition,including 45 cases(73.77%)of mild malnutrition,13 cases(21.31%)of moderate malnutrition,and 3 cases(4.92%)of severe malnutrition.The age and course of disease in the malnutrition group were higher than those in the normal nutrition group(P<0.05),while the circumference of the upper arm,triceps skinfold thickness,preoperative hemoglobin(Hb),glycosylated hemoglobin and triacylglycerol(TG)levels in the malnutrition group were lower than those in the normal nutrition group(P<0.05).Multivariate logistic regression analysis showed that age,course of disease,preoperative Hb and TG were influencing factors of malnutrition in type 2 diabetic patients 3 months after gastric bypass(P<0.05).Conclusion Gastric bypass is effective in patients with type 2 diabetes,but postoperative nutritional status still needs to be improved.Age,course of disease,preoperative Hb and TG levels will affect the nutritional status of patients with type 2 diabetes after gastric bypass.