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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 ›› 2022, Vol. 08 ›› Issue (02) : 97 -103. doi: 10.3877/cma.j.issn.2095-9605.2022.02.005

论著

腹腔镜袖状胃切除对心脏功能影响的分析
阮强1, 陈皖京1, 汪泳1,†()   
  1. 1. 230000　合肥，安徽医科大学第二附属医院普外科
  • 收稿日期:2021-12-15 出版日期:2022-05-30
  • 通信作者: 汪泳
  • 基金资助:
    安徽医科大学第二附属医院临床研究培养计划项目(2020LCZD07); 安徽医科大学第二附属医院临床医学学科建设项目(20211cxk003)

Effect of laparoscopic sleeve gastrectomy on cardiac function

Qiang Ruan1, Wanjing Chen1, Yong Wang1,†()   

  1. 1. Department of General Surgery, the Second Hospital of Anhui Medical University, Hefei 230000, China
  • Received:2021-12-15 Published:2022-05-30
  • Corresponding author: Yong Wang
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引用本文：

阮强, 陈皖京, 汪泳. 腹腔镜袖状胃切除对心脏功能影响的分析[J]. 中华肥胖与代谢病电子杂志, 2022, 08(02): 97-103.

Qiang Ruan, Wanjing Chen, Yong Wang. Effect of laparoscopic sleeve gastrectomy on cardiac function[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(02): 97-103.

目的

寻找术前术后肥胖症相关指标变化来研究腹腔镜袖状胃切除术（LSG）对肥胖症患者心脏功能的影响。

方法

收集2020年3月至2021年3月安徽医科大学第二附属医院普外科收治的153例行LSG的肥胖症患者的病例资料，术前将患者分为高血压伴糖尿病、高血压、糖尿病、单纯肥胖四组，进行多普勒心脏彩超检查，比较四组患者在心脏结构上有无显著差异性。术后通过心脏彩超检测左心容积、室壁的厚度和E/A值变化评价左心舒张功能。

结果

术前各组射血分数（EF）、二尖瓣a峰速度、E/A值、左室容积（LV）、左房容积（LA）、室间隔厚度（IVS）、左室后壁厚度（LVPW）组间有差异性（P<0.05），具有统计学意义。术后4月，各组二尖瓣a峰速度、E/A值、LA、LV、IVS和LVPW与术前相比均有明显差异；其中除术后E/A值显著上升外（P<0.05），二尖瓣a峰速度、LA、LV、IVS和LVPW均显著下降（P<0.05）。术前术后△空腹血糖与△E/A值呈正相关（r=0.283，P=0.002）；△收缩压与△IVS（r=0.395，P<0.001）、△LVPW（r=0.393，P<0.001）、△LV（r=0.322，P<0.001）及△LA（r=0.312，P<0.001）均呈显著正相关关系。

结论

LSG手术可以影响心脏功能从而有效改善心功能障碍。

关键词: 肥胖症, 心脏功能, 血脂谱, 炎症因子, 腹腔镜袖状胃切除术
Objective

To investigate the effects of Laparoscopic sleeve gastrectomy (LSG) on the cardiac function of obese patients by exploring the changes of obesity-related indexes before and after surgery.

Methods

A total of 153 obese patients who underwent laparoscopic sleeve gastectomy were collected from March 2020 to March 2021 in the Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University. The patients were divided into four groups before surgery: hypertension with diabetes, hypertension, diabetes and simple obesity, and underwent doppler echocardiography. The differences in cardiac structure were compared between the four groups.The diastolic function of the left heart was evaluated by color echocardiography to measure the volume of the left heart, the thickness of the ventricular wall and the change of E/A value.

Results

Before operation, there were differences in ejection fraction (EF), peak velocity of mitral valve A, E/A value, left ventricular volume (LV), left atrial volume (LA), interventricular septum thickness (IVS) and left ventricular posterior wall thickness (LVPW) among all groups (P<0.05), with statistical significance.Four months after operation, mitral valve peak A velocity, E/A value, LA, LV, IVS and LVPW were significantly different in each group compared with that before operation. The peak velocity, LA, LV, IVS and LVPW of mitral valve were significantly decreased (P<0.05), except E/A value increased significantly (P<0.05).There was A positive correlation between fasting blood glucose and △E/A before and after operation (r=0.283, P=0.002). △Systolic blood pressure was positively correlated with △IVS (r=0.395, P<0.001), △LVPW (r=0.393, P<0.001), △LV (r=0.322, P<0.001) and △LA (r=0.312, P<0.001).

Conclusions

LSG operation can affect cardiac function and improve cardiac dysfunction effectively.

Key words: Obesity, Cardiac function, Blood lipid spectrum, Inflammatory factors, Laparoscopic sleeve gastrectomy
表1 各组术前一般临床资料及心功能结构数据对比
项目 肥胖伴高血压糖尿病组（n=22） 肥胖伴高血压组（n=40） 肥胖伴糖尿病组（n=34） 单纯性肥胖组（n=57） P值 F值
EF（%） 63.91±3.69 62.20±4.02 63.82±3.75 64.82±2.77 0.005* 4.460
e（m/s） 0.74±0.20 0.84±0.24 0.77±0.20 0.83±0.18 0.164 1.725
a（m/s） 0.78±0.18 0.77±0.22 0.79±0.22 0.65±0.13 0.001* 5.656
E/A值 0.99±0.30 1.14±0.37 1.02±0.31 1.31±0.36 <0.001* 7.785
LV（mm） 52.00±5.44 49.78±5.75 45.97±3.55 46.82±3.72 <0.001* 11.090
LA（mm） 37.91±3.82 36.83±4.73 35.21±3.16 34.60±3.50 0.002* 5.310
IVS（mm） 10.82±1.53 10.65±1.63 9.15±0.99 9.37±1.06 <0.001* 15.270
LVPW（mm） 10.14±1.52 9.85±1.48 8.85±0.99 8.84±0.92 <0.001* 10.753
图2 术前各指标与心功能相关性分析注：纵坐标为心脏功能检测，横坐标为外在因素。不同的颜色表示两对之间相关系数的大小，蓝色越深，负相关越强，红色越深，正相关越强。网格上数字表示相关性r值
表2 LSG术前和术后4月一般指标变化情况
项目 术前 术后4月 P值 t值
n（人） 119 119 – –
年龄（岁） 32.54±6.92 / – –
性别（女：男） 115 38 – –
腹围（cm） 122.41±13.42 102.57±10.53 <0.001* 20.917
胸围（cm） 123.50±11.07 106.58±10.07 <0.001* 22.658
BMI （kg/m2） 41.32±5.29 32.31±3.26 <0.001* 32.614
收缩压（mmHg） 137.03±19.95 125.66±12.27 <0.001* 5.774
舒张压（mmHg） 85.21±15.60 78.18±9.24 <0.001* 4.768
LDL-C（mmol/L） 3.34±0.66 3.06±0.68 0.001* 3.495
HDL-C（mmol/L） 1.01±0.20 1.14±0.21 <0.001* -4.643
TC（mmol/L） 5.11±0.90 4.54±0.84 <0.001* 6.461
IL-6（pg/mL） 3.95±2.52 2.84±2.12 <0.001* 3.809
血肌酐（μmol/L） 46.92±10.47 50.22±10.52 0.003* -3.017
动脉粥样硬化指数 4.25±1.42 3.11±0.11 <0.001* 8.045
空腹血糖（mmol/L） 7.44±3.19 5.20±0.90 <0.001* 40.364
HbA1c（%） 7.09±1.85 5.82±0.53 <0.001* 46.131
表3 LSG术前和术后4月心功能指标变化情况
项目 术前 术后4月 P值 t值
EF（%） 63.76±3.72 64.55±3.25 0.079 -1.770
e（m/s） 0.81±0.19 0.84±0.16 0.070 -1.828
a（m/s） 0.73±0.19 0.69±0.14 0.030* 2.194
E/A值 1.17±0.38 1.27±0.30 0.009* -2.652
LV（mm） 48.40±5.11 44.24±3.25 <0.001* 8.356
LA（mm） 36.00±4.06 32.50±3.50 <0.001* 8.373
IVS（mm） 9.80±1.52 8.67±0.98 <0.001* 7.903
LVPW（mm） 9.28±1.32 8.44±0.90 <0.001* 6.224
图3 LSG术前和术后4月血糖、IL-6与E/A值相关性分析。3A：e、a、E/A值比较；3B：空腹血糖值比较；3C：IL-6比较；3D：△E/A值与△空腹血糖相关性；3E：△E/A值与△IL-6相关性
图4 LSG术前和术后4月收缩压、HDL-C与心脏结构指标相关性分析。4A：术后IVS和LVPW变化；4B：术后LA和LV变化；4C：收缩压术后变化；4D：HDL-C术后变化；4E：△LVPW与△收缩压相关性；4F：△LV与△收缩压相关性；4G：△LA与△收缩压相关性；4H：△IVS与△收缩压相关性；4I：△LA与△HDL-C相关性；4J：△LV与△HDL-C相关性；4K：△IVS与△HDL-C相关性；4L：△LVPW与△HDL-C相关性
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