摘要目的 探讨胃转流术后代谢综合征患者体脂分布的改变情况.方法 2009年7月至2010年2月间南京军区福州总院前瞻性入组收治26例胃癌合并代谢综合征病例,行胃转流手术.分别于术前和术后1、4、12、48周,检测体质量指数(BMI)、腰围、臀围和脂肪面积等体脂参数,以及胰岛素抵抗指数(HOMA-IR)等生化指标.结果 胃转流术后,26例代谢综合征患者肥胖、高血压、血脂紊乱及高血糖均获得了不同程度的好转.术后48周,26例患者HOMA-IR由术前的5.7±1.5降至3.4±1.0,BMI由术前的(27.1±3.8) kg/m2降至(22.6± 1.4) kg/m2(P＜0.05).其中心性肥胖指标腰围由术前的(95.3±2.5) cm降至(75.3±1.1) cm,内脏脂肪面积由术前的(101.7±13.8) cm2降至(78.7±11.2) cm2(P＜0.05)；而外周性肥胖指标皮下脂肪面积未见下降(P＞0.05).结论 胃转流术后体脂分布由中心性肥胖向外周性肥胖转变;胰岛素抵抗改善与中心性体脂参数下降有关.

abstractsObjective To evaluate the changes in body fat distribution after gastric bypass in gastric cancer patients with metabolic syndrome. Methods From July 2009 to February 2010, 26 patients with gastric cancer and concurrent metabolic syndrome were prospectively enrolled and underwent gastric bypass surgery at the Fuzhou General Hospital of Nanjing Military Command.Body mass index (BMI),waist circumference,hip circumference,insulin and insulin resistance index were measured before operation and at postoperative 1,4,12,24,48 weeks. Results After gastric bypass surgery,metabolic syndrome was improved including obesity,hypertension,disturbance of lipid and hyperglycemia.After 48 weeks postoperatively HOMA-IR decreased from 5.7±1.5 to 3.4±1.0 (P＜0.05).BMI decreased from (27.1±3.8) kg/m2 to (22.6±1.4) kg/m2 (P＜0.05).Indices for central obesity:waist circumference decreased from (95.3±2.5)cm to (75.3±1.1)cm,and visceral fat area decreased from (101.7±13.8) cm2 to (78.7±11.2) cm2 (P＜0.05).There were no decline in peripheral obesity indices including hip circumference and subcutaneous fat area(P＞0.05 ).Conclusions The distribution of body fat after gastric bypass changes from central obesity to peripheral obesity.Improvement of insulin resistance after gastric bypass surgery is associated with the decrease in central obesity indices.