基于全身免疫炎症指数预测肥胖合并非酒精性脂肪性肝病患者经腹腔镜袖状胃切除术的减重效果  

Predicting weight loss efficacy post-sleeve gastrectomy in obese patients with non-alcoholic fatty liver disease using the sys-temic immune inflammation

作　　者：韩晓萌 张磊 李永刚 吕昭迪 崔俊莹 姜媛媛 HAN Xiaomeng;ZHANG Lei;LI Yonggang;LYU Zhaodi;CUI Junying;JIANG Yuanyuan(Department of Gastroenterology,Zhengzhou Central Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院消化内科,450000

出　　处：《浙江医学》2025年第4期392-396,共5页Zhejiang Medical Journal

基　　金：河南省科技发展计划项目(232102310247)。

摘　　要：目的建立基于全身免疫炎症指数(SII)构建的肥胖合并非酒精性脂肪性肝病(NAFLD)患者预测经腹腔镜袖状胃切除术(LSG)后早期减重效果的临床预测模型。方法回顾性分析2017年1月至2022年12月郑州大学附属郑州中心医院胃肠代谢科行LSG的86例肥胖合并NAFLD患者的临床资料,术后随访12个月,将LSG后多余体重减少百分比≥50%定义为早期体重达标。采用单因素和多因素logistic回归分析患者基本资料、临床指标、术前血液学指标与LSG后早期体重达标的关系,并将独立影响因素纳入临床预测模型。采用ROC曲线、决策曲线分析法以及Bootstrap反复自抽样法验证模型的预测效能。结果行LSG后,早期减重达标65例,未早期减重达标21例。与未早期减重达标组比较,早期减重达标组患者术前体重指数(BMI)更小,空腹胰岛素(FINS)、腹围、臀围、SII水平更低(均P<0.05)。多因素logistic回归分析显示,术前BMI(OR=0.89,95%CI:0.81~0.98,P=0.021)、FINS(OR=0.93,95%CI:0.87~0.99,P=0.039)、γ-谷氨酰转移酶(OR=0.97,95%CI:0.95~0.99,P=0.032)和SII(OR=0.99,95%CI:0.99~0.99,P=0.003)是早期减重不达标的独立影响因素,并构建临床预测模型。ROC曲线、决策曲线分析显示,该模型的预测效能良好。结论基于SII构建的临床预测模型可以更好地预测肥胖合并NAFLD患者LSG后早期体重是否达标。Objective To develop a nomogram model based on the systemic immune inflammation index(SII)to predict early weight loss outcomes in obese patients with non-alcoholic fatty liver disease(NAFLD)after laparoscopic sleeve gastrectomy(LSG).Methods A retrospective analysis was conducted on the clinical data of 86 obese patients with NAFLD who underwent LSG at the Department of Gastrointestinal Metabolism,Zhengzhou Central Hospital of Zhengzhou University from January 2017 to December 2022.Patients were followed up for 12 months after surgery,and a reduction of≥50%excess body weight after LSG was defined as reaching the goal of early weight loss.Univariate and multivariate logistic regression analyses were used to evaluate the relationship between patients'basic information,clinical indicators,preoperative hematological parameters,and early weight loss achievement after LSG.Independent influencing factors were incorporated into the clinical prediction model.The predictive performance of the model was validated using ROC curves,decision curve analysis,and Bootstrap resampling methods.Results Among the patients who underwent LSG,65 achieved early weight loss,while 21 did not.Compared with the non-achievement group,the achievement group had lower preoperative body mass index(BMI),fasting insulin(FINS),waist circumference,hip circumference,and SII levels(all P<0.05).Multivariate logistic regression analysis showed that preoperative BMI(OR=0.89,95%CI:0.81-0.98,P=0.021),FINS(OR=0.93,95%CI:0.87-0.99,P=0.039),γ-glutamyl transferase(OR=0.97,95%CI:0.95-0.99,P=0.032),and SII(OR=0.99,95%CI:0.99-0.99,P=0.003)were independent influencing factors for non-achievement of early weight loss.A clinical prediction model was constructed based on these factors.ROC curves and decision curve analysis indicated that the model had good predictive performance.Conclusion The clinical prediction model constructed based on SII can better predict early weight loss achievement in obese patients with NAFLD after LSG.

关 键 词：非酒精性脂肪性肝病 全身免疫炎症指数 腹腔镜袖状胃切除术 肥胖 

分 类 号：R656.61[医药卫生—外科学] R575.5[医药卫生—临床医学]