代谢手术治疗肥胖伴代谢综合征的3年随访研究  

Remission of metabolic syndrome after bariatric surgery in Chinese obese patients with metabolic syndrome

作　　者：屠印芳[1] 潘洁敏[1] 韩峻峰[1] 张频[2] 韩晓东[2] 包玉倩[1] 于浩泳[1] Tu Yinfang;Pan Jiemin;Han Junfeng;Zhang Pin;Han Xiaodong;Bao Yuqian;Yu Haoyong(Department of Endocrinology and Metabolism,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai Clinical Center for Diabetes,Shanghai Key Clinical Center for Metabolic Disease,Shanghai Key Laboratory of Diabetes Mellitus,Shanghai 200233,China;Department of Bariatric&Metabolic Surgery,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科,上海市糖尿病临床医学中心,上海市代谢病临床医学中心,上海市糖尿病重点实验室,200233 [2]上海交通大学附属第六人民医院减重代谢外科,200233

出　　处：《中华糖尿病杂志》2020年第11期917-922,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：上海市科学技术委员会科研计划项目(17ZR1421200);国家自然科学基金(81670791)。

摘　　要：目的:探讨肥胖伴代谢综合征(MS)患者在接受胃转流手术(RYGB)后3年的MS缓解率及其临床影响因素。方法:本研究为回顾性队列研究,共纳入2011年7月至2016年4月在上海交通大学附属第六人民医院接受RYGB治疗的肥胖伴MS患者148例,并进行术后3年随访。采集病史及体格检查数据,包括病程、用药史、糖尿病家族史、血压、腰围等,检测空腹血糖(FPG)、糖化血红蛋白(HbA 1c)、血脂谱、C反应蛋白(CRP)等指标。并计算体质指数(BMI)、总体重减轻(TWL)百分比等。根据代谢手术后3年MS缓解与否,将所有患者分为MS缓解组(n=85)和未缓解组(n=34)。采用独立样本t检验、χ2检验比较两组间的临床参数差异,建立多因素logistic回归模型分析影响MS缓解的相关因素。结果:119例(80.4%)患者完成术后3年随访,平均年龄(48.3±11.4)岁,其中女性70例(58.8%)。术前BMI(31.6±3.5)kg/m 2。RYGB术后3年与术前比较,BMI下降为(25.3±3.3)kg/m 2,MS患病率从术前的100%(119/119)降至28.6%(34/119),差异具有统计学意义(χ2=132.2,P<0.01)。缓解组的TWL百分比高于未缓解组,差异具有统计学意义[分别为(20.9±6.9)%和(17.4±6.5)%,t=2.626,P=0.011]。Logistics多元回归分析结果显示,术前CRP(比值比0.79,95%可信区间0.68~0.92,P<0.01)和TWL百分比(比值比1.09,95%可信区间1.00~1.19,P=0.047)是术后3年MS缓解的独立影响因素。结论:RYGB手术可改善中国肥胖患者MS。TWL百分比越高,术前CRP越低,术后MS缓解的可能性越大。代谢手术中期的MS缓解可能与体重减轻和慢性炎症改善有关。Objective To evaluate the remission rate of metabolic syndrome(MS)3 years after Roux-en-Y gastric bypass(RYGB)and the predictive factors associated with MS remission in Chinese patients with obesity and MS.Methods This study was a retrospective cohort study and included 148 obese patients with MS who were treated with RYGB in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from July 2011 to April 2016.All patients were followed up for 3 years after surgery.The medical history and physical examination data,including duration of diseases,medication history,family history of diabetes,blood pressure,waist circumference,etc.were collected.Fasting blood glucose,glycated hemoglobin A1c,blood lipid profile,C-reactive protein(CRP)and other indicators were detected.Body mass index(BMI)and percentages of total weight loss(TWL)were calculated.According to whether or not their MS were remission 3 years after metabolic surgery,all patients were divided into MS remission group(n=85)and non-remission group(n=34).The t test andχ2 test were used to compare the clinical data between the two groups,and a multivariate logistic regression model was established to analyze the related factors affecting MS remission.Results A total of 119 patients(80.4%)with an average age of(48.3±11.4)years old were followed up for 3 years.Among these patients,70 cases(58.8%)were female.The BMI was(31.6±3.5)kg/m2 before surgery but was decreased to(25.3±3.3)kg/m23 years after surgery.The prevalence of MS decreased from 100%(119/119)before surgery to 28.6%(34/119)three years after RYGB surgery,and the differences were statistically significant(χ²=132.2,P<0.01).Percentage of TWL in the MS remission group was higher than that of the non-remission group,the differences were statistically significant[(20.9±6.9)%vs(17.4±6.5)%,t=2.626,P=0.011].Logistics multiple regression analysis revealed that preoperative CRP[odds ratio(OR)=0.79,95%confidence interval(CI):0.68-0.92,P<0.01]and percentage of TWL(OR=1.09,95%CI:1.00-1.19,P=0.047)were

关 键 词：肥胖症 C反应蛋白质 代谢综合征 代谢手术 ROUX-EN-Y胃转流术 

分 类 号：R656.61[医药卫生—外科学]