不同代謝性手術對身體組成之影響
 
曾暐翔^1#　劉冠伶^1#　黃詩芸²　張秦松^3,4　陳淑慧⁴　呂忻瑾⁵
郭素娥⁵　李國鼎⁶　吳至行^3,7

背景：代謝性手術主要為限制型及吸收不良型兩種，雖都可減輕體重，然而對於身體組成變化的影響可能有所不同。目前台灣尚未有以重水稀釋法評估體脂肪變化於兩種手術比較之文獻報導。
方法：蒐集自2008年至2015年於成大醫院接受代謝性手術個案共47人，其中胃袖狀切除術23人（男/女=9/14，平均年齡36.9±9.7歲，平均身體質量指數45.4±8.8 kg/m²），迷你胃繞道手術24人（男/女=16/8，平均年齡40.6±11.6歲，平均身體質量指數43.2±9.5 kg/m²）為研究對象。所有個案於術前及術後6個月均以重水稀釋法測量脂肪質量及去脂肪質量。同時量取腹部中線腰圍表示為腹部脂肪分布狀態。
結果：全體個案於手術後6個月之身體質量指數下降23.4±8.7%，體脂率下降22.4±18.4%，胰島素阻抗性下降47.2±50.6%。採用線性迴歸分析調整年齡、性別、術前有無糖尿病史或術前胰島素阻抗性等變項後，體脂率之下降幅度於迷你胃繞道手術顯著優於胃袖狀切除術(p<0.01)。術前有糖尿病史的患者，其脂肪質量下降幅度(p<0.05)及體脂率之下降幅度(p<0.05)均顯著高於無糖尿病史的患者，而術前胰島素阻抗性較高者，其脂肪質量下降幅度顯著較高(p<0.05)。
結論：接受兩種不同代謝性手術於術後6個月時其體重減輕幅度相近且均超過術前體重之20%以上。在接受迷你胃繞道手術的患者、有糖尿病史以及術前胰島素阻抗性高的患者在身體脂肪組成之下降幅度，更為顯著。
（台灣家醫誌2018; 28: 193-207）DOI: 10.3966/168232812018122804002

關鍵詞：重水稀釋法、身體組成、代謝性手術、胰島素阻抗性

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¹國立成功大學醫學院醫學系、⁷老年學研究所；²台中榮民總醫院耳鼻喉頭頸部；³國立成功大學醫學院附設醫院家庭醫學部、⁵營養部、⁶外科部；⁴國立成功大學化學系；# Equal contribution
受理日期：107年6月29日　　修改日期：107年8月31日　　同意刊登：107年9月25日
通訊作者：吳至行　　　　通訊地址：台南市勝利路138號　成大醫院家庭醫學部
共同通訊作者：李國鼎　　通訊地址：台南市勝利路138號　成大醫院外科部

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 Comparison of Body Composition Changes after Different Metabolic Surgeries
 
Wei-Hsiang Tseng¹, Kuan-Ling Liu¹, Shih-Yun Huang², Chin-Sung Chang^3,4, Shu-Hui Chen⁴, Xin-Jin Lu⁵, Su-E Kuo⁵, Kuo-Ting Lee⁶ and Chih-Hsing Wu^3,7

Background: Bariatric surgery can be restrictive or malabsorptive depending on the adopted mechanism, and the two different types of surgery may exert different impacts on body composition. So far in Taiwan, there is no study using the deuterium oxide dilution method to compare the impacts of different bariatric surgeries on the change of body fat composition.
Methods: A total of 47 obese subjects receiving bariatric surgery during 2008-2015 in National Cheng Kung University Hospital were recruited. Of the 47 subjects, 23 went through sleeve gastrectomy (male/female=9/14, mean age=36.9±9.7 years, mean body mass index (BMI)=45.4±8.8 kg/m²) and 24 received mini-gastric bypass surgery (male/female=16/8, mean age=40.6±11.6 years, mean BMI=43.2±9.5 kg/m²). Percent body fat and fat mass were determined by using deuterium oxide dilution method both before and 6 months after surgery. Waist circumference was also measured to assess abdominal fat distribution.
Results: At six months after surgery, subjects reported an average reduction in BMI, body fat percentage and insulin resistance by 23.4±8.7%, 22.4±18.4% and 47.2±50.6%, respectively. In comparison with sleeve gastrectomy, mini-gastric bypass achieved significantly greater reduction in body fat percentage (p<0.01) based on analysis by multiple linear regression (MLR) models with adjustment for age, sex, diabetes mellitus history, and baseline insulin resistance. The results also showed significantly greater reduction in fat mass (p<0.05) and body fat percentage (p<0.05) among subjects with diabetes mellitus and in fat mass (p<0.05) in subjects with higher preoperative insulin resistance.
Conclusion: Obese subjects undergoing either sleeve or mini-gastric bypass surgery achieved similar weight reduction and lost more than 20% of baseline body weight at 6 months after surgery. After mini-gastric bypass surgery, those diabetes patients and those with greater preoperative insulin resistance appeared to achieve better reduction of body fat composition.
(Taiwan J Fam Med 2018; 28: 193-207) DOI: 10.3966/168232812018122804002
 
Key words: body composition, deuterium oxide, insulin resistance, metabolic surgery

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¹Institute of Medicine, ⁷Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan; ²Department of Otolaryngology, Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; ³Department of Family Medicine, ⁵Nutritional Service, ⁶Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan; ⁴Department of Chemistry, National Cheng Kung University, Tainan,
Taiwan.
Received: June 29, 2018; Revised: August 31, 2018; Accepted: September 25, 2018.