不同减重代谢手术方式对代谢综合征患者骨髓脂肪的影响  

The impact of different bariatric metabolic surgery on bone marrow fat in patients with metabolic syndrome

作　　者：张婷 管文敏 李梦伊 刘佳[2] 苑筱晴 李向明 陈静[1] 吕晗[1] 杨正汉[1] Zhang Ting;Guan Wenmin;Li Mengyi;Liu Jia;Yuan Xiaoqing;Li Xiangming;Chen Jing;Lyu Han;Yang Zhenghan(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Bariatric and Metabolic Surgery,General Surgery Center,National Clinical Medical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050 [2]首都医科大学附属北京友谊医院普通外科中心减重与代谢外科、国家消化系统疾病临床医学研究中心,北京100050

出　　处：《中华医学杂志》2025年第14期1095-1100,共6页National Medical Journal of China

基　　金：国家自然科学基金(82302182);首都医科大学附属北京友谊医院“友谊种子计划”人才项目(YYZZ202130)。

摘　　要：目的探讨袖状胃切除术(SG)和胃旁路手术(RYGB)对代谢综合征患者骨髓脂肪组织(BMAT)含量的影响。方法回顾性收集2022年1月至2023年10月于北京友谊医院减重与代谢外科行减重代谢手术的82例代谢综合征患者的临床资料。根据减重手术方式将患者分为2组:接受SG和RYGB者分别为SG组和RYGB组。基于MRI非对称回波最小二乘估算法迭代水脂分离(IDEAL-IQ)序列测量T_(9)~L_(1)的骨髓脂肪分数(BMFF),比较两组手术前后体重、体质指数(BMI)、脂代谢指标及BMFF变化量。采用Pearson相关分析评价BMFF变化量与体重、BMI及脂代谢指标的相关性。结果82例患者年龄为(34.8±8.6)岁,男19例(23.2%),SG组患者51例(62.2%),RYGB组31例(37.8%)。82例患者术后1年体重、BMI、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、BMFF均较术前下降,高密度脂蛋白胆固醇(HDL-C)较术前升高(均P<0.05)。SG组术后TC、TG及LDL-C下降量均低于RYGB组(均P<0.05),两组术后体重、BMI、HDL-C、BMFF下降量差异均无统计学意义(均P>0.05)。Pearson相关分析发现,整体患者、SG组和RYGB组患者手术前后BMFF变化量与体重变化量(r=0.765、0.753、0.801)及BMI变化量(r=0.697、0.646、0.797)均呈正相关(均P<0.05)。结论代谢综合征患者减重代谢手术后BMFF下降,SG和RYGB术后BMFF变化量相似,BMFF变化量与体重及BMI变化量呈正相关。Objective To explore the impact of sleeve gastrectomy and Roux-en-Y gastric bypass on bone marrow adipose tissue(BMAT)in patients with metabolic syndrome.Methods A total of 82 patients with metabolic syndrome who underwent bariatric metabolic surgery at the Department of Bariatric and Metabolic Surgery in Beijing Friendship Hospital from January 2022 to October 2023 were conducted retrospectively.Patients who received SG and RYGB were divided into the SG group and RYGB group,respectively.Bone marrow fat fraction(BMFF)of T_(9)-L_(1)was measured using the MRI iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification(IDEAL-IQ)sequence.The changes of body weight,body mass index(BMI),lipid metabolism index and BMFF before and after operation were compared between the two groups.Pearson correlation analysis was used to evaluate the correlation between BMFF changes and body weight,BMI and lipid metabolism index.Results The age of the 82 patients was(34.8±8.6)years,with 19 males(23.2%).There were 51 patients in the SG group(62.2%)and 31 in the RYGB group(37.8%).The weight,BMI,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and BMFF were all decreased one year after surgery in metabolic syndrome patients,while the high-density lipoprotein cholesterol(HDL-C)increased compared with preoperative levels(all P<0.05).The decreases of TC,TG and LDL-C in SG group were lower than those in RYGB group(all P<0.05).There was no statistical difference in the decreases of weight,BMI,HDL-C and BMFF after surgery between two groups(all P>0.05).BMFF changes before and after surgery were positive correlated with changes in body weight(r=0.765,0.753,0.801)and BMI(r=0.697,0.646,0.797)in the whole patients,SG and RYGB groups(all P<0.05).Conclusions BMFF in patients with metabolic syndrome decreases after bariatric and metabolic surgery.BMFF changes are similar after different surgical methods,and positively correlated with body weight and BMI changes.

关 键 词：肥胖症 减重代谢手术 代谢综合征 骨髓脂肪 磁共振成像 

分 类 号：R656.6[医药卫生—外科学]