术前肝肾功能及血脂谱与减重代谢手术后进食紊乱症状改善的相关性研究

Association of preoperative hepatorenal function and lipid profile with improvement in disordered eating symptoms after bariatric metabolic surgery

摘要:

背景与目的 肥胖常伴随进食紊乱症状，减重代谢手术虽可改善相关问题，但术后疗效存在显著个体差异，缺乏有效预测指标。肝肾功能及血脂指标与代谢密切相关，或可用于术前风险分层与疗效预测。本研究旨在探讨术前相关代谢指标与进食紊乱症状的关系，进而识别肥胖患者术后的恢复特征，为个体化管理提供理论依据。方法 纳入2020年9月—2023年6月于上海交通大学医学院附属第六人民医院接受袖状胃切除术的肥胖患者41例（肥胖组），及同期招募的36名健康志愿者（健康组）。采集受试者的进食障碍调查量表-2（EDI-2）得分及术前血样，测定肝肾功能及血脂指标。采用Mantel检验分析相关性，并基于与EDI-2得分相关的指标进行潜在剖面分析（LPA），识别肥胖组亚群结构，再利用线性混合模型分析术后不同亚群进食紊乱症状的变化轨迹。结果 肥胖组的胱抑素C、胆碱酯酶、谷氨酰转移酶、甘油三酯和载脂蛋白E水平均显著高于健康组，EDI-2总分亦显著升高（均P<0.05）；健康组的前白蛋白水平显著高于肥胖组（P<0.05）。上述六项指标与EDI-2总分呈正相关（均r>0.20，P<0.05）。基于相关指标，LPA将肥胖组分为两类亚群，亚群2的多数代谢指标高于亚群1。术后18个月内，两亚群EDI-2总分均下降，但亚群2的改善起效时间晚于亚群1（分别为术后第6个月、第4个月）。结论 术前胆碱酯酶、谷氨酰转移酶、前白蛋白、甘油三酯和载脂蛋白E水平可作为预测进食紊乱症状改善潜力的指标。不同代谢特征的肥胖患者术后恢复进展存在异质性，需制定差异化干预策略。

Abstract:

Background and Aims Obesity is often accompanied by symptoms of disordered eating. Although bariatric metabolic surgery can alleviate these symptoms, there are significant individual differences in postoperative outcomes, and effective predictive indicators are lacking. Liver and kidney function, along with lipid profiles, are closely related to metabolic status and may serve as useful markers for preoperative risk stratification and prognosis prediction. This study was conducted to explore the relationship between preoperative metabolic indicators and symptoms of disordered eating, thereby identifying postoperative recovery patterns among obese patients to support individualized management strategies.Methods A total of 41 obese patients who underwent sleeve gastrectomy at Shanghai Sixth People's Hospital between September 2020 and June 2023 were enrolled, along with 36 healthy volunteers recruited during the same period. Participants completed the Eating Disorder Inventory-2 (EDI-2) questionnaire, and serum samples were collected to assess liver function, kidney function, and lipid levels prior to surgery. The Mantel test was used to analyze correlations between metabolic indicators and EDI-2 scores. Latent profile analysis (LPA) was conducted using the indicators significantly correlated with EDI-2 scores to identify subgroups within the obese cohort. Linear mixed models were then applied to examine the trajectories of postoperative symptom changes across subgroups.Results Levels of cystatin C, cholinesterase, gamma-glutamyl transferase, triglycerides,and apolipoprotein E were significantly higher in the obese group compared to the healthy group (all P<0.05), and EDI-2 total score was also significantly elevated (P<0.05); the prealbumin level in the healthy group was significantly higher than that in the obese group (P<0.05). These six indicators were positively correlated with EDI-2 score (all r>0.20, P<0.05). Based on these markers, the LPA classified the obese group into two subgroups, with subgroup 2 exhibiting higher levels of most metabolic indicators than subgroup 1. During the 18-month postoperative follow-up, both subgroups showed reductions in EDI-2 score, but symptom improvement in subgroup 2 occurred later (month 6) compared to subgroup 1 (month 4).Conclusion Preoperative levels of cholinesterase, gamma-glutamyl transferase, prealbumin, triglycerides, and apolipoprotein E may serve as predictive indicators for improvement in disordered eating symptoms. Recovery patterns after bariatric surgery vary among obese patients with different metabolic profiles, highlighting the need for tailored intervention strategies.