目的 探讨腹腔镜胃袖状切除术（LSG）治疗青少年重度肥胖的中期代谢结局及营养状况变化。方法 回顾性分析2017年7月至2022年7月上海市第六人民医院收治的行LSG的93例重度肥胖青少年病人的临床资料。收集并比较术前及术后3年的体重变化、糖代谢指标［糖化血红蛋白（HbA1c）、胰岛素抵抗指数（HOMA-IR）］以及铁缺乏、贫血和维生素D缺乏的动态变化。采用混合效应模型分析纵向数据变化趋势。结果 共纳入93例病人，术后1、2、3年分别有64、49、33例获得随访数据。术后2年平均多余体重减少百分比（%EWL）达99.7%。平均HbA1c由术前的6.2%降至术后2年的5.0%，HOMA-IR由11.6降至3.6（均 P<0.001）。铁缺乏发生率呈显著上升趋势（趋势 P=0.002），由基线的6.5%升至术后3年的33.3%；贫血发生率同样呈显著上升趋势（趋势 P=0.015），在术后3年达到24.2%。术前达91.4%的维生素D缺乏发生率在术后呈持续下降趋势（趋势 P<0.001）。结论 对于重度肥胖青少年病人，LSG能带来显著且持久的体重减轻及代谢改善，但术后铁缺乏及临床性贫血的风险显著增加，故应对病人进行长期、系统的多学科营养监测与管理。
Abstract
To investigate the mid-term metabolic outcomes and changes in nutritional status of adolescents with severe obesity undergoing laparoscopic sleeve gastrectomy (LSG). Methods A retrospective analysis was conducted on the clinical data of 93 adolescent patients who underwent LSG at Shanghai Sixth People’s Hospital between July 2017 and July 2022. Weight changes, glycemic metabolism indicators (HbA1c and HOMA-IR), and the dynamics of iron deficiency, anemia, and vitamin D deficiency were collected and compared from preoperation to up to 3 years postoperatively. Mixed-effects models were used to analyze longitudinal data trends. Results A total of 93 patients were included for baseline analysis, with follow-up data available for 64, 49, and 33 patients at 1, 2, and 3 years postoperatively, respectively. Significant weight loss was achieved, with a mean percentage of excess weight loss (%EWL) of 99.7% at 2 years post-surgery. Glycemic metabolism improved, with mean HbA1c decreasing from 6.2% at baseline to 5.0% at 2 years, and HOMA-IR from 11.6 to 3.6 (both P<0.001). However, the prevalence of iron deficiency showed a significant upward trend (trend P=0.002), increasing from 6.5% at baseline to 33.3% at 3 years. More importantly, the prevalence of anemia also showed a significant upward trend (trend P=0.015), reaching 24.2% at 3 years. In contrast, the high preoperative prevalence of vitamin D deficiency (91.4%) showed a continuous and significant downward trend postoperatively (trend P<0.001). Conclusion For adolescents with severe obesity, LSG provides significant and durable weight loss and metabolic improvement. However, the risk of postoperative iron deficiency and even clinical anemia is significantly increased, highlighting the importance of long-term, systematic, multidisciplinary nutritional monitoring and management for these patients.
关键词
青少年 /
肥胖症 /
胃袖状切除术 /
体重减轻 /
代谢改善 /
营养风险
Key words
adolescent /
obesity /
sleeve gastrectomy /
weight loss /
metabolic improvement /
nutritional risk
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