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肥胖症腹腔镜胃袖状切除术后脱发相关危险因素分析

Risk factors analysis of hair loss in obese patients afer laparoscopic sleeve gastrectomy

摘要:

目的 探讨影响肥胖症腹腔镜胃袖状切除术(LSG)后脱发的相关危险因素.方法 采用回顾性病例对照研究方法.收集2013年11月至2015年6月同济大学附属东方医院收治的54例行LSG肥胖症患者的临床资料.患者均行LSG,术后观察患者脱发情况,分析影响其术后脱发严重程度的因素:性别、年龄、术前BMI、术后多余体质量减少率(EWL)、TBil、Alb、Hb、铁、锌、铜、叶酸、维生素B12、维生素D.观察指标:(1)随访和术后脱发情况:随访例数、随访时间、脱发例数、脱发严重程度、脱发时间、脱发治疗情况.(2)影响LSG术后脱发严重程度的单因素分析.(3)影响LSG术后脱发严重程度的多因素分析.采用门诊和微信方式进行随访.随访的内容为患者体质量变化情况、脱发情况.随访时间截至2016年9月.正态分布的计量资料以(x)±s表示,组间比较采用t检验;计数资料比较采用x2检验;多因素分析采用Logistic回归模型.结果 (1)随访和术后脱发情况:54例行LSG患者术后均获得随访,随访时间为术后15个月.术后42例患者发生脱发,男性脱发比例为6/11,女性脱发比例为36/43.42例脱发患者中,轻、中、重度分别为21、10、11例,开始脱发时间为术后(3.4±1.4)个月,脱发结束时间为(9.0±3.6)个月.42例脱发患者中,15例口服药物治疗(硫酸亚铁剂6例、复合维生素5例、葡萄糖酸锌口服液制剂4例)脱发无明显改善.随访期内42例患者脱发均停止并逐渐长出新头发.(2)影响LSG术后脱发严重程度的单因素分析结果显示:性别、术后EWL、叶酸是影响LSG术后脱发严重程度的因素(x2=5.161,t=-5.114,4.266,P<0.05).(3)影响LSG术后脱发严重程度的多因素分析结果显示:术后EWL和叶酸是影响LSG术后脱发严重程度的独立因素(OR=1.039,0.499,95%可信区间:1.011~1.068,0.300~0.802,P<0.05).该模型对术后脱发严重程度的预测准确率为85.2%.结论 术后EWL和叶酸是影响LSG减重手术后脱发的独立因素.

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abstracts:

Objective To investigate the related risk factors of hair loss in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods The retrospective case-control study was conducted.The clinical data of 54 obese patients who underwent LSG in the East Hospital of Tongji University between November 2013 and June 2015 were collected.All the patients received LSG,and postoperative hair loss of patients was observed.Factors affecting postoperative severe hair loss were analyzed,including gender,age,preoperative body mass index (BMI),postoperative excess weight loss (EWL),total bilirubin (TBil),albumin (Alb),hemoglobin (Hb),iron,zinc,copper,folic acid,vitamin B12 and vitamin D.Observation indicators:(1) follow-up and postoperative hair loss situations:cases with follow-up,follow-up time,cases with hair loss,severity of hair loss,time of hair loss,treatment of hair loss;(2) univariate analysis affecting severity of hair loss after LSG;(3) multivariate analysis affecting severity of hair loss after LSG.Follow-up using outpatient examination and Wechat was performed to detect the changes of BMI and hair loss up to September 2016.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Comparison of count data was analyzed by the chi-square test.Multivariate analysis was done using the Logistic regression model.Results (1) Follow-up and postoperative hair loss situations:all the 54 patients were followed up for 15 months.Forty-two patients had hair loss,including 21 with slight hair loss,10 with moderate hair loss and 11 with severe hair loss.A proportion of hair loss was 6/11 in male and 36/43 in female.The onset time and end time of hair loss were (3.4± 1.4) months and (9.0± 3.6) months,respectively.Of 42 patients,15 took oral medication (6 with ferrous sulfate,5 with decavitamin and 4 with zinc gluconate oral solution) against hair loss,with no obvious improvement.During the follow-up,42 patients stopped hair loss and gradually grow new hair.(2) Univariate analysis affecting severity of hair loss after LSG:gender,postoperative EWL and folic acid were factors affecting severity of hair loss after LSG (x2 =5.161,t =-5.114,4.266,P<0.05).(3) Multivariate analysis of affecting severity of hair loss after LSG:postoperative EWL and folic acid were independent factors affecting severity of hair loss after LSG (OR=1.039,0.499,95% confidence interval:1.011-1.068,0.300-0.802,P<0.05).A prediction accuracy of severity of hair loss after LSG was 85.2%.Conclusion Postoperative EWL and folic acid are independent factors affecting severity of hair loss after LSG.

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