肥胖病人单吻合口十二指肠回肠旁路联合胃袖状切除术后早期减重效果预测模型构建与验证  

Construction and validation of an early weight loss predictive model of obese patients after single-anastomotic duodenal ileal bypass combined with sleeve gastrectomy

作　　者：张振华 张峥 胡力夫 肖明昊 姜涛[1] ZHANG Zhen-hua;ZHANG Zheng;HU Li-fu(Department of Bariatric and Metabolic Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院减重与代谢外科,吉林长春130033

出　　处：《中国实用外科杂志》2024年第12期1400-1406,共7页Chinese Journal of Practical Surgery

基　　金：吉林省直厅局项目(No.2018SCZ032)。

摘　　要：目的 构建基于术前指标的列线图模型,以预测肥胖病人单吻合口十二指肠回肠旁路联合胃袖状切除术(SADI-S)后早期(1年内)减重效果,并对模型进行验证。方法 回顾性分析2018年10月至2023年3月于吉林大学附属中日联谊医院接受SADI-S手术的肥胖症病人资料。排除腹部大手术史、术后1年内妊娠、术后未严格遵循个案管理要求的病人以及失访者后,共180例病人入组。病人均接受标准化程序的SADI-S。将数据随机拆分为建模集和验证集,比例为7∶3。对建模集的125例病人进行单因素和多因素Logistic回归分析,将筛选出的相关因素纳入列线图模型。通过Hosmer Lemeshow拟合优度检验、校准曲线、ROC曲线和临床决策曲线对模型进行验证。结果 早期减重达标组与未达标组相比,达标组病人术前体重指数(BMI)、腰围、尿酸水平更低,而空腹血糖和糖化血红蛋白水平更高,差异具有统计学意义(均P<0.05)。多因素Logistic回归分析显示,高BMI是阻碍早期减重达标的独立负性影响因素(OR=0.64,95%CI:0.54~0.76,P<0.001),高腰围是有利于早期减重达标的独立正性影响因素(OR=1.10,95%CI:1.03~1.17,P=0.003)。基于这些变量建立的列线图模型在建模集和验证集中表现出良好的校准度和区分度,验证集的AUC达到0.92,说明模型具有较高的预测价值。结论 基于BMI和腰围的术前指标构建的预测模型可以有效地预测SADI-S术后1年内是否达到早期减重目标。该模型有助于临床医生筛选出早期减重效果可能不佳的肥胖症病人,并为这些病人提供个体化的干预和管理建议,以提高治疗效果。Objective To construct a nomogram model based on preoperative indicators to predict the early(within 1year) weight loss effect of obese patients after single-anastomotic duodenal ileal bypass combined with sleeve gastrectomy(SADI-S) and verify it.Methods The clinical case data of obesity patients who underwent SADI-S at the China-Japan Union Hospital of Jilin University from October 2018 to March 2023 were retrospectively analyzed.After excluding patients with a history of major abdominal surgery,those who were pregnant within 1 year after surgery,those who did not make adjustments to their personal lifestyle habits in strict accordance with the requirements of our case managers after surgery,and those who were lost to follow-up,a total of 180 patients were enrolled.All patients underwent SADI-S surgery with standardized procedures.The data were randomly split into a modeling set and a validation set in a ratio of 7:3.Univariate and multivariate logistic regression analyses were performed on the 125patients in the modeling set,and the relevant factors identified were incorporated into the nomogram model.The model was verified using Hosmer Lemeshoe goodness-of-fit test,calibration curve,ROC curve,and clinical decision curve.Results Compared to the group that did not achieve the early weight loss target,the patients in the target-achieving group had lower preoperative body mass index(BMI),waist circumference,and uric acid levels,while their fasting blood glucose and glycosylated hemoglobin levels werehigher,with statistically significant differences(all P<0.05).Multivariate logistic regression analysis showed that high BMI was an independent negative influencing factor for achieving early weight loss(OR=0.64,95% CI:0.54-0.76,P<0.001) while high waist circumference was an independent positiveinfluencing factor(OR=1.10,95%CI:1.03-1.17,P=0.003).The nomogram model based on these variables demonstratedgood calibration and discrimination in both the modeling and validation sets,with an AUC of 0.92 in the validation set,i

关 键 词：肥胖症 SADI-S 早期减重达标 体重指数 腰围 

分 类 号：R6[医药卫生—外科学]