Abstract：
OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) is a widely recognized effective bariatric surgery. However, variable weight loss outcomes post-surgery remained a clinical challenge. Currently, there is no established consensus on the factors influencing weight loss failure following LSG. This study aimed to explore the association between preoperative cortisol secretion autonomy and postoperative weight loss in obese patients undergoing LSG.
METHODS: A cohort of 181 patients with simple obesity (BMI ≥ 28 kg/m2) who underwent LSG and were followed up for one year was analyzed. Weight loss was measured by the percentage of excess weight loss (%EWL), and cortisol secretion autonomy was evaluated using a 1 mg dexamethasone suppression test (DST). Regression models were used to analyze the correlation between preoperative 1 mg DST results and %EWL one year after laparoscopic sleeve gastrectomy (LSG).
RESULTS: Cortisol secretion autonomy was significantly lower in the %EWL ≥ 75% group and higher in the %EWL < 75% group, showing a negative correlation with %EWL (R = -0.336, p = 0.001). Logistic regression analysis indicated that high cortisol secretion autonomy was significantly correlated with %EWL < 75% after LSG. The likelihood of %EWL being < 75% was 10.47 times greater in patients with high cortisol secretion autonomy compared to those with low cortisol secretion autonomy (odds ratio 10.472, confidence interval: 1.660-66.048, p = 0.012).
CONCLUSIONS: Cortisol secretion autonomy emerges as an independent predictor of weight loss outcomes in Asian patients undergoing LSG. This finding suggests the potential for cortisol secretion autonomy to inform preoperative assessments and personalized treatment strategies in bariatric surgery.
METHODS: A cohort of 181 patients with simple obesity (BMI ≥ 28 kg/m2) who underwent LSG and were followed up for one year was analyzed. Weight loss was measured by the percentage of excess weight loss (%EWL), and cortisol secretion autonomy was evaluated using a 1 mg dexamethasone suppression test (DST). Regression models were used to analyze the correlation between preoperative 1 mg DST results and %EWL one year after laparoscopic sleeve gastrectomy (LSG).
RESULTS: Cortisol secretion autonomy was significantly lower in the %EWL ≥ 75% group and higher in the %EWL < 75% group, showing a negative correlation with %EWL (R = -0.336, p = 0.001). Logistic regression analysis indicated that high cortisol secretion autonomy was significantly correlated with %EWL < 75% after LSG. The likelihood of %EWL being < 75% was 10.47 times greater in patients with high cortisol secretion autonomy compared to those with low cortisol secretion autonomy (odds ratio 10.472, confidence interval: 1.660-66.048, p = 0.012).
CONCLUSIONS: Cortisol secretion autonomy emerges as an independent predictor of weight loss outcomes in Asian patients undergoing LSG. This finding suggests the potential for cortisol secretion autonomy to inform preoperative assessments and personalized treatment strategies in bariatric surgery.
摘要：
目的：腹腔镜袖状胃切除术（LSG）是一种公认的有效减肥手术。然而,可变的术后体重减轻结果仍然是一个临床挑战.目前,对于影响LSG后减肥失败的因素尚无共识。本研究旨在探讨LSG肥胖患者术前皮质醇分泌自主性与术后体重减轻之间的关系。
方法：对181例单纯性肥胖（BMI≥28kg/m2）患者进行LSG并随访一年的队列进行分析。重量损失通过过量重量损失的百分比(%EWL)来测量,使用1mg地塞米松抑制试验（DST）评估皮质醇分泌自主性。采用回归模型分析术前1mgDST结果与腹腔镜袖状胃切除术(LSG)后1年EWL%的相关性。
结果：%EWL≥75%组皮质醇分泌自主性显著降低，%EWL<75%组显著升高，与%EWL呈负相关(R=-0.336，p=0.001)。Logistic回归分析显示，LSG后皮质醇分泌自主性高与%EWL<75%显著相关。与皮质醇分泌自主性低的患者相比，皮质醇分泌自主性高的患者的百分比EWL<75％的可能性高10.47倍（比值比10.472，置信区间：1.660-66.048，p=0.012）。
结论：在接受LSG的亚洲患者中，皮质醇分泌自主性成为体重减轻的独立预测因素。这一发现表明皮质醇分泌自主性在减肥手术中告知术前评估和个性化治疗策略的潜力。
方法：对181例单纯性肥胖（BMI≥28kg/m2）患者进行LSG并随访一年的队列进行分析。重量损失通过过量重量损失的百分比(%EWL)来测量,使用1mg地塞米松抑制试验（DST）评估皮质醇分泌自主性。采用回归模型分析术前1mgDST结果与腹腔镜袖状胃切除术(LSG)后1年EWL%的相关性。
结果：%EWL≥75%组皮质醇分泌自主性显著降低，%EWL<75%组显著升高，与%EWL呈负相关(R=-0.336，p=0.001)。Logistic回归分析显示，LSG后皮质醇分泌自主性高与%EWL<75%显著相关。与皮质醇分泌自主性低的患者相比，皮质醇分泌自主性高的患者的百分比EWL<75％的可能性高10.47倍（比值比10.472，置信区间：1.660-66.048，p=0.012）。
结论：在接受LSG的亚洲患者中，皮质醇分泌自主性成为体重减轻的独立预测因素。这一发现表明皮质醇分泌自主性在减肥手术中告知术前评估和个性化治疗策略的潜力。
