双能X线吸收测量法评估腹腔镜胃袖状切除术代谢指标改善的临床价值

Clinical value of dual energy X-ray absorptiometry in evaluating the improvement of metabolic indexes after laparoscopic sleeve gastrectomy

    摘要
  • 摘要: 目的:观察双能X线吸收测量法(DEXA)评估行腹腔镜胃袖状切除术的肥胖症患者术前与术后体脂改变情况，探讨其体脂改变与胰岛素抵抗改变之间的相关性。
    方法:采用队列研究方法。收集2015年10月至2017年2月中国医科大学附属第四医院收治的10例肥胖症患者的临床资料。患者均行腹腔镜胃袖状切除术，于术前和术后分别使用DEXA测量患者全身不同部位及区域(全身、上肢、下肢、躯干、A区和G区)的脂肪含量以及计算胰岛素抵抗指数(HOMAIR)。观察指标：(1)DEXA脂肪评估参数及其他肥胖相关指标检测结果。(2)胰岛素敏感性指标检测结果。患者随访由代谢外科专业团队管理，采用电话、门诊、住院方式进行随访，并于术后6个月通过门诊或住院方式行DEXA检测。随访时间截至2017年2月。正态分布的计量资料以±s表示，重复测量数据采用重复测量方差分析，相关性分析采用Pearson法，相关程度采用因子分析及多元线性回归分析法。
    结果:(1)DEXA脂肪评估参数及其他肥胖相关指标检测结果：10例患者均获得随访。患者术前全身、上肢、下肢、躯干、A区、G区的脂肪含量及百分比以及BMI、腰围、HOMAIR分别为(55.6±13.7)kg、(6.2±1.9)kg、(17.8±3.6)kg、(31.7±12.7)kg、(5.6±2.4)kg、(8.8±1.5)kg，50%±3%、54%±5%、50%±4%、52%±3%、57%±4%、52%±4%，(42±8)kg/m2，(123±23)cm，8.7±5.6，术后6个月上述指标分别为(37.4±11.3)kg、(4.0±1.2)kg、(11.2±3.0)kg、(20.4±9.6)kg、(3.5±1.7)kg、(5.1±1.4)kg，43%±5%、46%±5%、42%±5%、46%±5%、48%±6%、46%±5%，(30±6)kg/m2，(101±20)cm，3.5±2.4，上述指标手术前后比较，差异均有统计学意义(F=11.282，6.308，15.789，6.083，7.836，9.027，5.485，7.743，8.620，3.743，4.704，5.421，13.281，14.258，4.465，P<0.05)；而术前患者腰臀比和A区脂肪含量百分比/G区脂肪含量百分比(A/G)分别为0.94±0.09，1.10±0.09，术后6个月分别为0.93±0.12，1.05±0.13，上述指标手术前后比较，差异均无统计学意义(F=0.324，1.361，P>0.05)。(2) 胰岛素敏感性指标检测结果：术前患者全身、躯干、A区、G区脂肪含量、BMI和腰围与HOMAIR呈正相关(r=0.873，0.874，0.894，0.696，0.843，0.816，P<0.05)，上肢和下肢脂肪含量与HOMAIR不相关(r=0.442，0.242，P>0.05)。经因子分析得出主成分F1和F2，F1反映全身(躯干为主)的各部位脂肪含量，F2反映四肢脂肪含量，且F1模型建立合理(t=5.033，P<0.05)，在F1中，全身、上肢、下肢、躯干、A区、G区、BMI和腰围的贡献率分别为0.994，0.633，0.487，0.887，0.900，0.897，0.959，0.897，在F2中，全身、上肢、下肢、躯干、A区、G区、BMI和腰围的贡献率分别为-0.030，0.716，0.829，-0.446，-0.405，0.423，-0.201，-0.283，其中全身脂肪含量对评估术前HOMAIR的贡献率最大，为0.994。术后6个月G区脂肪含量下降与HOMAIR改善呈正相关(r=0.717，P<0.05)。
    结论:全身脂肪含量是评估女性患者存在胰岛素抵抗的重要指标，G区脂肪含量下降是女性肥胖症患者行腹腔镜胃袖状切除术后早期胰岛素抵抗得以缓解的重要因素。

     

    Abstract: Objective:To observe the changes of pre and postoperative body fats of obese patients undergoing laparoscopic sleeve gastrectomy which were evaluated by dualenergy Xray absorptiometry (DEXA) and investigate the correlation of the changes between body fat and insulin resistance.
    Methods:The cohort study was conducted. The clinical data of 10 obese patients who were admitted to the Fourth Affiliated Hospital of China Medical University from October 2015 to February 2017 were collected. Ten obese patients received laparoscopic sleeve gastrectomy (LSG). The pre and postoperative body fat masses in the different parts and regions of the whole body ［whole body, upper limbs, lower limbs, trunk, region of android (region A) and region of gynoid (region G)］ were measured by DEXA and pre and postoperative indexes of insulin resistance (HOMAIR) were calculated. Observation indicators: (1) fat parameters evaluated by DEXA and test results of other obesity related indicators; (2) test results of insulin sensitivity index. The patients were followed up by the professional team of metabolic surgery using telephone interview, outpatient and inpatient examinations up to February 2017, and DEXA using outpatient and inpatient examinations was performed at 6 months postoperatively. The measurement data with normal distribution were represented as ±s, and repeated measurement data were analyzed by the repeated measures ANOVA. The correlation analysis was performed by the Pearson, and the degree of correlation was analyzed by the factor analysis and multiple linear regression.
    Results:(1) Fat parameters evaluated by DEXA and test results of other obesity related indicators: all the 10 patients were followed up. The fat masses and percentages of the whole body, upper limbs, lower limbs, trunk, region A and region G, BMI, waist circum ference and HOMAIR were respectively (55.6±13.7)kg, (6.2±1.9)kg, (17.8±3.6)kg, (31.7±12.7)kg, (5.6±2.4)kg, (8.8±1.5)kg, 50%±3%, 54%±5%, 50%±4%, 52%±3%, 57%±4%, 52%±4%, (42± 8)kg/m2, (123±23)cm, 8.7±5.6 before operation and (37.4±11.3)kg, (4.0±1.2)kg, (11.2±3.0)kg, (20.4±9.6)kg, (3.5±1.7)kg, (5.1±1.4)kg, 43%±5%, 46%±5%, 42%±5%, 46%±5%, 48%±6%, 46%±5%, (30±6)kg/m2, (101±20)cm, 3.5±2.4 at 6 months postoperatively, with statistically significant differences between preand postoperations (F=11.282, 6.308, 15.789, 6.083, 7.836, 9.027, 5.485, 7.743, 8.620, 3.743, 4.704, 5.421, 13.281, 14.258, 4.465, P<0.05). The waisthip ratio and percentage of region A / percentage of region G (A/G) were 0.94±0.09, 1.10±0.09 before operation and 0.93±0.12, 1.05±0.13 at 6 months postoperatively, with no statistically significant difference between preand postoperations (F=0.324, 1.361, P>0.05). (2) Test results of insulin sensitivity index: there was a positive correlation in the fat masses of the whole body, trunk, region A and region G, BMI, waist circumference and HOMAIR (r=0.873, 0.874, 0.894, 0.696, 0.843, 0.816, P<0.05), and no correlation between the fat masses of the upper and lower limbs and HOMAIR (r=0.442, 0.242, P>0.05). The principal component of F1 and F2 were constructed by the factor analysis, F1 (trunk for the most) reflected the fat mass of the different parts of the whole body and F2 reflected the fat mass of peripheral limbs, the model of F1 was reasonable (t=5.033, P<0.05). The contribution rate of the whole body, upper and lower limbs, trunk, region A, region G, BMI and waist circumference were respectively 0.994, 0.633, 0.487, 0.887, 0.900, 0.897, 0.959, 0.897 in the F1 and -0.030, 0.716, 0.829, -0.446, -0.405, 0.423, -0.201, -0.283 in the F2, and the whole body fat mass (BFM) made a largest contribution rate for the preoperative HOMAIR (0.994). There was a positive correlation between decrease of fat mass in region G and improvement of HOMAIR at 6 months postoperatively (r=0.717, P<0.05).
    Conclusion:BFM is an important index to evaluate the insulin resistance in female patients, and the decrease of fat mass in the region G is an important factor for the early remission of insulin resistance in female patients after laparoscopic sleeve gastrectomy.

     

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