中国内地减肥手术治疗肥胖型2型糖尿病的Meta分析  

Bariatric Surgery for Obese Type 2 Diabetes Patients in China's Mainland: A Systematic Review

作　　者：潘雯[1] 宫建[2] 郑刚[3] 翟德军 孙云萍[5] 任莉娜[6] 李景栋7 

机构地区：[1]辽宁省疾病预防控制中心,沈阳110005 [2]沈阳药科大学生命科学与生物制药学院临床药学教研室,沈阳110016 [3]沈阳医学院奉天医院骨外三科,沈阳110024 [4]盘锦市第二人民医院泌尿外科,辽宁盘锦124000 [5]沈阳市妇婴医院产六科,沈阳110011 [6]中国医科大学附属第一医院心内科,沈阳110001

出　　处：《中国循证医学杂志》2013年第4期441-445,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价中国内地减肥手术治疗肥胖型2型糖尿病(T2DM)的疗效。方法计算机检索Cochrane图书馆临床对照试验资料库(2012年第2期)、MEDLINE(1990～2012年2月)、EMbase(1990～2012年2月)、CBM(1990～2012年2月)、CNKI(1990～2012年2月)、WanFang Data(1999～2012年2月)和VIP数据库(1996～2012年2月),并追溯纳入文献的参考文献,按纳入与排除标准选择文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入6个自身前后对照试验,共100例患者。纳入文献总体质量不高,均为C级。Meta分析结果显示,肥胖型T2DM患者减肥手术术后1个月空腹血糖水平[MD=–2.27,95%CI(–4.12,–0.42),P=0.02]、术后6个月空腹血糖水平[MD=–2.73,95%CI(–2.91,–2.56),P<0.000 01]、术后6个月糖化血红蛋白水平[SMD=–1.97,95%CI(–2.98,–0.96),P=0.000 1]均明显低于术前,其差异均有统计学意义。敏感性分析显示,Meta分析的合并结果稳定可靠,但倒漏斗图分析提示纳入研究可能存在发表偏倚。结论现有研究结果表明,中国内地行减肥手术治疗肥胖型T2DM疗效较好,但由于纳入文献样本量小、方法学质量存在缺陷,尚需高质量、大样本、长期随访的研究进一步验证疗效。Objective To assess the effectiveness of bariatric surgery for obese type 2 diabetes mellitus （T2DM） in China's Mainland. Methods Such databases as the Cochrane Central Register of Controlled Trials （Issue 2, 2012）, MED- LINE （1990 to February 2012）, EMbase （1990 to February 2012）, CBM （1990 to February 2012）, CNKI （1990 to February 2012）, WanFang Data （1999 to February 2012） and VIP （1996 to February 2012） were searched, and the references of the included literature were also retrieved. The studies were screened according to the predefined inclusion and exclusion cri- teria, the data were extracted, the quality was evaluated, and then the meta-analysis was performed using RevMan 5.2 soft- ware. Results A total of 6 controlled before-and-after studies involving 100 patients were included. The overall quality of all literature was as low as grade C. The results of meta-analysis showed that the following indexes after operation obvi- ously decreased than before： 1-month postoperative fasting plasma glucose （MD-- -2.27, 95%CI -4.12 to -0.42, P=0.02）, 6-month postoperative fasting plasma glucose （MD= -2.73, 95%CI -2.91 to 2.56, P〈0.000 01）, and 6-month postoperative glycated hemoglobin （SMD= -1.97, 95%CI -2.98 to -0.96, P=0.000 1）, and the differences were statistically significant. The sensitivity analysis indicated the results of meta-analysis were credible and stable, but the funnel-plot analysis dis- played publication bias might exist in the included studies. Conclusion Current studies show that bariatric surgery is effective for obese T2DM patients in China's Mainland. However, due to small sample size and low methodological quality of the included studies, its effect has to be proved by high quality, large sample, and long follow-up studies.

关 键 词：减肥手术 糖尿病 肥胖 系统评价 META分析 自身前后对照试验 

分 类 号：R656.6[医药卫生—外科学]