| 许艳,窦翊愷,王敏,杨潇,程中,陈亿,马小红.肥胖患者情绪异常与减重手术效果的相关性[J].四川精神卫生杂志,2024,37(1):46-51.Xu Yan,Dou Yikai,Wang Min,Yang Xiao,Cheng Zhong,Chen Yi,Ma Xiaohong,Correlation of emotional abnormalities with the effectiveness of bariatric surgery in obese patients[J].SICHUAN MENTAL HEALTH,2024,37(1):46-51 |
| 肥胖患者情绪异常与减重手术效果的相关性 |
| Correlation of emotional abnormalities with the effectiveness of bariatric surgery in obese patients |
| 投稿时间：2023-12-20 |
| DOI：10.11886/scjsws20231220002 |
| 中文关键词: 肥胖 减重手术 抑郁 炎症因子水平 减重效果 |
| 英文关键词:Obesity Bariatric surgery Depression Level of inflammatory factors Weight loss effect |
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| 中文摘要: |
| 背景 减重手术是治疗肥胖的重要手段之一，部分拟行减重手术的患者存在异常的情绪及较高的外周血炎症因子水平，可能会影响减重手术效果。目前国内对于该群体术前情绪状态和外周血炎症因子水平与减重手术效果相关性的研究有限。目的 探讨术前情绪异常与肥胖患者减重手术效果的相关性，以期为提高患者减重手术的效果提供参考。方法 纳入2022年12月30日—2023年6月30日，于四川大学华西医院胃肠外科住院的、拟行减重手术的肥胖患者81例，采用汉密尔顿抑郁量表17项版（HAMD-17）和汉密尔顿焦虑量表（HAMA）评定患者的情绪状态，将HAMD-17或HAMA评分≥7分或有抑郁或焦虑障碍史的患者纳入情绪异常组（n=34），将HAMD-17与HAMA评分均<7分且无上述既往史的患者纳入不伴情绪异常组（n=47）。采用自制问卷收集一般资料，采用贝克自杀意念量表中文版（BSI-CV）、进食障碍调查问卷（EDI）以及匹兹堡睡眠质量指数量表（PSQI）分别评定自杀意念、进食及睡眠情况；检测两组患者外周血C反应蛋白（CRP）和白细胞介素-6（IL-6）水平。术后1个月和术后6个月通过门诊或电话随访收集患者当日清晨空腹体质量和身高。采用Pearson相关分析考查BMI与患者术前HAMD-17总评分及外周血炎症因子水平之间的相关性。结果 最终共62例肥胖患者完成本研究，其中情绪异常组27例、不伴情绪异常组35例。情绪异常组最近一周和最抑郁时的BSI-CV评分、EDI总评分、PSQI总评分、外周血CRP及IL-6水平均高于不伴情绪异常组（Z=2.677、2.975，t=3.573、4.035、1.990、2.799，P<0.05或0.01）。两组BMI的组别效应及组别与时间的交互效应均无统计学意义（P均>0.05），时间效应有统计学意义（F=227.740，P<0.01）。情绪异常组基线期、术后1个月以及术后6个月的BMI与IL-6水平均呈正相关（r=0.419、0.510、0.559，P<0.05或0.01），术后6个月的BMI与HAMD-17总评分呈正相关（r=0.390，P<0.05），术后6个月ΔBMI%与HAMD-17总评分呈负相关（r=-0.421，P<0.05）。不伴情绪异常组基线期BMI与IL-6水平呈正相关（r=0.338，P<0.01）。结论 伴或不伴情绪异常的肥胖患者行减重手术的短期效果可能一致，减重手术的效果可能与术前抑郁情绪严重程度无关。 |
| 英文摘要: |
| Background Bariatric surgery has emerged as an important tool in the management of obesity. Some patients undergoing bariatric surgery are prone to develop emotional abnormalities and have abnormally elevated concentrations of inflammatory factors level in peripheral blood， whereas current domestic research focusing on the impact of preoperative emotional states and peripheral blood inflammatory factors level on weight loss effect remains limited.Objective To explore the correlation of preoperative emotional abnormalities with the effectiveness of bariatric surgery in obese patients， and to provide theoretical basis for improving the clinical efficacy of bariatric surgery.Methods Eighty-one obese patients scheduled for bariatric surgery at gastrointestinal surgery Department of West China Hospital， Sichuan University from December 30， 2022 to June 30， 2023 were enrolled and assessed using Hamilton Depression Scale-17 item （HAMD-17） and Hamilton Anxiety Scale （HAMA）. Patients who scored 7 or above on HAMD-17 or HAMA or had a history of previous depression or anxiety diagnoses were classified into emotional abnormality group （n=34）， and samples who scored less than 7 on HAMD-17 and HAMA and were free of history of previous depression and anxiety diagnoses were set as non-emotional abnormality group （n=47）. The data were collected by the self made questionnaire. Patients were subjected to complete the assessment of Beck Scale for Suicide Ideation-Chinese Version （BSI-CV）， Eating Disorder Inventory （EDI） and Pittsburgh Sleep Quality Index （PSQI）. Laboratory tests including peripheral blood C-reactive protein （CRP） and interleukin-6 （IL-6）. Body weight and height assessed in the early morning after an overnight fasting period were recorded in all participants at 1- and 6-month after surgery through outpatient clinic visits or telephone follow-up. Pearson correlation coefficient was used to examine relationship among body mass index （BMI）， preoperative emotional states and peripheral blood inflammation mediators.Results Among 81 obese patients， 62 completed the study， including 27 cases in emotional abnormality group and 35 cases in non-emotional abnormality group. Emotional abnormality group scored higher on BSI-CV （current）， BSI-CV （worst）， EDI and PSQI， and detected higher levels of CRP and IL-6 compared with non-emotional abnormality group （Z=2.677， 2.975， t=3.573， 4.035， 1.990， 2.799， P<0.05 or 0.01）. For BMI， there was no significant group effect and time×group interaction effect （P>0.05）， but a significant time effect （F=227.740， P<0.01）. Within emotional abnormality group， BMI at the baseline， 1- and 6-month after surgery showed a positive correlation with IL-6 level （r=0.419， 0.510， 0.559， P<0.05 or 0.01）， BMI at 6-month after surgery was positively correlated with HAMD-17 total score （r=0.390， P<0.05）， and ΔBMI% at 6-month after surgery was negatively correlated with HAMD-17 total score （r=-0.421， P<0.05）. Within non-emotional abnormality group， baseline BMI was positively correlated with IL-6 level （r=0.338， P<0.01）.Conclusion The short-term effect of bariatric surgery may be comparable in obese patients with or without emotional abnormalities， while it cannot be ruled out whether the outcome of bariatric surgery is related to the severity of preoperative depression. |
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