青少年 Roux-en-Y 胃旁路术后两年的心理社会功能变化趋势。
Two-year trends in psychosocial functioning after adolescent Roux-en-Y gastric bypass.
机构信息
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
出版信息
Surg Obes Relat Dis. 2011 Nov-Dec;7(6):727-32. doi: 10.1016/j.soard.2011.01.034. Epub 2011 Mar 5.
BACKGROUND
Comprehensive studies of adolescent bariatric surgery outcomes are in their infancy and are critically needed. The present study examined the rate of change in the body mass index (BMI), health-related quality of life (HRQOL), depressive symptoms, and self-concept in adolescents undergoing Roux-en-Y gastric bypass (RYGB) during the first 24 postoperative months using a prospective longitudinal design at a pediatric medical center.
METHODS
A total of 16 adolescents (mean age 16.2 yr; 62.5% female, mean BMI 59.9 kg/m2; 97% of eligible, consecutive patients) completed the Impact of Weight on Quality of Life-Kids, Pediatric Quality of Life Inventory, Beck Depression Inventory, Self-Perception Profile for Adolescents, and height and weight measurements at baseline and 6, 12, 18, and 24 months after RYGB. A total of 75% participated at all follow-up points.
RESULTS
Before RYGB, global psychosocial impairments were documented. Hierarchical linear modeling was used to examine the growth trajectories. Several quadratic (nonlinear) trends were revealed. A substantial reduction in weight and depressive symptoms, as well as improved HRQOL and self-concept were identified across the first postoperative year, followed by decelerations in year 2, including weight regain (P < .0001) and slight increases in depressive symptoms (P = .004) and decreases in HRQOL (Social, P = .002; Body Esteem, P = .0007; Physical Comfort, P < .0001; and Total, P < .0001), and self-concept (Social, P = .02; Appearance, P = .002; and Close Friendship, P = .008).
CONCLUSION
During the first 24 months after RYGB, preliminary evidence suggests adolescents experience significant weight loss as well as psychosocial and HRQOL improvements. A deceleration in these gains occurred in the second postoperative year. Longer term follow-up with larger samples is critical to determine the weight and psychosocial trajectories, and what role psychosocial status plays in adolescents' weight change and maintenance.
背景
青少年减重手术结局的综合研究尚处于起步阶段，迫切需要开展此类研究。本研究采用前瞻性纵向设计，在一家儿科医学中心，对 16 名青少年（平均年龄 16.2 岁；62.5%为女性，平均 BMI 为 59.9kg/m2；为符合条件的连续患者的 97%）在 Roux-en-Y 胃旁路术（RYGB）后的前 24 个月内的体重指数（BMI）、健康相关生活质量（HRQOL）、抑郁症状和自我概念的变化率进行了研究。所有患者在基线以及 RYGB 后 6、12、18 和 24 个月时完成了生活质量影响-儿童（Impact of Weight on Quality of Life-Kids）、儿科生活质量量表（Pediatric Quality of Life Inventory）、贝克抑郁量表（Beck Depression Inventory）、青少年自我知觉量表（Self-Perception Profile for Adolescents）和身高体重测量。共有 75%的患者完成了所有随访。
结果
RYGB 前，记录了全球心理社会障碍。采用分层线性模型来检验生长轨迹。揭示了几个二次（非线性）趋势。在术后第一年，体重和抑郁症状明显减轻，HRQOL 和自我概念得到改善，随后在第二年减缓，包括体重反弹（P<0.0001）和抑郁症状略有增加（P=0.004），以及 HRQOL 降低（社会，P=0.002；身体自尊，P=0.0007；身体舒适，P<0.0001；以及总体，P<0.0001），以及自我概念（社会，P=0.02；外貌，P=0.002；亲密友谊，P=0.008）。
结论
在 RYGB 后的前 24 个月，初步证据表明青少年经历了显著的体重减轻以及心理社会和 HRQOL 的改善。在术后第二年，这些收益的速度减缓。需要进行更长时间的随访并扩大样本量，以确定青少年的体重和心理社会轨迹，以及心理社会状况在青少年体重变化和维持中的作用。
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