Clinical value of dual-energy X-ray absorptiometry in evaluating the improvement of metabolic indexes after laparoscopic sleeve gastrectomy
10.3760/cma.j.issn.1673-9752.2017.06.014
- VernacularTitle: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
- Author:
Keyi LIU
;
Mofei WANG
;
Yong WANG
- Keywords:
Obesity;
Sleeve gastrectomy;
Insulin resistance;
Dual-energy X-ray absorptiometry
- From:
Chinese Journal of Digestive Surgery
2017;16(6):602-607
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the changes of pre-and post-operative body fats of obese patients undergoing laparoscopic sleeve gastrectomy which were evaluated by dual-energy X-ray 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 post-operative 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 post-operative indexes of insulin resistance (HOMA-IR) 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-x ±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 circumference and HOMA-IR 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 pre-and post-operations (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 waist-hip 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 pre-and post-operations (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 HOMA-IR (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 HOMA-IR (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 HOMA-IR (0.994).There was a positive correlation between decrease of fat mass in region G and improvement of HOMA-IR 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.
