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  • 李贵芳,张君宜,梅芳芸,等.腹腔镜下袖状胃切除术治疗不同血脂水平肥胖患者的疗效研究[J].同济大学学报(医学版),2020,41(2):178-184.    [点击复制]
  • LI Gui-fang,ZHANG Jun-yi,MEI Fang-yun,et al.Efficacy of laparoscopic sleeve gastrectomy in severe obese patients with different levels of triglycerides[J].同济大学学报(医学版),2020,41(2):178-184.   [点击复制]
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腹腔镜下袖状胃切除术治疗不同血脂水平肥胖患者的疗效研究
李贵芳,张君宜,梅芳芸,高晶扬,黄玥晔,程晓芸,曲伸
0
(同济大学附属第十人民医院内分泌代谢病科,国家标准化代谢性疾病管理中心(十院),上海200072)
摘要:
目的探讨在重度肥胖患者中,不同三酰甘油(TG)水平对减重效果及相关代谢指标的影响。方法回顾性收集2012年12月—2019年4月同济大学附属第十人民医院收治的行LSG手术的105例肥胖患者(BMI≥35kg/m2)的基线和术后6个月人体测量学指标和临床代谢指标。按基线TG水平分为TG正常组与TG异常组,两组间进行比较,并把腰围(WC)差值和臀围(HC)差值与各检测指标进行相关性分析(差值用Δ表示)。结果基线时,TG正常组空腹血糖(FPG)、餐后2h血糖(2hPG)、总胆固醇(TC)低于TG异常组(P<0.01)。术后6个月,两组多项代谢指标有明显改善,FPG及2hPG、TC无差异。与异常组相比,TG正常组的ΔBMI、ΔWC和ΔHC下降幅度更大。多元线性回归分析显示,TG正常组WC差值(ΔWC)与ΔBMI(r=0.765,P<0.001)、颈围(NC)差值(ΔNC,r=0.394,P=0.021)、肌酐(Cr)差值(ΔCr,r=0.442,P=0.009)存在正相关,与ΔTC(r=-0.449,P=0.008)、高密度脂蛋白(HDL)差值(ΔHDL,r=-0.354,P=0.040)、低密度脂蛋白(LDL)差值(ΔLDL,r=-0.401,P=0.019)存在负相关。结论LSG能有效改善代谢紊乱情况。TG正常组WC和HC改善更显著,术前TG水平可作为LSG术后预测减重效果的指标之一。
关键词:  肥胖  袖状胃切除术  三酰甘油  腰围
DOI:10.16118/j.1008-0392.2020.02.007
投稿时间:2019-10-21
基金项目:国家科技部重点研发计划(2018YFC1314100、2016YFC1305600);上海市科学技术委员会项目(18411951803、17DZ1910603)
Efficacy of laparoscopic sleeve gastrectomy in severe obese patients with different levels of triglycerides
LI Gui-fang,ZHANG Jun-yi,MEI Fang-yun,GAO Jing-yang,HUANG Yue-ye,CHENG Xiao-yun,QU Shen
(Dept. of Endocrinology and Metabolism, National Metabolic Management Center, Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China)
Abstract:
ObjectiveTo investigate the efficacy of laparoscopic sleeve gastrectomy(LSG)in severe obese patients with different triglyceride(TG)levels. MethodsOne hundred and five patients with severe obesity(BMI≥35kg/m2)who underwent LSG in Shanghai Tenth People's Hospital from December 2012 to April 2019 were enrolled in study. The anthropometric parameters and metabolic indicators were collected preoperatively and 6 months postoperatively. There were 49 patients with high triglyceride level at baseline(≥1.7mmol/L, high TG group)and 56 patients with normal TG level at baseline(<1.7mmol/L, normal TG group). The differences of waist circumference(WC)and hip circumference(HC)were compared between the two groups, and the changes of other metabolic indices was analyzed before and after surgery. ResultsInitially, fasting plasma glucose(FPG), 2h plasma glucose(2hPG) and total cholesterol(TC) in normal TG group were lower than those in high TG group(P<0.01). There was no difference in FPG, 2hPG and TC 6 months after operation, and the metabolic indexes of the two groups were significantly improved. Compared with the higher TG group, the ΔBMI, ΔWC and ΔHC in the normal TG group was greater. Multivariate linear regression analysis showed that the change value of WC level(ΔWC)was positively correlated with the change value of BMI level(ΔBMI, r=0.765, P<0.001), ΔNC(r=0.394, P=0.021), ΔCr(r=0.442, P=0.009), but negatively correlated with ΔTC(r=-0.449, P=0.008), high-density lipoprotein(ΔHDL, r=-0.354, P=0.040)and low-density lipoprotein(ΔLDL, r=-0.401, P=0.019). ConclusionLSG can effectively improve metabolic disorders. There were differences in weight loss between normal TG group and abnormal TG group 6 months after LSG, and the baseline TG level can be used as one of the indicators to predict the short-term effects of weight loss after LSG.
Key words:  obesity  sleeve gastrectomy  triglyceride  waist circumference

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