基于潜在类别分析的肥胖人群减重手术获益亚型识别及干预策略研究

doi:10.12183/j.scjpm.2025.1181

摘要/Abstract

摘要： 目的探讨基于潜在类别分析识别肥胖人群减重手术获益亚型,并分析干预策略。方法采用回顾性研究,选择2022年7月至2024年2月安徽医科大学第二附属医院收治的234例肥胖患者资料,随访术后1个月（T1）、3个月（T2）、6个月（T3）、12个月（T4）术后多余体重减少率（%EWL）,应用无条件潜类别增长模型（LCGM）分析患者手术获益轨迹亚型,并分析其影响因素。结果 234例肥胖患者在腹腔镜袖状胃切除术后T1、T2、T3、T4时%EWL分别为（40.57±4.76）%、（54.57±6.12）%、（65.17±8.46）%、（79.76±8.47）%,4个时点%EWL差异有统计学意义（P<0.01）。基于潜在类别分析的肥胖人群减重手术获益亚型分别为手术获益高水平组（C1）共138例（58.97%）、手术获益低水平组（C2）共34例（14.53%）患者、手术获益中等水平组（C3）共62例（26.50%）。多因素logistic回归分析结果显示,术前BMI分级（OR=3.970）、焦虑/抑郁（OR=2.268）、术后蛋白质摄入量（OR=2.152）、术后不良进食行为（OR=2.765）、术后每周运动时长（OR=2.018）是肥胖人群减重手术获益轨迹的相关因素（均P<0.05）。结论减重手术可为肥胖人群带来手术获益,但仍有部分患者术后获益处于中低水平,可能与BMI分级、焦虑/抑郁、术后蛋白质摄入量低、不良进食行为及每周运动时长<150 min有关,应根据上述因素制定的干预策略尽早干预,提高此类患者减重手术获益。

关键词: 肥胖, 减重手术, 手术获益, 多余体重减少率, 潜在类别分析

Abstract: Objective To identify subtypes of benefits from bariatric surgery among the obese population using latent class analysis and to analyze corresponding intervention strategies. Methods A retrospective study was conducted on 234 obese patients admitted to the Second Affiliated Hospital of Anhui Medical University from July 2022 to February 2024. The percentage of excess weight loss (%EWL) was followed up at 1 month (T1), 3 months (T2), 6 months (T3), and 12 months (T4) postoperatively. An unconditional latent class growth model (LCGM) was employed to analyze the trajectory subtypes of surgical benefits, and the influencing factors were investigated. Results The mean %EWL for the 234 patients after laparoscopic sleeve gastrectomy was (40.57±4.76)%, (54.57±6.12)%, (65.17±8.46)%, and (79.76±8.47)% at T1, T2, T3, and T4, respectively, with statistically significant differences across the four time points (P<0.01). Based on latent class analysis, three subtypes of surgical benefits were identified: a high-level benefit group (C1) with 138 cases (58.97%), a low-level benefit group (C2) with 34 cases (14.53%), and a medium-level benefit group (C3) with 62 cases (26.50%). Multivariate logistic regression analysis indicated that preoperative BMI classification (OR=3.970), anxiety/depression (OR=2.268), postoperative protein intake (OR=2.152), postoperative adverse eating behaviors (OR=2.765), and postoperative weekly exercise duration (OR=2.018) were significant factors associated with the surgical benefit trajectories (all P<0.05). Conclusions Bariatric surgery confers benefits to the obese population; however, a subset of patients exhibits low to medium levels of postoperative benefit. This may be associated with preoperative BMI classification, anxiety/depression, low postoperative protein intake, adverse eating behaviors, and weekly exercise duration of less than 150 minutes. Intervention strategies based on these factors should be implemented early to enhance the surgical benefits for this patient population.

Key words: Obesity, Bariatric surgery, Surgical benefit, Percentage of excess weight loss, Latent class analysis

中图分类号:

R193.3

屠倩, 黄婷, 万春子, 陈皖京, 张永鸿. 基于潜在类别分析的肥胖人群减重手术获益亚型识别及干预策略研究[J]. 华南预防医学, 2025, 51(11): 1181-1186.

TU Qian, HUANG Ting, WAN Chunzi, CHEN Wanjing, ZHANG Yonghong. A study on the identification of subtypes of bariatric surgery benefits in obese populations based on latent class analysis and intervention strategies[J]. South China Journal of Preventive Medicine, 2025, 51(11): 1181-1186.

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