肥胖合并多囊卵巢综合征患者心理特征及其对减重手术疗效的影响

Psychological characteristics of obese patients with polycystic ovary syndrome and their impact on the efficacy of bariatric surgery

摘要:

背景与目的 多囊卵巢综合征（PCOS）是肥胖女性中常见的内分泌紊乱性疾病，常伴发焦虑、抑郁等心理问题。腹腔镜胃袖状切除术（LSG）作为治疗肥胖及其相关代谢疾病的重要手段，在改善PCOS患者体质量与代谢状态方面效果明确。然而，心理状态对减重疗效的潜在影响机制尚未明确。本研究旨在评估肥胖症合并PCOS患者的心理特征，并探讨其对术后减重效果的影响，为个体化干预策略提供依据。方法 纳入2020年11月—2022年9月拟行LSG的女性肥胖患者，根据是否合并PCOS分组，采用标准化心理量表评估焦虑、抑郁、自尊、饮食行为等指标，记录术后6个月与12个月的体质量变化。采用倾向性评分匹配控制年龄和BMI等混杂因素，并通过相关性分析探讨心理状态与减重效果之间的关系。结果 共纳入314例患者，PCOS组130例（41.4%）。匹配前，PCOS组在多项心理指标及减重效果方面明显差于非PCOS组（均P<0.05）；匹配后，两组间以上差异均无统计学意义（均P>0.05）。情绪性进食与PCOS组术后12个月减重效果呈正相关，非PCOS组中焦虑及体质量内在化歧视与减重效果相关（P<0.05）。此外，在中度和极重度肥胖患者中，PCOS组的减重效果优于非PCOS组（均P<0.05）；BMI与自尊、饮食行为、生活质量等心理指标呈负相关（均P<0.05）。结论 肥胖合并PCOS患者存在明显的心理困扰，但其心理状态及减重效果在控制BMI与年龄后与非PCOS患者无显著差异。BMI可能是二者之间的重要混杂因素，心理因素可能通过饮食行为间接影响减重疗效，建议术前应加强心理筛查与干预。

Abstract:

Background and Aims Polycystic ovary syndrome (PCOS) is a common endocrine disorder among obese women, often accompanied by psychological issues such as anxiety and depression. Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for obesity and its related metabolic conditions, and has shown clear benefits in improving weight and metabolic profiles in PCOS patients. However, the potential mechanisms by which psychological status may affect weight loss outcomes remain unclear. This study aimed to evaluate the psychological characteristics of obese patients with PCOS and explore their impact on postoperative weight loss outcomes, in order to provide evidence for individualized intervention strategies.Methods Female obese patients scheduled for LSG between November 2020 and September 2022 were enrolled and divided into PCOS and non-PCOS groups. Standardized psychological scales were used to assess anxiety, depression, self-esteem, and eating behaviors. Weight loss outcomes were recorded at 6 and 12 months postoperatively. Propensity score matching was used to control for confounding factors such as age and body mass index (BMI), and correlation analysis was conducted to explore the relationship between psychological status and weight loss outcomes.Results A total of 314 patients were included, with 130 cases (41.4%) in the PCOS group. Before matching, the PCOS group had significantly worse psychological indicators and lower weight loss outcomes compared to the non-PCOS group (all P<0.05); after matching, these differences were no longer statistically significant (all P>0.05). Emotional eating was positively correlated with 12-month weight loss outcomes in the PCOS group, while anxiety and internalized weight stigma were associated with weight loss outcomes in the non-PCOS group (P<0.05). Additionally, among patients with moderate and extreme obesity, weight loss outcomes in the PCOS group were superior to those in the non-PCOS group (P<0.05). BMI was negatively correlated with self-esteem, eating behaviors, and quality of life (all P<0.05).Conclusion Obese patients with PCOS exhibit notable psychological distress. However, after controlling for BMI and age, their psychological status and weight loss outcomes are comparable to those of non-PCOS patients. BMI may serve as an important confounding factor, and psychological factors may influence weight loss indirectly through eating behaviors. Preoperative psychological screening and intervention are recommended.