腹腔镜袖状胃切除术后肥胖患者肺功能变化与炎症介质及脂肪因子的相关性分析

doi:10.3877/cma.j.issn.2095-9605.2020.04.002

目的

探究肥胖患者在接受腹腔镜袖状胃切除术（LSG）治疗后6个月时肺功能的变化并评估其与炎症介质及脂肪因子的相关性。

方法

回顾性分析2019年1月至2020年5月在安徽医科大学第二附属医院行LSG手术的116例肥胖患者的病例资料，比较术前及术后6个月患者体重、体质量指数（BMI）、肺功能、脂肪因子及炎症介质等指标的变化，并进一步分析肺功能的变化与炎症介质及脂肪因子之间相关性。本研究共纳入116例行LSG手术的病态肥胖患者，其中男性53例，女性63例，平均年龄（32.52±6.08）岁，BMI（43.35±7.20） kg/m²。

结果

术后6个月体重、BMI、颈围、腰围及腹围较术前均明显降低（P<0.05），用力肺活量（FVC）、第一秒用力呼气量（FEV1）、第一秒用力肺活量占用力肺活量的百分比（FEV1/FVC）、最大呼气中期流速（MMEF75/25）等肺功能指标在术后6个月均明显改善（P<0.05）。瘦素（leptin）、肿瘤坏死因子-a（TNF-a）、白细胞介素-6（IL-6）、C-反应蛋白（CRP）水平在术后6个月均明显降低（P<0.05）；白细胞介素-10（IL -10）及脂联素（adiponectin）在术后6个月均显著升高（P<0.05）。术前TNF-a、IL-6、CRP、leptin与FEV1呈负相关，adiponectin与FVC呈正相关，而TNF-a、leptin与FVC呈负相关；而在术后6个月，IL-6与FEV1呈负相关；adiponectin与FVC呈显著正相关；而TNF-a与FVC呈负相关。

结论

LSG可显著改善肥胖患者肺功能，肺功能的改善可能与术后脂肪因子及炎症介质的水平变化有关。

关键词: 肥胖, 肺功能, 炎症介质, 脂肪因子, 腹腔镜袖状胃切除术

Objective

To explore the changes of pulmonary function in obese patients 6 months after treatment with laparoscopic sleeve gastrectomy (LSG), and to evaluate its correlation with adipokines and inflammatory factors.

Methods

A retrospective analysis was made on 116 obese patients who underwent LSG surgery in the second affiliated Hospital of Anhui Medical University from January 2019 to May 2020. The changes of body weight, BMI, pulmonary function, adipose factors and inflammatory mediators were compared before and 6 months after operation, and the correlation between the changes of pulmonary function and inflammatory mediators and adipose factors was further analyzed. A total of 116 obese patients undergoing LSG were included in this study, including 53 males and 63 females, with an average age of (32.52±6.08) years and BMI of (43.35±7.20) kg/m².

Results

Weight, BMI, neck circumference, waist circumference, and abdominal circumference were significantly lower at 6 months after surgery (P<0.05), and pulmonary function indexes such as FVC, FEV1, FEV1/FVC (%), and MMEF75/25 were significantly lower after surgery (P<0.05). The levels of leptin, TNF-a, IL-6, and CRP were significantly reduced at 6 months after surgery (P<0.05); IL -10 and adiponectin were significantly increased at 6 months after surgery (P<0.05). Before surgery, TNF-a, IL-6, CRP and Leptin were negatively correlated with FEV1, adiponectin was positively correlated with FVC, while TNF-a and leptin was negatively correlated with FVC; and at 6 months after surgery, IL-6 is negatively correlated with FEV1; adiponectin is significantly positively correlated with FVC; and TNF-a is negatively correlated with FVC.

Conclusions

LSG can significantly improve the lung function of obese patients. The improvement of lung function may be related to the changes of postoperative adipose factors and inflammatory mediators.

Key words: Obesity, Pulmonary function, Inflammatory mediators, Adipokines, Laparoscopic sleeve gastrectomy

表1 患者术前术后一般资料及肺功能指标变化（n=116）

变量	术前	术后6月	t值	P值
性别			/	/
男（人）	53	53
女（人）	63	63
年龄（岁）	32.52±6.08	32.52±6.08	/	/
体重（kg）	117.40±14.79	90.88±6.85	17.524	<0.001*
BMI（kg/m²）	43.35±7.20	28.13±4.15	19.724	<0.001*
颈围（cm）	125.46±15.7	102.27±6.95	14.538	<0.001*
腹围（cm）	130.59±10.13	118.53±11.06	8.660	<0.001*
腰围（cm）	128.94±11.61	114.96±14.11	8.237	<0.001*
肺功能指标
FVC	3.05±0.46	3.48±0.45	-7.216	<0.001*
FEV1	2.58±0.39	3.27±0.58	-10.585	<0.001*
FEV1/FVC（%）	80.54±6.00	85.38±4.21	-7.115	<0.001*
PEF（L/S）	5.23±1.12	5.17±1.01	-6.850	0.707
MMEF75/25	2.90±0.32	3.39±0.71	0.376	<0.001*

表1 患者术前术后一般资料及肺功能指标变化（n=116）

变量	术前	术后6月	t值	P值
性别			/	/
男（人）	53	53
女（人）	63	63
年龄（岁）	32.52±6.08	32.52±6.08	/	/
体重（kg）	117.40±14.79	90.88±6.85	17.524	<0.001*
BMI（kg/m²）	43.35±7.20	28.13±4.15	19.724	<0.001*
颈围（cm）	125.46±15.7	102.27±6.95	14.538	<0.001*
腹围（cm）	130.59±10.13	118.53±11.06	8.660	<0.001*
腰围（cm）	128.94±11.61	114.96±14.11	8.237	<0.001*
肺功能指标
FVC	3.05±0.46	3.48±0.45	-7.216	<0.001*
FEV1	2.58±0.39	3.27±0.58	-10.585	<0.001*
FEV1/FVC（%）	80.54±6.00	85.38±4.21	-7.115	<0.001*
PEF（L/S）	5.23±1.12	5.17±1.01	-6.850	0.707
MMEF75/25	2.90±0.32	3.39±0.71	0.376	<0.001*

图1 术前和术后脂肪因子及炎症介质水平的变化

图2 术前肺功能指标与炎症介质及脂肪因子的相关性分析

图3 术后6个月肺功能指标与炎症介质及脂肪因子的相关性分析

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Correlation analysis of the relationship between the changes of pulmonary function and inflammatory mediators and adipokines in obese patients after LSG.

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Correlation analysis of the relationship between the changes of pulmonary function and inflammatory mediators and adipokines in obese patients after LSG.