Studies on the Correlation of Early Blood Uric Acid Fluctuation after Bariatric Surgery
-
摘要:
目的 探究减重手术后患者早期血尿酸波动的相关性。 方法 选取在2021年1月至2022年6月期间,昆明市延安医院收治的代谢综合征患者中完成术后1月随访的80例患者,开展此次研究实验,根据术后1月血尿酸指标分为2组,术后血尿酸较术前升高为升高组,术后血尿酸较术前降低为降低组,对比2组患者减重手术前后的BMI值及各项生化指标改变情况。 结果 手术方式、术后的蛋白摄入量、有氧运动量及饮水量并不是导致减重术后患者血尿酸波动的原因(P > 0.05),肝功能的改变同样也不能解释减重术后1月患者出现血尿酸升高和降低2种情况(P > 0.05),血糖及甘油三酯改变量是影响患者术后血尿酸波动的主要原因(P < 0.05),术后甘油三酯下降量越大,越不容易出现尿酸升高的情况。另外,术后1月血尿酸升高的幅度要大于术后血尿酸降低的幅度,同时血尿酸改变量与血肌酐及单核细胞/高密度脂蛋白(MHR)改变量具有相关性(P < 0.05),相关系数分别为0.204和0.511。 结论 甘油三脂和血糖在减重术后早期的改变情况是导致减重患者术后出现血尿酸升高或下降2种情况的原因,且血尿酸改变量主要受到肌酐和单核细胞/高密度脂蛋白(MHR)改变量的影响。 -
关键词:
- 代谢综合征 /
- 高尿酸血症 /
- 单核细胞/高密度脂蛋白(MHR) /
- 腹腔镜袖状胃切除术(LSG) /
- 腹腔镜胃旁路术(LRYGB)
Abstract:Objective To explore the correlation of early serum uric acid fluctuations in patients after the bariatric surgery. Methods From January 2021 to June 2022, 80 patients with the metabolic syndrome who were admitted to Yan'an Hospital of Kunming and completed the follow-up one month after the surgery were selected as the objective of this research experiment.And according to the serum uric acid index one month after the surgery, they were divided into group A with the increase of serum uric acid after the operation and group B with the decrease of serum uric acid after the operation. The BMI value and the changes of various biochemical indexes were compared between the two groups before and after the bariatric surgery. Results Surgery method, postoperative protein intake, aerobic exercise and water intake were not the reasons for the fluctuation of serum uric acid in patients after weight loss(P > 0.05), and the changes in liver function also could not explain the changes in patients 1 month after weight loss(P > 0.05). The changes of blood sugar and triglyceride were the main reasons for the fluctuation of postoperative blood uric acid(P < 0.05). The greater the decrease in triglycerides after the surgery, the less likely the increase in uric acid will occur.In addition, the increase of blood uric acid at 1 month after operation was greater than the decrease of blood uric acid after the operation, and the change of blood uric acid was correlated with the change of serum creatinine and monocyte/high-density lipoprotein(MHR)(P < 0.05). The correlation coefficients were 0.204 and 0.511 respectively.respectively. Conclusion The changes of triglyceride and blood sugar in the early postoperative period are the reasons for the increase or decrease of blood uric acid in patients with weight loss after the surgery, and the changes of blood uric acid are mainly affected by creatinine and monocyte/high density. -
表 1 2组患者术前各项指标比较
Table 1. The preoperative t test of each index in the two groups of patients
项目 升高组(n = 30) 降低组(n = 50) t P 年龄(岁) 31.90 ± 7.73 32.28 ± 10.09 −0.177 0.239 BMI(kg/m2) 37.41 ± 7.27 36.70 ± 6.21 0.464 0.71 血糖(μmol/L) 6.61 ± 3.12 5.81 ± 1.62 1.506 0.22 血尿酸(μmol/L) 377.37 ± 92.84 443.70 ± 106.15 −2.832 0.516 肌酐(μmol/L) 61.80 ± 14.80 61.84 ± 15.85 −0.011 0.393 ALT(U/L) 41.53 ± 31.75 41.38 ± 24.21 0.024 0.388 AST(U/L) 27.50 ± 13.51 29.08 ± 15.77 −0.457 0.672 单核细胞占比(%) 6.28 ± 1.46 6.49 ± 1.87 −0.508 0.205 总胆固醇(μmol/L) 4.67 ± 0.75 4.96 ± 1.08 −1.318 0.072 甘油三酯(μmol/L) 1.76 ± 0.67 2.48 ± 2.74 −1.413 0.114 高密度脂蛋白(μmol/L) 1.18 ± 0.23 1.19 ± 0.28 −0.137 0.185 低密度脂蛋白(μmol/L) 3.05 ± 0.64 3.10 ± 0.83 −0.295 0.103 MHR(%/μmol/L) 5.56 ± 1.19 5.78 ± 2.20 −0.447 0.467 表 2 2组患者术后1月各项指标对比
Table 2. Comparison of various indicators between the two groups of patients at 1 month after operation
项目 升高组(n = 30) 降低组(n = 50) t P 年龄(岁) 31.90 ± 7.73 32.28 ± 10.09 −0.177 0.239 BMI(kg/m2) 32.47 ± 6.31 32.51 ± 5.34 −0.03 0.78 血糖(μmol/L) 5.18 ± 1.10 5.39 ± 0.83 −1 0.267 血尿酸(μmol/L) 481.15 ± 182.67 362.49 ± 98.63 3.776 0.015* 肌酐(μmol/L) 62.12 ± 16.56 60.82 ± 12.42 0.402 0.207 ALT(U/L) 38.99 ± 21.31 35.62 ± 18.37 0.748 0.678 AST(U/L) 31.85 ± 14.49 29.10 ± 11.29 0.942 0.072 单核细胞占比(%) 7.35 ± 1.95 7.59 ± 2.32 −0.458 0.499 总胆固醇(μmol/L) 4.01 ± 0.82 4.31 ± 0.87 −1.399 0.586 甘油三酯(μmol/L) 1.37 ± 0.42 1.39 ± 0.54 −0.135 0.889 高密度脂蛋白(μmol/L) 0.98 ± 0.39 1.03 ± 0.29 −0.548 0.206 低密度脂蛋白(μmol/L) 2.62 ± 0.69 2.73 ± 0.76 −0.565 0.567 MHR(%/μmol/L) 8.65 ± 4.86 7.67 ± 2.93 1.012 0.253 *P < 0.05。 表 3 2组患者术式、性别、蛋白摄入量、饮水量、有氧运动量比较
Table 3. The χ2 test of surgical method,gender,protein intake,water intake,and aerobic exercise in the two groups of patients
项 目 升高组 降低组 χ2 P 性别 男 8 9 0.842 0.359 女 22 41 术式 袖状胃 18 38 2.286 0.208 胃旁路 12 12 蛋白摄入量(g) ≤20 5 4 2.375 0.498 > 20且≤40 9 19 > 40且≤60 15 22 > 60 1 4 有氧运动量
(分钟)≤30 13 18 0.543 0.762 > 30且≤60 14 25 > 60 3 7 饮水量
(mL)< 1000 1 3 1.723 0.632 1500~2000 18 30 2000~2500 11 15 > 2500 0 2 表 4 2组患者术后各指标改变量比较
Table 4. The t test of the changes of each index after the operation in the two groups of patients
项目 升高组(n = 30) 降低组(n = 50) t P BMI(kg/m2) −4.93 ± 2.37 −4.19 ± 1.56 −1.688 0.2 血糖(μmol/L) −1.42 ± 2.82 −0.41 ± 1.36 −2.157 0.012* 血尿酸(μmol/L) 103.78 ± 131.84 −81.21 ± 71.11 8.159 0.02* 肌酐(μmol/L) 0.32 ± 12.56 −1.02 ± 8.05 0.586 0.023* ALT(U/L) −0.30 ± 34.63 −5.75 ± 23.51 0.838 0.355 AST(U/L) 4.35 ± 15.86 −0.56 ± 16.58 1.303 0.723 单核细胞占比(%) 1.07 ± 1.59 0.94 ± 2.19 0.265 0.185 总胆固醇(μmol/L) −0.66 ± 1.33 −0.66 ± 0.89 −0.009 0.221 甘油三酯(μmol/L) −0.11 ± 0.24 −0.17 ± 0.44 −0.635 0.048* 高密度脂蛋白(μmol/L) −0.39 ± 0.70 −1.16 ± 2.94 1.28 0.25 低密度脂蛋白(μmol/L) −0.46 ± 0.94 −0.43 ± 0.71 −0.146 0.237 MHR(%/μmol/L) 3.44 ± 3.884 1.78 ± 2.67 2.021 0.094 *P < 0.05。 -
[1] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志,2018,10(1):4-67. doi: 10.3760/cma.j.issn.1674-5809.2018.01.003 [2] Noubiap J J,Nansseu J R,Lontchi-Yimagou E,et al. Global,regional,and country estimates of metabolic syndrome burden in children and adolescents in 2020:A systematic review and modelling analysis[J]. The Lancet Child & Adolescent Health,2022,6(4):158-170. [3] 齐莹. 北京某社区成年体检人群代谢综合症流行现状分析[J]. 中国卫生统计,2020,37(4):590-592. [4] Pammer L M,Lamina C,Schultheiss U T,et al. Association of the metabolic syndrome with mortality and major adverse cardiac events:A large chronic kidney disease cohort[J]. Journal of Internal Medicine,2021,290(6):1219-1232. doi: 10.1111/joim.13355 [5] 梁辉,林士波,管蔚. 减重代谢外科手术方式的选择[J]. 中华胃肠外科杂志,2017,2(4):388-392. doi: 10.3760/cma.j.issn.1671-0274.2017.04.006 [6] Gao B,Zhou J,Ge J,et al. Association of maximum weight with hyperuricemia risk:A retrospective study of 21,414 Chinese people[J]. Plos One,2012,7(11):e51186. doi: 10.1371/journal.pone.0051186 [7] 刘金钢,胡敬尧. 减重代谢外科新手术方式对学科发展的影响[J]. 中华消化外科杂志,2020,19(11):1135-1139. doi: 10.3760/cma.j.cn115610-20200820-00567 [8] 罗衡桂,唐彬,毛岳峰,等. 不同类型减重代谢手术治疗重度肥胖合并2型糖尿病的近期疗效分析[J]. 中国普通外科杂志,2020,29(10):1224-1233. doi: 10.7659/j.issn.1005-6947.2020.10.009 [9] 卢存龙. 减重手术对高尿酸血症大鼠代谢和肠道菌群的影响[D]. 青岛: 青岛大学硕士学位论文, 2018. [10] 郭朋森. 减重手术后患者血清维生素B_(12)水平升高的危险因素探究[D]. 成都: 西南交通大学硕士学位论文, 2021. [11] Arterburn D E,Telem D A,Kushner R F,et al. Benefits and risks of bariatric surgery in adults:A review[J]. Jama,2020,324(9):879-887. doi: 10.1001/jama.2020.12567 [12] Kwon Y,Kim H J,Menzo E L,et al. Anemia,iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass:A meta-analysis[J]. Surgery for Obesity and Related Diseases,2014,10(4):589-597. doi: 10.1016/j.soard.2013.12.005 [13] Jean-Charles Fruchart,Patrick Duriez. HDL and triglyceride as the therapeutic targets[J]. Curr OPin LiPidol,2002,13(6):605-616. doi: 10.1097/00041433-200212000-00003 [14] Amato M C,Giordano C,Galia M,et al. Visceral adiposity index:A reliable indicator of visceral fat function associated with cardiometabolic risk[J]. Diabetes Care,2010,33(4):920-922. doi: 10.2337/dc09-1825 [15] 杨阳,秦迁,闫肃,等. 正常体质量人群的内脏脂肪面积与尿酸的相关性研究[J]. 中国预防医学杂志,2022,23(2):115-120. [16] 王燕萍,邬美花,杨胜,等. 单核细胞/高密度脂蛋白胆固醇与高尿酸血症患病率的关联及性别差异研究[J]. 中国全科医学,2022,25(6):714-718,723. [17] 吴美豪,曹慧霞,王丽姣,等. 单核细胞/高密度脂蛋白比值与慢性肾脏病疾病严重程度及预后的关系[J]. 中华肾脏病杂志,2021,37(7):567-575. doi: 10.3760/cma.j.cn441217-20210202-00086