基于生物电阻抗法减重手术早期身体成分变化的研究

Changes of body composition in an early stage after bariatric surgery through bioelectrical resistance analysis

目的探讨减重手术后早期病人身体成分变化,从而制定营养及治疗方案。方法回顾性分析2019年3月至2022年4月于南京医科大学附属淮安第一医院接受腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)的106例病人。手术前及随访病人利用生物电阻抗法检测人体成分指标、肥胖指标、肌肉指标、水分指标及营养指标。结果106例病人均成功实施LSG,女性66例(62.3%),男性40例(37.7%),年龄(28.4±7.2)岁。于术后1个月、3个月、6个月及12个月完成随访的病人分别有85例(80.2%)、72例(67.9%)、65例(61.3%)、60例(56.6%)。人体成分指标:体重、身体总水分、蛋白质、无机盐、体脂肪、肌肉量及去脂体重较术前下降;体重及体脂肪不断下降,分别由术前(108.6±20.5)kg及(49.8±12.8)kg下降至术后12个月时的(72.4±14.7)kg及(20.1±5.7)kg。肥胖指标:体重指数、体脂百分比、腰臀比、内脏脂肪面积、肥胖度、四肢及躯干脂肪均呈进行性下降;术后12个月时,体重指数由术前的(38.6±5.9)kg/m2下降至(26.2±4.6)kg/m2,体脂百分比由术前的(45.4±5.2)%下降至(26.9±6.2)%,内脏脂肪面积由术前的(173±46)cm2下降至(78±32)cm2。肌肉指标:骨骼肌质量、上臂围度、上臂肌肉围度、双上肢及躯干节段肌肉量在术后6个月内不同程度降低;双下肢节段肌肉量在术后1个月即下降至稳定。水分指标:细胞内水分及细胞外水分减少,细胞外水分比率在术后3个月升高。营养指标:InBody评分在术后3个月及6个月均较前一随访时间点升高,身体细胞量在3个月内呈现下降趋势。结论减重手术后身体成分获得改变,可为体重控制、肌肉增减、营养平衡等提供一定的科学依据。

Objective To explore the changes of body composition in an early stage after bariatric surgery to formulate the nutrition and treatment plan.Methods From March 2019 to April 2022,retrospective analysis was performed for 106 patients undergoing laparoscopic sleeve gastrectomy(LSG).Bioelectrical resistance analysis(BIA)was utilized for detecting body composition,obesity,muscle,water and nutritional parameters pre-operation and during follow-ups.Results LSG was all successfully performed.There were 40(37.7%)males and 66(62.3%)females with an average age of(28.4±7.2)year.85 patients(80.2%),72(67.9%),65(61.3%)and 60(56.6%)were followed up at Month 1/3/6/12.Body weight,total body water(TBW),protein,minerals,body fat mass(BFM),soft lean mass and fat-free mass declined post-operation.Body weight and BFM dropped from(108.6±20.5)and(49.8±12.8)to(72.4±14.7)and(20.1±5.7)kg at Month 12 post-operation.Body mass index(BMI),percent body fat(PBF),waist-hip ratio,visceral fat area(VFA),obesity degree and BFM of limbs/trunk showed a progressive decline.At Month 12 post-operation,BMI decreased from(38.6±5.9)to(26.2±4.6)kg/m2,PBF dropped from(45.4±5.2)%to(26.9±6.2)%and VFA declined from(173±46)to(78±32)cm2.Skeletal muscle mass,arm circumference,arm muscle circumference,muscle mass of upper limbs and trunk decreased in different degrees at Month 6 post-operation.Muscle mass of lower limbs decreased and stabilized at Month 1 post-operation.Intracellular water and extracellular water(ECW)declined while ECW/TBW rose at Month 3 postoperation.InBody score increased at Month 3 and 6 post-operation than that of the previous follow-up time point and body cell mass showed a lowering trend at Month 3 post-operation.Conclusion Body composition changes after bariatric surgery.Thus it may provide scientific rationales for weight control,muscle gain/loss and nutrition balance.