Wysocki Michał, Mizera Magdalena, Karpińska Izabela, Ptaszkiewicz Kuba, Małczak Piotr, Pisarska-Adamczyk Magdalena, Kania Michał, Major Piotr
Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Poland.
2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland.
Pol Przegl Chir. 2024 May 9;96(6):20-30. doi: 10.5604/01.3001.0054.5125.
<b>Introduction:</b> Due to a short history of laparoscopic sleeve gastrectomy (LSG) as an independent bariatric procedure, we stilllack studies providing analysis of the quality of life (QoL) in patients with type 2 diabetes mellitus (DM2).<b>Aim:</b> We aimed to assess the influence of LSG on QoL in obese patients with DM2.<b>Material and Methods:</b> Prospective, observational study included patients with: morbid obesity, body mass index (BMI) ≥ 35 kg/m and ≤ 50 kg/m<sup>2</sup>, DM2 shorter than 10 years, qualified for LSG. Bariatric Analysis and Reporting Outcome System (BAROS) that included the Moorehead-Ardelt Quality of Life Questionnaire II (MA-QoLQII) score, and the SF-36 Health Survey (SF-36) questionnaire were used for repetitive assessment of QoL before LSG and after one and 12 months following surgery. Selected clinical and biochemical parameters were also repeatedly measured.<b>Results:</b> Thirty-three patients were included in the study (23 females). Patients' mean age was 45 10 years. BAROS significantly increased before LSG, one month, and one year after surgery (0.63 1.12, 2.94 1.90, and 4.97 2.08, respectively). The MA-QoLQII score significantly rose with an increase of excess body mass index loss (EBMIL) (P = 0.002) and remission of DM2 (P = 0.049), while inversely correlated with Homeostatic Model Assessment for Insulin Resistance index (HOMA-IR) (P = 0.003). Degenerative joint disease (P = 0.025) and average time of low glucose concentration in continuous glucose monitoring (CGM) (P = 0.005) had an inverse correlation with SF-36 Physical Component Summaries (PCS), standardized for cardiovascular comorbidity, EBMIL and HOMA-IR (P = 0.839; P = 0.086; P = 0.571, respectively). EBMIL (P = 0.003), remission of DM2 (P < 0.001) had a positive correlation with Mental Component Summaries (MCS), while HOMA-IR (P < 0.001) and count of low glucose concentration events (P = 0.022) had an inverse correlation with MCS, while standardized for average glucose concentration in CGM after 12 months (P = 0.586).<b>Discussion:</b> Significant improvement in QoL was observed in patients with DM2 after LSG. Remission of DM2, higher EBMIL, lower HOMA-IR, fewer and shorter low glucose concentration events in CGM after 12 months were factors that increased selected QoL scores.
引言：由于腹腔镜袖状胃切除术（LSG）作为一种独立的减肥手术历史较短，我们仍然缺乏对2型糖尿病（DM2）患者生活质量（QoL）进行分析的研究。
目的：我们旨在评估LSG对肥胖DM2患者生活质量的影响。
材料和方法：前瞻性观察性研究纳入了符合以下条件的患者：病态肥胖，体重指数（BMI）≥35kg/m²且≤50kg/m²，DM2病程短于10年，符合LSG手术指征。使用包括穆尔黑德 - 阿德尔特生活质量问卷II（MA - QoLQII）评分的减肥分析和报告结果系统（BAROS）以及SF - 36健康调查（SF - 36）问卷，在LSG手术前、术后1个月和12个月对生活质量进行重复评估。还反复测量了选定的临床和生化参数。
结果：33例患者纳入研究（23例女性）。患者平均年龄为45±10岁。BAROS在手术前、术后1个月和1年后显著升高（分别为0.63±1.12、2.94±1.90和4.97±2.08）。MA - QoLQII评分随着多余体重指数损失（EBMIL）的增加（P = 0.002）和DM2的缓解（P = 0.049）而显著上升，而与胰岛素抵抗稳态模型评估指数（HOMA - IR）呈负相关（P = 0.003）。退行性关节病（P = 0.025）和连续血糖监测（CGM）中低血糖浓度的平均时间（P = 0.005）与针对心血管合并症、EBMIL和HOMA - IR进行标准化后的SF - 36身体成分摘要（PCS）呈负相关（分别为P = 0.839；P = 0.086；P = 0.571）。EBMIL（P = 0.003）、DM2的缓解（P < 0.001）与精神成分摘要（MCS）呈正相关，而HOMA - IR（P < 0.001）和低血糖浓度事件计数（P = 0.022）与MCS呈负相关，同时针对12个月后CGM中的平均血糖浓度进行标准化（P = 0.586）。
讨论：LSG术后DM2患者的生活质量有显著改善。DM2的缓解、更高的EBMIL、更低的HOMA - IR、12个月后CGM中更少且持续时间更短的低血糖浓度事件是提高选定生活质量评分的因素。
