双能X线吸收测量法评估腹腔镜胃袖状切除术代谢指标改善的临床价值  

Clinical value of dual-energy X-ray absorptiometry in evaluating the improvement of metabolic indexesafter laparoscopic sleeve gastrectomy

作　　者：刘克毅[1] 王墨飞[1] 王勇[1] 

机构地区：[1]中国医科大学附属第四医院代谢外科,沈阳110032

出　　处：《中华消化外科杂志》2017年第6期602-607,共6页Chinese Journal of Digestive Surgery

基　　金：中国医疗手牵手工程委员会（YJHYXKYJJ-142）;辽宁省自然科学基金指导计划（201602866）

摘　　要：目的：观察双能X线吸收测量法（DEXA）评估行腹腔镜胃袖状切除术的肥胖症患者术前与术后体脂改变情况，探讨其体脂改变与胰岛素抵抗改变之间的相关性。 方法：采用队列研究方法。收集2015年10月至2017年2月中国医科大学附属第四医院收治的10例肥胖症患者的临床资料。患者均行腹腔镜胃袖状切除术，于术前和术后分别使用DEXA测量患者全身不同部位及区域（全身、上肢、下肢、躯干、A区和G区）的脂肪含量以及计算胰岛素抵抗指数（HOMAIR）。观察指标：（1）DEXA脂肪评估参数及其他肥胖相关指标检测结果。（2）胰岛素敏感性指标检测结果。患者随访由代谢外科专业团队管理，采用电话、门诊、住院方式进行随访，并于术后6个月通过门诊或住院方式行DEXA检测。随访时间截至2017年2月。正态分布的计量资料以±s表示，重复测量数据采用重复测量方差分析，相关性分析采用Pearson法，相关程度采用因子分析及多元线性回归分析法。 结果：（1）DEXA脂肪评估参数及其他肥胖相关指标检测结果：10例患者均获得随访。患者术前全身、上肢、下肢、躯干、A区、G区的脂肪含量及百分比以及BMI、腰围、HOMAIR分别为（55.6±13.7）kg、（6.2±1.9）kg、（17.8±3.6）kg、（31.7±12.7）kg、（5.6±2.4）kg、（8.8±1.5）kg，50%±3%、54%±5%、50%±4%、52%±3%、57%±4%、52%±4%，（42±8）kg/m2，（123±23）cm，8.7±5.6，术后6个月上述指标分别为（37.4±11.3）kg、（4.0±1.2）kg、（11.2±3.0）kg、（20.4±9.6）kg、（3.5±1.7）kg、（5.1±1.4）kg，43%±5%、46%±5%、42%±5%、46%±5%、48%±6%、46%±5%，（30±6）kg/m2，（101±20）cm，3.5±2.4，上述指标手术前后比较，差异均有统计学意义（F=11.282，6.308，15.789，6.083，7.836，9.027，5.485，7.743，8.620，3.743，4.704，5.421，13.281，14.258，4.465，P〈0.05）；而术前患者腰�Objective：To observe the changes of pre and postoperative body fats of obese patients undergoing laparoscopic sleeve gastrectomy which were evaluated by dualenergy Xray absorptiometry （DEXA） and investigate the correlation of the changes between body fat and insulin resistance. Methods：The cohort study was conducted. The clinical data of 10 obese patients who were admitted to the Fourth Affiliated Hospital of China Medical University from October 2015 to February 2017 were collected. Ten obese patients received laparoscopic sleeve gastrectomy （LSG）. The pre and postoperative body fat masses in the different parts and regions of the whole body [whole body, upper limbs, lower limbs, trunk, region of android （region A） and region of gynoid （region G）] were measured by DEXA and pre and postoperative indexes of insulin resistance （HOMAIR） were calculated. Observation indicators： （1） fat parameters evaluated by DEXA and test results of other obesity related indicators; （2） test results of insulin sensitivity index. The patients were followed up by the professional team of metabolic surgery using telephone interview, outpatient and inpatient examinations up to February 2017, and DEXA using outpatient and inpatient examinations was performed at 6 months postoperatively. The measurement data with normal distribution were represented as ±s, and repeated measurement data were analyzed by the repeated measures ANOVA. The correlation analysis was performed by the Pearson, and the degree of correlation was analyzed by the factor analysis and multiple linear regression. Results：（1） Fat parameters evaluated by DEXA and test results of other obesity related indicators： all the 10 patients were followed up. The fat masses and percentages of the whole body, upper limbs, lower limbs, trunk, region A and region G, BMI, waist circum ference and HOMAIR were respectively （55.6±13.7）kg, （6.2±1.9）kg, （17.8±3.6）kg, （31.7±12.7）kg, （5.6±2.4）kg, （8.8±1.5）kg, 50%±3%,

关 键 词：肥胖症 胃袖状切除术 胰岛素抵抗 双能X线吸收测量法 

分 类 号：R656.6[医药卫生—外科学]