代谢手术治疗超重或肥胖短期疗效观察及减重效果的影响因素分析

doi:10.3877/cma.j.issn.2095-9605.2017.03.005

目的

观察代谢手术的短期疗效并探讨减重效果的影响因素，以进一步提高对代谢手术的认识。

方法

回顾性分析2008年1月至2016年6月在长春嘉和外科医院接受代谢手术治疗的83例患者的临床资料，收集并观察患者手术前后的身高、体重、体质量指数（body mass index，BMI）、腰围、臀围。

结果

共80例患者完成术后1年随访，术后患者体重、BMI呈下降趋势（P<0.05），腰高比对术后减重效果影响的差异有统计学意义（P<0.05），但是年龄、性别、术式、是否合并糖尿病、体质量指数以及腰臀比的差异均无统计学意义。

结论

代谢手术在短期内能明显降低肥胖患者体重，并且腰高比较小的患者减重效果更佳。

关键词: 肥胖症, 代谢手术, 减重效果

Objective

To explore the influencing factors on weight loss of metabolic surgery to improve the understanding of metabolic surgery.

Methods

The clinical data of 83 patients who underwent metabolic surgery from Jan. 2008 to Jun. 2016 in Jiahe Surgical Hospital were analyzed retrospectively. Weight and BMI were observed before and at 12 months after operation.

Results

A total of 80 patients completed a 1-year follow-up. Postoperative patients with body weight and BMI showed a downward trend (P<0.05) , and weight loss is more obvious in patients who have lower waist-to-height ratio (P<0.05) , but there was no significant difference in age, sex, surgery approaches, whether with diabetes mellitus, body mass index, and waist-to-hip ratio.

Conclusions

Metabolic surgery can significantly reduce the weight of obese patients, and patients who have lower waist-to-height ratio will get more weight loss.

Key words: Obesity, Metabolic surgery, Weight loss

表1 术后患者参数变化

参数	术前	术后	P值
体重（kg）	103.22±32.3	78.5±22.5	<0.01
BMI（kg/m²）	36.1±8.3	27.5±5.7	<0.01
EWL%	?	70±31	?

表1 术后患者参数变化

参数	术前	术后	P值
体重（kg）	103.22±32.3	78.5±22.5	<0.01
BMI（kg/m²）	36.1±8.3	27.5±5.7	<0.01
EWL%	?	70±31	?

表2 两组患者各因素比较（±s，n=80）

参数	效果极佳或良好（EWL%≥50%）	效果不足或无效（EWL%<50%）	P值
例数（例）	60	20	?
男性[%（例）]	41.7（25）	45.0（9）	0.794
年龄（岁）	37.85±11.29	40.45±11.40	0.376
T2DM[%（例）]	71.7（43）	70.0（14）	0.887
LRYGB[%（例）]	60.0（36）	65（13）	0.691
WHtR（%）	0.97±0.08	0.99±0.06	0.301
WHR（%）	0.66±0.10	0.75±0.11	0.001
BMI（kg/m²）	34.78±7.86	40.1±8.55	0.012

表2 两组患者各因素比较（±s，n=80）

参数	效果极佳或良好（EWL%≥50%）	效果不足或无效（EWL%<50%）	P值
例数（例）	60	20	?
男性[%（例）]	41.7（25）	45.0（9）	0.794
年龄（岁）	37.85±11.29	40.45±11.40	0.376
T2DM[%（例）]	71.7（43）	70.0（14）	0.887
LRYGB[%（例）]	60.0（36）	65（13）	0.691
WHtR（%）	0.97±0.08	0.99±0.06	0.301
WHR（%）	0.66±0.10	0.75±0.11	0.001
BMI（kg/m²）	34.78±7.86	40.1±8.55	0.012

表3 两组患者各因素logistic分析

参数	OR值	P值
WHtR	0.000	0.021
BMI	1.125	0.173

表3 两组患者各因素logistic分析

参数	OR值	P值
WHtR	0.000	0.021
BMI	1.125	0.173

[1]	Jiang N, Yu H, An R. Body weight status and health-care expenditure among university retirees in Beijing, China[J]. Australas J Ageing, 2017. 36(Suppl.1).
[2]	He Y, Pan A, Wang Y, et al. Prevalence of overweight and obesity in 15.8 million men aged 15-49 years in rural China from 2010 to 2014[J]. Sci Rep, 2017, 7(1):5012.
[3]	Zhang Y X, Wang S R, Chen M, et al. Recent Trends in Body Mass Index and Waist Circumference among Children and Adolescents in Shandong China[J]. J Trop Pediatr, 2017.
[4]	Song P, Yu J, Chang X, et al. Prevalence and Correlates of Metabolic Syndrome in Chinese Children: The China Health and Nutrition Survey[J]. Nutrients, 2017, 9(1):79.
[5]	Arterburn D E, Olsen M K, Smith V A, et al. Association between bariatric surgery and long-term survival[J]. JAMA, 2015, 313(1):62-70.
[6]	Schauer P R, Bhatt D L, Kirwan J P, et al. Bariatric surgery versus intensive medical therapy for diabetes:3-year outcomes[J]. N Engl J Med, 2014, 370(21):2002-2013.
[7]	Fernandez-Soto M L, Martin-Leyva A, Gonzalez-Jimenez A, et al. Remission of type 2 diabetes mellitus after bariatric surgery- comparison between procedures[J]. Endokrynol Pol, 2017, 68(1):18-25.
[8]	刘金刚，郑成竹，王勇. 中国肥胖和2型糖尿病外科治疗指南(2014)[J]. 中国实用外科杂志, 2014(11):1005-1010.
[9]	Liang H, Guan W, Yang Y, et al. Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI 28 kg/m²: a multi-institutional study[J]. J Biomed Res, 2015, 29(2):112-117.
[10]	Association. A D. Standards of medical care in diabetes 2012[J]. Diabetes Care, 2012, 35 Suppl 1:S11-S63.
[11]	方登华，李滢旭，余雄武, 等. 腹腔镜袖状胃切除术治疗单纯性肥胖症的短期疗效观察[J]. 中华肥胖与代谢病电子杂志, 2015 (01):26-29.
[12]	郑成竹，柯重伟，印慨, 等. 腹腔镜垂直捆绑胃成形术治疗病态肥胖(附25例报告)[J]. 中国实用外科杂志, 2002(10):17-19.
[13]	Buchwald H, Oien D M. Metabolic/bariatric surgery worldwide 2011[J]. Obes Surg, 2013, 23(4):427-436.
[14]	Al-Khyatt W, Ryall R, Leeder P, et al. Predictors of Inadequate Weight Loss After Laparoscopic Gastric Bypass for Morbid Obesity[J]. Obes Surg, 2017, 27(6):1446-1452.
[15]	Chikunguwo S M, Wolfe L G, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass[J]. Surg Obes Relat Dis, 2010, 6(3):254-259.
[16]	Thereaux J, Lesuffleur T, Paita M, et al. Long-term follow-up after bariatric surgery in a national cohort[J]. Br J Surg, 2017, 104(10): 1362-1371.
[17]	Leyba J L, Llopis S N, Aulestia S N. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. a prospective study with 5 years of follow-up[J]. Obes Surg, 2014, 24(12):2094-2098.
[18]	Zhang N, Maffei A, Cerabona T, et al. Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy[J]. Surg Endosc, 2013, 27(4):1273-1280.
[19]	Fernandez-Soto M L, Martin-Leyva A, Gonzalez-Jimenez A, et al. Remission of type 2 diabetes mellitus after bariatric surgery- comparison between procedures[J]. Endokrynol Pol, 2017, 68(1):18-25.
[20]	Fernandez-Soto M L, Martin-Leyva A, Gonzalez-Jimenez A, et al. Remission of type 2 diabetes mellitus after bariatric surgery- comparison between procedures[J]. Endokrynol Pol, 2017, 68(1):18-25.
[21]	Perrone F, Bianciardi E, Ippoliti S, et al. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years[J]. Updates Surg, 2017,69(1):101-107.
[22]	Li J F, Lai D D, Lin Z H, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials[J]. Surg Laparosc Endosc Percutan Tech, 2014,24(1):1-11.
[23]	Li J, Lai D, Wu D. Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis[J]. Obes Surg, 2016, 26(2):429-442.
[24]	Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013[J]. Obes Surg, 2015, 25(10):1822-1832.
[25]	刘金钢. 中国肥胖及2型糖尿病手术治疗的现状与未来[J]. 中国糖尿病杂志, 2015(09):773-775.
[26]	Zhang Y X, Wang Z X, Chu Z H, et al. Blood pressure profiles of children and adolescents categorized by waist-to-height ratio cutoffs: study in a large sample in Shandong, China[J]. Blood Press Monit, 2017, 22(3):143-148.
[27]	Stevens J, Katz E G, Huxley R R. Associations between gender, age and waist circumference[J]. Eur J Clin Nutr, 2010,64(1):6-15.
[28]	Zimmet P, Magliano D, Matsuzawa Y, et al. The metabolic syndrome: a global public health problem and a new definition[J]. J Atheroscler Thromb, 2005, 12(6):295-300.
[29]	Yoo K B, Suh H J, Lee M, et al. Breakfast eating patterns and the metabolic syndrome: the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2009[J]. Asia Pac J Clin Nutr, 2014, 23(1):128-137.
[30]	Hong S, Song Y, Lee K H, et al. A fruit and dairy dietary pattern is associated with a reduced risk of metabolic syndrome[J]. Metabolism, 2012, 61(6):883-890.
[31]	Praveen R P, Bhattacharya S, Saravana K S, et al. Do Bariatric Surgery-Related Type 2 Diabetes Remission Predictors Add Clinical Value? A Study on Asian Indian Obese Diabetics[J]. Obes Surg, 2017, 27(8):2113-2119.
[32]	Wang G F, Yan Y X, Xu N, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis[J]. Obes Surg, 2015, 25(2):199-208.
[33]	Cooper T C, Simmons E B, Webb K, et al. Trends in Weight Regain Following Roux-en-Y Gastric Bypass (RYGB) Bariatric Surgery[J]. Obes Surg, 2015, 25(8):1474-1481.
[34]	Golomb I, Ben D M, Glass A, et al. Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy[J]. JAMA Surg, 2015, 150(11):1051-1057.
[35]	Paul L, van der Heiden C, Hoek H W. Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients[J]. Curr Opin Psychiatry, 2017, 30(6):474-479.
[36]	Puzziferri N, Roshek T R, Mayo H G, et al. Long-term follow-up after bariatric surgery: a systematic review[J]. JAMA, 2014, 312(9):934-942.

[1]	陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[2]	吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[3]	杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[4]	刘盾, 潘晟. 不同入路腹腔镜袖状胃切除术用于肥胖症合并2型糖尿病的效果[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 150-154.
[5]	颜帅, 胡旭, 苟晓梅, 谢铭. 腹腔镜胃袖状切除术后并发症处置策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 220-224.
[6]	中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库：2023年度报告[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 73-83.
[7]	颜宥彤, 赵锐, 万谦益, 张贵祥, 沈弘毅, 程中, 陈亿. GLP-1受体激动剂——司美格鲁肽的应用及安全性[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 88-93.
[8]	周彪, 李政奇, 孟化. 肥胖与内镜下减重治疗研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 100-107.
[9]	王婉杰, 宋文超, 王键, 倪良晨, 洪健, 朱孝成, 姚立彬. 肥胖与中枢神经系统调控的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 108-112.
[10]	陆远欣, 龚莉琳, 曾梦华. 肥胖与非酒精性脂肪肝研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 113-119.
[11]	庄建彬, 杨明建. 肥胖与结直肠癌的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 120-126.
[12]	崔磊, 徐东升. 减重手术治疗肥胖患者胰岛素抵抗的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 127-132.
[13]	邢颖, 闫文貌. 单孔腹腔镜袖状胃切除术发展现状[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 133-137.
[14]	中国医师协会外科医师分会肥胖和糖尿病外科专家工作组. 减重手术相关贫血管理策略中国专家共识（2024版）[J]. 中华肥胖与代谢病电子杂志, 2024, 10(01): 1-8.
[15]	谭莺, 雷普润, 莫子健, 陈图锋, 陈燕铭. 减重代谢手术在糖胖病治疗中的应用及效果分析[J]. 中华肥胖与代谢病电子杂志, 2024, 10(01): 9-14.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Analysis of influencing factors for metabolic surgery treating overweight or obesity Short-term efficacy

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Analysis of influencing factors for metabolic surgery treating overweight or obesity Short-term efficacy