减重代谢手术对贫血相关指标影响的回顾性研究

doi:10.16139/j.1007-9610.2020.05.012

摘要/Abstract

摘要：

目的： 比较袖状胃切除术（sleeve gastrectomy, SG）和Roux-en-Y胃旁路术（Roux-en-Y gastric bypass, RYGB）后体重和血糖的改变,重点分析对贫血相关指标的影响。方法： 回顾性分析2017年12月至2019年7月我院收治的107例肥胖病人,分为SG组（56例）和RYGB组（51例）。术后病人均服用200%推荐量的多种维生素和微量元素,并额外补充B族维生素。比较两组术前和术后3、6个月时的减重和降糖效果及贫血相关指标的变化。结果： 两组年龄、性别、术前体重和体质量指数具有可比性,但RYGB组糖尿病病人显著多于SG组（88.2%比25.0%,P<0.01）。SG和RYGB组体重减轻差异无统计学意义,术后6个月两组总体重减轻百分比分别为26.92%和22.20%（P>0.05）,术后6个月时糖化血红蛋白降低平均绝对值分别为0.69%和2.31%（P<0.001）,RYGB组下降更明显。结果显示,RYGB治疗2型糖尿病疗效显著。贫血相关指标包括血红蛋白、血清铁、铁蛋白和叶酸,术后两组间差异均无统计学意义。RYGB组维生素B₁₂在术后6个月下降趋势较明显,从术前的421.42 ng/L下降至327.46 ng/L。结论： RYGB更多应用于合并2型糖尿病的肥胖病人。SG和RYGB对体重减轻相当,对血糖代谢均有益。术后补充维生素和微量元素,可有效预防贫血的发生。RYGB术后病人需补充更大剂量维生素B₁₂和叶酸。

关键词: 肥胖病, 2型糖尿病, 袖状胃切除术, Roux-en-Y胃旁路术, 术后贫血

Abstract:

Objective To compare the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on body weight, glycemic regulation, and especially on anemia associated parameters. Methods A total of 107 obese patients who underwent metabolic and bariatric surgery in our hospital between December 2017 and July 2019 were studied retrospectively including SG(n=56) and RYGB(n=51). All patients took multi-vitamin and multi-mineral supplements postoperatively at a dose of 200% of daily suggested amount and vitamin B complex was additionally supplemented. Weight loss, diabetes remission and anemia related parameters were compared before and 3, 6 months after surgery. Results Age, sex, weight, and body mass index were comparative between two groups preoperatively. RYGB group had significantly more diabetes patients than SG group (88.2% vs. 25.0%, P<0.01). There was no significant difference in body weight loss between two groups. Percentages of total weight loss in SG and RYGB group were 26.92% and 22.20% (P>0.05), respectively. RYGB group had significant drop in glycosylated hemoglobin A1c than SG group at 6 months after surgery (2.31% vs. 0.69%, P<0.001), which indicated RYGB was effective in type-2 diabetes remission. No difference in anemia related parameters including hemoglobin, serum ferrum, ferritin, and folic acid after surgery was present between two groups. However, vitamin B₁₂ of the patients in RYGB group was 327.46 ng/L at 6 months after surgery indicating a strong dropping from 421.42 ng/L preoperatively. Conclusions RYGB was used much more for obese patients with 2 type diabetes when both SG and RYGB had robust effects on weight loss and beneficial outcomes in glycemic regulation. Anemia can be effectively prevented by supplementing vitamin and minerals and RYGB patients need even more supplement of vitamin B₁₂ and folic acid.

Key words: Obesity, Type 2 diabetes mellitus, Sleeve gastrectomy, Roux-en-Y gastric bypass, Postoperative anemia

中图分类号:

R589.2

田沛荣, 刘洋, 边识博, 李梦伊, 张萌, 刘佳, 金岚, 张忠涛, 张鹏. 减重代谢手术对贫血相关指标影响的回顾性研究[J]. 外科理论与实践, 2020, 25(05): 413-416.

TIAN Peirong, LIU Yang, BIAN Shibo, LI Mengyi, ZHANG Meng, LIU Jia, JIN Lan, ZHANG Zhongtao, ZHANG Peng. Effect of bariatric and metabolic surgery on anemia related parameters: a retrospective study[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 413-416.

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参考文献 15

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项目	SG组	RYGB组	P值
总数	56	51
男/女（n）	18/38	15/36	0.760
年龄（岁）	36.71±10.17	36.88±9.76	0.932
体重（kg）	97.83±17.27	95.69±16.09	0.513
BMI	35.12±6.62	33.70±5.14	0.139
T2DM（%）	14（25.0）	45（88.2）	<0.001^#
术前贫血	4	8	0.223

项目	SG组	RYGB组	P值
体重（kg）
术前	97.83±17.27	95.69±16.09	0.513
术后3个月	77.92±13.43	77.43±13.50	0.878
术后6个月	72.46±12.07	76.08±11.57	0.441
体重减轻量（kg）
术后3个月	19.54±5.71	18.68±8.43	0.595
术后6个月	27.05±9.45	22.70±11.22	0.257
BMI
术前	35.12±6.62	33.70±5.14	0.139
术后3个月	28.13±3.85	26.63±4.22	0.114
术后6个月	26.16±3.47	25.31±2.82	0.518
%TWL（%）
术后3个月	19.95±4.41	18.90±6.42	0.395
术后6个月	26.92±6.51	22.20±7.52	0.075

项目	SG组	RYGB组	P值
空腹血糖（mmol/L）
术前	5.63±1.74	8.60±3.70	<0.001^#
术后3个月	4.77±0.80	6.17±2.97	0.030^*
术后6个月	4.70±0.63	6.92±1.36	0.002^#
餐后2 h血糖（mmol/L）
术前	10.27±4.03	16.92±5.57	<0.001^#
术后3个月	5.83±2.27	8.01±3.78	0.021^*
术后6个月	5.16±1.37	7.20±1.76	0.040^*
糖化血红蛋白（%）
术前	5.83±0.83	8.45±2.49	<0.001^#
术后3个月	5.22±0.49	5.94±1.16	0.008^#
术后6个月	5.29±0.50	6.37±0.65	<0.001^#
糖化血红蛋白降低绝对值（与术前比）（%）
术后3个月	0.73±0.83	2.11±1.90	0.001^#
术后6个月	0.69±0.90	2.31±1.54	<0.001^#

项目	SG组	RYGB组	P值
血红蛋白（g/L）
术前	141.36±15.86	135.68±16.96	0.078
术后3个月	135.67±14.25	129.93±13.04	0.082
术后6个月	137.41±15.21	136.14±9.04	0.833
血清铁（μmol/L）
术前	15.42±4.79	13.68±4.48	0.057
术后3个月	15.13±5.17	11.75±4.81	0.024^*
术后6个月	14.91±4.48	14.79±7.16	0.962
铁蛋白（μg/L）
术前	123.25±146.27	122.43±114.71	0.975
术后3个月	146.27±182.21	107.24±83.25	0.336
术后6个月	131.01±128.31	129.26±176.21	0.435
叶酸（ng/L）
术前	8.94±4.41	8.86±4.04	0.920
术后3个月	12.29±6.86	12.98±6.22	0.697
术后6个月	11.14±7.03	13.33±7.68	0.574
维生素B₁₂（ng/L）
术前	385.21±162.71	421.42±202.73	0.313
术后3个月	457.70±272.43	450.11±183.55	0.906
术后6个月	381.62±185.25	327.46±364.44	0.170