摘要
目的比较腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)治疗高BMI与低BMI肥胖症合并代谢紊乱病人的临床疗效。方法回顾性分析2013—2018年复旦大学附属浦东医院收治的因肥胖症或肥胖合并2型糖尿病(T2DM)等代谢紊乱而接受LSG的113例病人的临床资料,按术前BMI值将病人分为低BMI组(BMI≤35,38例)和高BMI组(BMI>35,75例),术后1、3、6和12个月进行随访,比较两组病人体重、血糖代谢、血脂和血压等相关指标的改善情况。结果 LSG术后高BMI组较低BMI组体重下降更为明显,12个月时,平均总体重减轻百分比(%TWL)分别为32.6%和26.1%(P<0.001),低BMI组的平均BMI降至23.3,而高BMI组则为28.3(P<0.001)。术后,高BMI组比低BMI组有更多病人的空腹血糖(FPG)和糖化血红蛋白A1c(HbA1c)下降至理想水平,两组在术前和术后12个月时,FPG>7 mmol/L的病例数占比分别为33.3%和2.7%、44.7%和15.8%(P均<0.05),HbA1c> 6.5%的病例数占比分别为48.0%和57.9%、2.7%和26.3%(P均<0.05)。两组病人术后甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-c)水平下降以及血压变化差异无统计学意义,但低BMI组病人高密度脂蛋白胆固醇(HDL-c)的上升幅度较高BMI组更加显著(P<0.05)。结论 LSG术后,高BMI病人体重减轻更多,所合并的T2DM有更大可能获得临床缓解,但低BMI病人术后体重有较大可能降低为正常体重水平,且血脂的改善优于高BMI病人。
Objective To compare the clinical outcome of laparoscopic sleeve gastrectomy(LSG) in the metabolic disordered patients with high body mass index(BMI) versus low BMI obesity.Methods A total of 113 patients who underwent LSG due to obesity and metabolic disorders in Hehai University Pudong Hospital between 2013 and 2018 were divided into low BMI(BMI ≤ 35,n=38) and high BMI groups(BMI > 35,n=75) for the retrospective analysis. The body weight related parameters,glycemic metabolic related parameters,lipid panel as well as arterial blood pressure were compared at pre-operative baseline,1,3,6,and 12 months after surgery.ResultsHigh BMI patients had better weight loss than low BMI patients after surgery. At 12 months after surgery, percentage of total weight loss(%TWL) in high BMI and low BMI groups were 32.6% and 26.1%, respectively(P<0.001). However,mean BMI of low BMI group achieved 23.3 which was within the normal range,while high BMI group still had 28.29(P<0.001). In addition,high BMI group had more patients achieved ideal fasting plasma glucose(FPG) and hemoglobin A1c(HbA1c) levels. The ratios of patients with FPG >7 mmol/L preoperatively and 12 months after LSG in high and low BMI groups were 33.3% vs 44.7% and 2.7% vs 15.8%,and the ratios of patients with HbA1c > 6.5%were 48.0% vs 57.9% and 2.7% vs 26.3%,respectively(P<0.05). Although there was not any significant difference between two groups in triglyceride(TG), low density lipoprotein cholesterol(LDL-c),or arterial blood pressure, the escalation of high density lipoprotein cholesterol(HDL-c) were more favorable in the low BMI group.Conclusion Although more weight loss and higher remission rate of type 2 diabetes mellitus(T2DM) are achieved if preoperative BMI is high,the body weight in low BMI patients has a higher chance to return back to normal range. The qualities of plasma lipid panel improvements are more favorable in the low BMI patients.
作者
张鹏
陈丽华
王廷峰
伍雯
章雄
田沛荣
张忠涛
ZHANG Peng;CHEN Li-hua;WANG Ting-feng(Division of Metabolic and Bariatric Surgery,Department of General Surgery,Beijing Friendship Hospital,Capital Medical University&National Clinical Research Center for Digestive Diseases,Beijing 100050,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第7期806-810,共5页
Chinese Journal of Practical Surgery
基金
上海市浦东新区卫生系统重点学科项目(No.PWZxk2017-16)
上海市自然科学基金(No.18ZR434000)。
关键词
腹腔镜胃袖状切除术
肥胖症
2型糖尿病
高脂血症
高血压病
laparoscopic sleeve gastrectomy
obesity
type 2 diabetes mellitus
hyperlipidemia
hypertension
