探討縮胃減重患者於手術前後血漿維生素A與E濃度之變化

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標題:	探討縮胃減重患者於手術前後血漿維生素A與E濃度之變化 Investigation of the changes of plasma vitamin A and E levels in patients before and after laparoscopic sleeve gastrectomy 肥胖是現代人最常見的疾病，同時也是造成其他慢性病如高血壓、心臟病與糖尿病等之源頭。縮胃手術是應用於解決病態性肥胖最常見的減肥手術，其藉由切除部分胃以降低攝食量與食物消化、吸收的能力來達到減重。肥胖病患因為飲食品質或是代謝異常問題而可能有脂溶性維生素營養不均衡問題，經由縮胃手術後又面臨營養素攝取與吸收能力下降之威脅，因此病患在術前後的營養狀況評估成為確保病患健康的重要議題。本研究目的為探討肥胖患者接受縮胃手術前後其血漿中維生素A與E濃度的改變。方法 : 由中國醫藥大學附設醫院提供縮胃手術患者之手術前 (n=50) 與手術後6個月(n=38) 血液樣本，以HPLC分析血漿內維生素A與α-、γ-生育醇等兩種維生素E的含量。以皮爾森相關分析患者年齡、體位測量、血液生化值與血中維生素A、E濃度之相關性;手術前後血中維生素A、E濃度變化則採用成對樣本t檢定進行統計。結果:肥胖患者術前血漿維生素A、E濃度並無顯著缺乏情形，而且α-生育醇濃度甚至有較參考值高之現象，但是經由三酸甘油或是總膽固醇進行校正後，證實其維生素E的營養狀況並無較佳，只是落在正常範圍內。術前血漿維生素A濃度與體脂率呈顯著負相關(r=-0.366,p<0.01)，α-生育醇濃度則與BMI、腰圍、臀圍、腰臀比呈顯著負相關(p<0.05)。γ-生育醇濃度與年齡及體位測量指標皆無顯著相關性。術前血漿視網醇與腎功能指標如BUN、CRE呈顯著正相關，也與代謝症候群指標TG、HbA1c、GluAC呈顯著正相關，卻與與LDL呈現顯著負相關。血漿γ-生育醇與TG、HbA1c、GluAC顯著正相關，與其他生化數值皆無顯著相關性。血漿α-生育醇與BUN、GluAC呈現顯著正相關。術前後血漿之維生素濃度以成對樣本T檢定後指出，血漿視網醇濃度於術前後並無顯著差異，然而血漿α-生育醇濃度則顯著增加1.47 μg/mL (p<0.05)。血漿γ-生育醇濃度則於術後顯著降低1.73 μg/mL (p<0.01)。綜上所述，肥胖病患之血漿維生素A與E濃度未有缺乏現象，但是兩者與肥胖指標及代謝症候群指標皆具有某種相關性，術後經高量維生素補充後尚能持續維持正常的血漿維生素濃度。因此術後建議接受營養評估與介入，適時補充營養素、正確的飲食與生活觀念，方可確保術後之減重成效及健康維持。 Obesity is increasing in worldwide, which causes higher risk of some chronic disease such as hypertension, heart disease and diabetes. The most common surgery used for treatment of severe obesity is laparoscopic sleeve gastrectomy (LSG), which removes part of the stomach to induce weight loss by reduction of food intake, digestibility and absorption. Obese individuals may have a fat-soluble vitamin nutrition inadequacy due to poor dietary quality or metabolic disorders. After LSG surgery, the vitamin status could be exacerbated by reduced nutrient intake and absorption. Therefore, the nutritional status assessment of patients before and after surgery becomes an important issue. The purpose of this study aims to investigate the changes of plasma vitamin A and E levels in patients before and after LSG. Methods: Blood samples were obtained from patients before (n = 50) and 6 months after surgery (n = 38) by the hospital of China Medical University. Plasma vitamin A and both α-, γ-tocopherol vitamers were analyzed by HPLC. The correlation between plasma vitamin and anthropometric index, blood biochemical values were analyzed with Pearson correlation statistics. The significance of the changes in plasma vitamin A, E before and after surgery were analyzed by paired T test. Results: There were no significant vitamin deficiency was observed in obese patients before surgery. Though a higher α-tocopherol levels than normal range was found in obese subject. After corrected with plasma triglyceride or total cholesterol, the vitamin E nutritional status falls within the normal range. Plasma vitamin A concentration and body fat percentage show significant negative correlation (p <0.01). A significant negatively correlation between α- tocopherol concentration and BMI, waist circumference, hip circumference, waist-hip ratio (p <0 .05 ) . There was no significant correlation between γ - tocopherol concentration and basic data, anthropometric indicators. Plasma retinol was significantly positively correlated to renal function parameters such as BUN, CRE , TG , HbA1c, GluAC. A reverse relationship between plasma retinol and LDL was found. Plasma γ - tocopherol was significantly positively correlated with TG , HbA1c , and GluAC , and had no significant correlation with other biochemical values. There was a significant positive correlation between plasma α - tocopherol and BUN and GluAC. The concentrations of plasma retinol show no significant difference before and after surgy. However, plasma α- tocopherol level is significantly increased ( p < 0.05 ), and plasma γ- tocopherol concentration is significantly decreased ( p < 0.01 ) after surgery. In summary, no nutrient deficiency was observed in obese subject before surgery. However, there are some correlation between plasma vitamin A, E and obesity index, metabolic syndrome. The supplementation with high levels of vitamins after surgery keeps the normal vitamin levels. Therefore, the intervention of nutritional assessment, micronutrients supplement, a healthy diet and life style establishment, is necessary for subjects health and the weight loss maintenance after surgery.
作者:	楊竣翔
貢獻者:	保健營養系蕭慧美
關鍵字:	腹腔鏡胃袖狀切除維生素A 維生素E Laparoscopic sleeve gastrectomy Vitamin A Vitamin E
日期:	2020
上傳時間:	2022-10-21 10:26:28 (UTC+8)
關聯:	電子全文公開日期：2025-02-10 學年度：108， 64頁
顯示於類別:	[保健營養系(所) ] 博碩士論文

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