袖状胃切除术对患者术后早期的身体成分变化及糖脂代谢的影响

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目的:观察袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对患者术后早期身体成分变化的影响,探究身体成分与糖脂代谢的关系,为减重团队医生评估代谢术后效果、术后随访和指导提供阶段性的信息。方法:采用回顾性队列研究,纳入2017年12月1日至2021年5月30日在宁夏医科大学总院胃肠外科行LSG的44例患者。采用生物电阻抗技术测量患者术前及术后的身体成分资料。结果:患者术后1个月以及3个月的身体成分显著改变,糖脂代谢指标明显改善,身体成分指标包括体重指数、身体水分含量、无机盐、体脂肪、骨骼肌、去脂体重、体脂百分比、腰臀脂肪比、内脏脂肪、基础代谢以及骨矿物质含量在术后3个月内显著下降,差异有统计学意义(n P<0.05)。上肢肌肉以及下肢肌肉与体重之比[(the ratio of upper muscle to body weight,U/W)、(the ratio of lower limbs muscle to body weight,L/W)]在术后明显增加(n P<0.05)。躯体肌肉与体重之比(the ratio of trunk muscle to body weight,T/W)在术后3个月内有所下降n P<0.05)。Pearson与Spearman结果显示,术后早期3个月的骨骼肌质量、U/W与甘油三酯呈正相关(n r=0.637,0.304,n P<0.05),L/W与空腹血糖呈正相关(n r=0.454,n P<0.05)。T/W与甘油三酯呈负相关(n r=-0.643,n P<0.05)。n 结论:LSG患者在术后早期身体成分显著改变,不同部位的肌肉含量变化不尽相同,对糖脂代谢的影响也不同,躯体肌肉含量与糖脂代谢呈负相关而四肢肌肉含量与骨骼肌质量与糖脂代谢呈正相关。提示对于LSG术后患者效果的评估应观察不同部位的身体成分变化,且应尽量保存躯体肌肉质量。“,”Objective:To observe early postoperative changes in body composition in patients receiving laparoscopic sleeve gastrectomy (LSG) and to explore the relationship between body composition and glycolipid metabolism, so as to provide stage-specific information for doctors in the weight loss team on metabolic surgery effect assessment and postoperative follow-up and guidance.Methods:The study was a retrospective cohort study. According to inclusion and exclusion criteria, a total of 44 patients who underwent LSG in the Department of Gastrointestinal Surgery, General Hospital of Ningxia Medical University from December 1, 2017 to May 30, 2021 were included. Body composition was measured using bio-electrical impedance analysis at baseline and after surgery.Results:The patients\' body composition changed significantly at 1 month and 3 months after surgery, and glucose and lipid metabolism indicators improved significantly. Body composition indicators, including body mass index (BMI), the amount of moisture in the body, inorganic salts, body fat, skeletal muscle mass, fat free mass, body fat percentage, waist-to-hip fat ratio, visceral fat, basal metabolic rate and bone mineral content, decreased significantly within 3 months after surgery (n P<0.05). The ratio of upper and lower limb muscle to body weight (U/W, L/W) increased significantly after surgery (n P<0.05). The ratio of trunk muscle to body weight (T/W) decreased within 3 months after surgery (n P<0.05). Pearson and Spearman correlation analyses showed that skeletal muscle mass and U/W were positively correlated with triglyceride (n r=0.637 and 0.304, respectively, both n P<0.05) in 3 months after operation. L/W was positively correlated with fasting blood glucose (n r=0.454, n P<0.05). T/W was negatively correlated with triglyceride (n r=-0.643, n P<0.05).n Conclusions:Patients undergoing LSG displayed significant changes in body composition in the early postoperative period. Changes in muscle mass of different body parts varies and showed different effects on glucose and lipid metabolism parameters. The trunk muscle mass is negatively correlated with glucose and lipid metabolism indicators, while limb muscle mass and skeletal muscle mass are positively. It is suggested that the changes of body composition in different parts should be observed when evaluating patient outcomes after LSG and the trunk body mass should be preserved as far as possible.
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