肥胖患者代谢手术前后糖脂代谢与中医证素的相关性分析

Correlation analysis of glycolipid metabolism and Chinese medicine syndrome elements before and after metabolic surgery in obese patients

目的探讨肥胖患者代谢手术前后糖脂代谢与中医证素的相关性。方法选取2023年2月至2024年3月在中日友好医院住院行代谢手术并且术后1、3个月在门诊随访复查的肥胖患者,分别采集患者术前、术后1个月和术后3个月的血生化指标和中医证素特点,并分析二者的相关性。结果共纳入95例肥胖患者,术后1个月复查的患者共85例,术后3个月复查的患者共60例。术后1、3个月男性和女性体重、体重指数及腰围均低于术前(均P<0.05)。术后1、3个月,重度肥胖组总体体重减轻百分比均高于轻度、中度肥胖组(均P<0.001)。肥胖患者术后1、3个月空腹血糖、糖化血红蛋白、空腹胰岛素及稳态模型胰岛素抵抗指数(HOMA-IR)水平均低于术前(均P<0.05)。肥胖合并糖尿病患者热证素组空腹胰岛素、HOMA-IR水平均高于非热证素组[37.4(17.0,55.4)mIU/L比19.8(14.4,32.6)mIU/L、12.3(11.0,21.8)比6.6(5.6,11.2)](均P<0.05),且热证素与空腹胰岛素和HOMA-IR水平均呈正相关(风险比=0.371,P=0.030;风险比=0.415,P=0.026)。结论代谢手术能迅速且有效降低肥胖患者体重,改善肥胖患者的糖脂代谢。肥胖合并糖尿病患者术前热证素越明显,空腹胰岛素和HOMA-IR水平越高。

Objective To explore the correlation between glucose and lipid metabolism and traditional Chinese medicine(TCM)syndrome elements in obese patients before and after metabolic surgery.Methods The obese patients who underwent metabolic surgery in China-Japan Friendship Hospital from February 2023 to March 2024 and followed-up in outpatient clinic 1 and 3 months after operation were selected.The blood biochemical indexes and TCM syndrome factors were collected before operation,1 and 3 months after operation,and the correlation between them was analyzed.Results A total of 95 obese patients were included,85 patients were reexamined 1 month after operation,and 60 patients were reexamined 3 months after operation.The body mass,body mass index and waist circumference of male and female at 1 and 3 months after operation were lower than those before operation(all P<0.05).At 1 and 3 months after operation,the percentage of overall body mass reduction was higher in the severely obese group than in the mildly and moderately obese group(all P<0.001).The levels of fasting blood glucose,glycosylated hemoglobin,fasting insulin and homeostasis model assessment of insulin resistance index(HOMA-IR)in obese patients at 1 and 3 months after operation were lower than those before operation.The levels of fasting insulin and HOMA-IR in the heat syndrome group were higher than those in the non-heat syndrome group in obese patients with diabetes mellitus[37.4(17.0,55.4)mIU/L vs 19.8(14.4,32.6)mIU/L,12.3(11.0,21.8)vs 6.6(5.6,11.2)](all P<0.05).Heat syndrome factor was positively correlated with fasting insulin and HOMA-IR levels,respectively(Hazard ratio=0.371,P=0.030)and(Hazard ratio=0.415,P=0.026).Conclusions Metabolic surgery can quickly and effectively reduce the body mass of obese patients and improve glucose and lipid metabolism in obese patients.The more obvious the heat syndrome factor before operation,the higher the fasting insulin and HOMA-IR levels in patients with obesity combined with diabetes mellitus.