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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 153 -158. doi: 10.3877/cma.j.issn.2095-9605.2020.03.003

所属专题： 文献；

论著

腹腔镜袖状胃切除术对重度肥胖患者非酒精性脂肪肝病及糖脂代谢的短期影响
陈伟1, 罗衡桂1,†(), 赵象文2, 毛岳峰1, 唐彬1, 李绍杰1, 张晓玲1, 陈香林1, 王力1   
  1. 1. 411100　湘潭，湖南省湘潭市中心医院减重代谢外科中心
    2. 528415　中山，广东省中山市小榄人民医院减重代谢外科
  • 收稿日期:2020-05-17 出版日期:2020-08-30
  • 通信作者: 罗衡桂
  • 基金资助:
    湘潭市医学科研基金项目(2018xtyx-7)

The short-term effects of laparoscopic sleeve gastrectomy on nonalcoholic fatty liver disease and glycolipid metabolism in severely obese patients

Wei Chen1, Henggui Luo1,†(), Xiangwen Zhao2, Yuefeng Mao1, Bing Tang1, Shaojie Li1, Xiaoling Zhang1, Xianglin Chen1, Li Wang1   

  1. 1. Bariatric and Metabolic Surgery Center, Xiangtan Central Hospital, Xiangtang 411100
    2. Department of Weight Loss and Metabolism, Xiaolan People’s Hospital, Zhongshan 528415, China
  • Received:2020-05-17 Published:2020-08-30
  • Corresponding author: Henggui Luo
  • About author:
    Correspongding author: Luo Henggui, Email:
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陈伟, 罗衡桂, 赵象文, 毛岳峰, 唐彬, 李绍杰, 张晓玲, 陈香林, 王力. 腹腔镜袖状胃切除术对重度肥胖患者非酒精性脂肪肝病及糖脂代谢的短期影响[J]. 中华肥胖与代谢病电子杂志, 2020, 06(03): 153-158.

Wei Chen, Henggui Luo, Xiangwen Zhao, Yuefeng Mao, Bing Tang, Shaojie Li, Xiaoling Zhang, Xianglin Chen, Li Wang. The short-term effects of laparoscopic sleeve gastrectomy on nonalcoholic fatty liver disease and glycolipid metabolism in severely obese patients[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(03): 153-158.

目的

探讨腹腔镜袖状胃切除术（LSG）对重度肥胖合并非酒精脂肪肝病（NAFLD）患者的疗效及糖脂代谢的影响。

方法

回顾性分析2016年12月至2019年3月在湘潭市中心医院减重代谢外科中心及中山市小榄人民医院减重代谢外科中心行LSG手术的78例合并NAFLD肥胖患者的临床资料，术后随访1年以上，比较患者体重、糖脂代谢、肝功能[谷草转氨酶（ALT）；谷丙转氨酶（AST）]、肝平均CT值及肝脏体积的变化情况。

结果

术后1年患者体重、体质量指数（BMI）、腰围、臀围均较术前明显下降（P<0.01）；空腹血糖、空腹胰岛素、糖化血红蛋白、胰岛素抵抗指数较术前有显著性改善（P<0.01） ；胆固醇、甘油三脂、低密度脂蛋白相比术前均有显著改善（P<0.01）；肝功能（ALT、AST）均较术前明显改善（P<0.01)；术后1年肝平均CT值（39.84±4.25）较术前（22.34±6.64）较明显升高，肝脏体积从术前（1983.61±821.7）cm3下降至术后（1549.32±752.01）cm3，差异有显著统计学意义（P<0.01），腰围及BMI与胰岛素抵抗、肝脏体积呈正相关，与肝脏CT值呈负相关。

结论

LSG手术不仅能有效减轻肥胖患者体重，改善糖脂代谢，能明显改善NAFLD的作用。对于重度肥胖合并NAFLD的患者，LSG手术是一种有效的治疗方法。

关键词: 肥胖, 非酒精性脂肪肝病, 腹腔镜袖状胃切除术, 糖脂代谢
Objective

To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on the glucose and lipid metabolism in patients with severe obesity and non-alcoholic fatty liver disease (NAFLD).

Methods

To retrospectively analyze the clinical data of 78 severely obese patients with non-alcoholic fatty liver disease, followed up for more than 1 year after operation. The change of body weight, glucose and lipid metabolism, liver function (aspartate aminotransferase, ALT; alanine aminotransferase, AST), average liver CT value and liver volume were compared.

Results

The body weight, body mass index (BMI), waist circumference, and hip circumference of the patient decreased significantly compared with that before operation (P<0.01); fasting blood glucose, fasting insulin, glycosylated hemoglobin, and insulin resistance index were significantly improved (P<0.01); Cholesterol, triglyceride and low density lipoprotein were significantly improved (P<0.01); Liver function (ALT, AST) were significantly improved compared with that before operation (P<0.01). The average liver CT value (39.84±4.25) one year after operation was significantly higher than that before operation (22.34±6.64). The liver volume decreased from (1983.61±821.7) cm3 before operation to (1549.32±752.01) cm3 after operation, and the difference was statistically significant (P<0.01). Waist circumference and BMI were positively correlated with insulin resistance and liver volume, and negatively with liver CT value.

Conclusions

LSG can not only effectively reduce the weight of obese patients, improve glucose and lipid metabolism, but also has a significant effect on the treatment of NAFLD. For patients with severe obesity and NAFLD, LSG surgery is an effective treatment.

Key words: Obesity, Nonalcoholic fatty liver disease, Laparoscopic sleeve gastrectomy, Glucolipid metabolism
表1 78例患者手术前后体重指标变化情况
指标 体重（kg） BMI（kg/m2） 臀围（cm） 腰围（cm）
术前 118.55±35.59 40.86±8.22 114.61±11.91 128.92±10.67
术后1年 82.24±22.49 28.39±4.07 95.20±11.91 86.86±9.54
t值 7.61 12.00 10.18 25.95
P值 <0.01 <0.01 <0.01 <0.01
表2 78例患者手术前后患者糖脂代谢变化情况
指标 术前 术后1年 t值 P值
FBG （mmol/L） 8.90±7.05 5.20±0.76 4.60 <0.01
FINS（mU/L） 38.66±15.40 27.31±5.73 6.10 <0.01
HbA1 c（%） 7.30± 1.20 5.20± 1.05 15.4 <0.01
HOMA-IR 28.34±9.98 4.52±5.40 18.53 <0.01
TC（mmol /L） 6.58±0.28 4.21±0.75 26.15 <0.01
TG（mmol /L） 2.44±0.76 1.51±0.60 1.67 <0.01
HDL-C（mmol /L） 0.84±0.31 1.45±0.86 9.12 <0.01
LDL-C（mmol /L） 3.56±1.66 2.3±0.67 6.21 <0.01
表3 8例患者手术前后转氨酶、CT值、肝体积变化
? 术前 术后1年 t值 P值
谷草转氨酶ALT（IU/L） 59.82±14.56 32.45±5.29 15.60 <0.01
谷丙转氨酶AST（IU/L） 42.98±8.16 26.98±5.84 14.08 <0.01
肝平均CT值（Hu） 20.34±7.64 39.84±4.25 19.70 <0.01
肝体积（cm3） 1983.61±821.7 1549.32±752.01 3.44 <0.01
表4 ALT、肝平均CT值、肝体积、胰岛素抵抗指数与BMI、腰围之间相关分析显示
? BMI 腰围
R值 P值 R值 P值
ALT 0.1901 0.760 0.271 0.659
肝平均CT值 -0.986 0.002a -0.934 0.020*
肝体积（cm3） 0.988 0.002a 0.893 0.041*
胰岛抵抗指数 0.990 0.001a 0.978 0.004a
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