摘要： 背景 減重代謝手術(shù)是目前治療肥胖的有效措施，但手術(shù)效果對(duì)患者心理狀況的影響仍不明確。 目的 探討減重代謝手術(shù)后1年，治療效果對(duì)患者心理狀況的影響。 方法 采用回顧性橫斷面研究方法，選取2019年6月至2020年6月于南京醫(yī)科大學(xué)第一附屬醫(yī)院普外科進(jìn)行減重代謝手術(shù)的患者172例為研究對(duì)象，收集患者的臨床資料。減重代謝手術(shù)治療效果相關(guān)指標(biāo)包括身體成分指標(biāo)〔體質(zhì)量、體質(zhì)指數(shù)（BMI）、多余體質(zhì)量減少率（EWL%）、體肌肉量（BM）、體脂肪量（BF）、內(nèi)臟脂肪面積（VSF）〕、代謝相關(guān)生化指標(biāo)〔丙氨酸氨基轉(zhuǎn)移酶（ALT）、天冬氨酸氨基轉(zhuǎn)移酶（AST）、總蛋白（TP）、白蛋白（ALB）〕、術(shù)前合并癥、術(shù)后合并癥緩解情況、術(shù)后并發(fā)癥、術(shù)后相關(guān)主訴、手術(shù)術(shù)式；術(shù)后心理狀況相關(guān)指標(biāo)包括生活質(zhì)量、壓力感、幸福感和手術(shù)滿(mǎn)意度，分別采用簡(jiǎn)明生命質(zhì)量量表（SF-12）、中文版壓力知覺(jué)量表（CPSS）、幸福感量表（GWS）、減重代謝手術(shù)患者滿(mǎn)意度調(diào)查表進(jìn)行調(diào)查。采用Pearson相關(guān)分析和Spearman秩相關(guān)分析探討身體成分指標(biāo)及代謝相關(guān)生化指標(biāo)與患者術(shù)后心理狀況指標(biāo)的相關(guān)性，采用多元線(xiàn)性回歸分析探討術(shù)后心理狀況的影響因素。 結(jié)果 患者術(shù)后1年多余體質(zhì)量減少率（EWL%）為（82.7±31.7）%，BMI下降（10.3±4.3）kg/m2。96例（55.8%）患者術(shù)前存在2型糖尿病、高血壓、脂肪肝等代謝相關(guān)合并癥，術(shù)后完全緩解48例（27.9%），部分緩解30例（17.4%），未緩解18例（10.5%）?；颊咝g(shù)后1年體質(zhì)量、BMI、BM、BF、VSF、ALT、AST低于術(shù)前，TP、ALB高于術(shù)前（P<0.05）。相關(guān)性分析結(jié)果顯示，患者精神生活質(zhì)量（MCS）得分與ΔALT呈負(fù)相關(guān)（rs=-0.160，P=0.036）；CPSS得分與EWL%（r=-0.181，P=0.017）、Δ體肌肉率（BM%）（rs=-0.174，P=0.022）呈負(fù)相關(guān)，與ΔALT（rs=-0.236，P=0.002）呈正相關(guān)；GWS得分與ΔALT（rs=-0.228，P=0.003）、ΔAST（rs=-0.216，P=0.004）呈負(fù)相關(guān)；滿(mǎn)意度與ΔBMI（r=-0.171，P=0.025）、Δ體脂肪率（BF%）（r=-0.174，P=0.022）、ΔVSF（r=-0.154，P=0.043）呈負(fù)相關(guān)，與EWL%（r=0.284，P<0.001）呈正相關(guān)。多元線(xiàn)性回歸分析結(jié)果顯示，術(shù)后胃痛（β=-0.239，P=0.002）、術(shù)后體虛乏力（β=-0.169，P=0.025）是PCS得分的影響因素；ΔALT（β=-0.181，P=0.017）、術(shù)后體虛乏力（β=0.171，P=0.024）是MCS得分的影響因素；EWL%（β=-0.188，P=0.010）、ΔBM%（β=-0.146，P=0.047）、ΔALT（β=0.219，P=0.003）、術(shù)后體虛乏力（β=0.169，P=0.022）是CPSS得分的影響因素；ΔALT（β=-0.254，P=0.001）、術(shù)后反酸胃灼熱（β=-0.251，P=0.001）是GWS得分的影響因素；ΔBMI（β=-0.245，P=0.010）、EWL%（β=0.247，P=0.003）、ΔBF%（β=-0.366，P<0.001）是滿(mǎn)意度得分的影響因素。96例有術(shù)前合并癥的患者中，多元線(xiàn)性回歸分析結(jié)果顯示，術(shù)后合并癥緩解（β=0.411，P<0.001）、術(shù)后胃痛（β=-0.192，P=0.040）是軀體生活質(zhì)量（PCS）得分的影響因素；ΔALT（β=-0.273，P=0.006）、術(shù)后反酸胃灼熱（β=-0.263，P=0.008）是MCS得分的影響因素；術(shù)后合并癥緩解（β=-0.220，P=0.024）、ΔALT（β=0.301，P=0.002）、術(shù)后胃痛（β=0.214，P=0.023）、ΔVSF（β=0.212，P=0.031）是CPSS得分的影響因素；術(shù)后合并癥緩解（β=0.290，P=0.002）、ΔALT（β=-0.310，P=0.001）、術(shù)后胃痛（β=-0.271，P=0.004）是GWS得分的影響因素；術(shù)后合并癥緩解（β=0.402，P<0.001）、ΔBF%（β=-0.452，P<0.001）、ΔBMI（β=-0.364，P<0.001）是滿(mǎn)意度得分的影響因素。 結(jié)論 減重代謝手術(shù)后1年，患者BMI顯著降低，術(shù)后反酸胃灼熱、胃痛、體虛乏力及ΔBF%、ΔALT升高對(duì)患者心理狀況產(chǎn)生負(fù)面影響；EWL%、ΔBM%升高對(duì)患者心理狀況產(chǎn)生正面影響。存在合并癥的患者，術(shù)后合并癥緩解程度越高對(duì)患者心理狀況產(chǎn)生的積極影響越大。

關(guān)鍵詞: 肥胖癥, 減重代謝手術(shù), 治療效果, 心理狀況, 影響因素分析

Abstract:

Background

Bariatric surgery is the effective treatment for obesity, however, the effect of surgery on patients' psychological status is still unclear.

Objective

To investigate the treatment effects of bariatric surgery on patients' psychological status one year after the surgery.

Methods

This is a retrospective cross-sectional study. This study selected 172 patients who underwent bariatric surgery in the department of general surgery, First Affiliated Hospital of Nanjing Medical University during June 2019 to June 2020, and collected their clinical data. The indicators of the treatment effects of bariatric surgery include body composition indicators〔Weight, Body mass index (BMI) , Percentage of excess weight loss (EWL%) , Body muscle mass (BM) , Body fat mass (BF) , Visceral fat (VSF) , metabolism-related biochemical indexes〔Alanine aminotransferase (ALT) , Aspartate aminotransferase (AST) , Total protein (TP) , Albumin (ALB) 〕, preoperative comorbidities, relief of comorbidities after surgery, postoperative complications, postoperative complaints, surgery methods; Indicators of the postoperative psychological status include quality of life, perceived stress, general well-being and satisfaction degree of surgery. This study used the12-item Short Form Survey (SF-12) , Chinese version of the Perceived Stress Scale (CPSS) , General Well-being Schedule (GWS) , Questionnaire of Bariatric Surgery Patient' Satisfaction Survey to investigate the psychological status. This study used the Pearson correlation analysis and Spearman rank correlation analysis to explore the correlation between body composition indicators and metabolic-related biochemical indexes and postoperative psychological status, used the multivariate linear regression analysis to explore the factors that affect postoperative psychological status.

Results

One year after surgery, EWL% was (82.7±31.7) %, and BMI decreased by (10.3±4.3) kg/m2. 96 patients (55.8%) had metabolic-related comorbidities such as type 2 diabetes mellitus, hypertension, fatty liver before surgery, 48 patients (27.9%) achieved complete remission, 30 patients (17.4%) achieved partial remission, and 18 patients (10.5%) had no remission after surgery. Patients'weight, BMI, BM, BF, VSF, ALT, AST were lower than those before surgery, the TP and ALB were higher than those before surgery (P<0.05) .The correlation analysis showed that patients' MCS scores were negatively correlated with ΔALT (rs=-0.160, P=0.036) ; the CPSS scores were negatively correlated with EWL% (r=-0.181, P=0.017) and ΔBM% (rs=-0.174, P=0.022) but positively correlated with ΔALT (rs=-0.236, P=0.002) ; the GWS scores were negatively correlated with ΔALT (rs=-0.228, P=0.003) and ΔAST (rs=-0.216, P=0.004) ; the satisfaction of surgery were negatively correlated with ΔBMI (r=-0.171, P=0.025) , ΔBF% (r=-0.174, P=0.022) and ΔVSF (r=-0.154, P=0.043) but positively correlated with EWL% (r=0.284, P<0.001) . The multivariate linear regression analysis showed that postoperative stomachache (β=-0.239, P=0.002) and postoperative fatigue (β=-0.169, P=0.025) were factors that affect PCS scores; ΔALT (β=-0.181, P=0.017) and postoperative fatigue (β=0.171, P=0.024) were factors that affect MCS scores; EWL% (β=-0.188, P=0.010) , ΔBM% (β=-0.146, P=0.047) , ΔALT (β=0.219, P=0.003) and postoperative fatigue (β=0.169, P=0.022) were factors that affect CPSS scores; ΔALT (β=-0.254, P=0.001) and acid reflux (β=-0.251, P=0.001) were factors that affect GWS scores; ΔBMI (β=-0.245, P=0.010) , EWL% (β=0.247, P=0.003) and ΔBF% (β=-0.366, P<0.001) were factors that affect satisfaction of surgery. Among the 96 patients with preoperative comorbidities, multiple linear regression analysis showed that postoperative relief of comorbidities (β=0.411, P<0.001) and stomachache (β=-0.192, P=0.040) were factors that affect PCS scores; ΔALT (β=-0.273, P=0.006) and acid reflux (β=-0.263, P=0.008) were factors that affect MCS scores; postoperative relief of comorbidities (β=-0.220, P=0.024) , ΔALT (β=0.301, P=0.002) , stomachache (β=0.214, P=0.023) and ΔVSF (β=0.212, P=0.031) were factors that affect CPSS scores; postoperative relief of comorbidities (β=0.290, P=0.002) , ΔALT (β=-0.310, P=0.001) and stomachache (β=-0.271, P=0.004) were factors that affect GWS scores; postoperative relief of comorbidities (β=0.402, P<0.001) , ΔBF% (β=-0.452, P<0.001) and ΔBMI (β=-0.364, P<0.001) were factors that affect satisfaction of surgery.

Conclusion

Patients' BMI decreased significantly one year after bariatric surgery. The postoperative acid reflux, stomachache, fatigue and the increase of ΔBF% and ΔALT negatively affect patients'psychological status; the increase of EWL% and ΔBM% positively affect patients'psychological status. For patients with comorbidities, the higher the degree of postoperative comorbidity remission, the greater the positive impact on the patient's psychological status.

Key words: Obesity, Bariatric surgery, Treatment effects, Psychological status, Root cause analysis

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