摘要
目的评价不同减重手术术式对超重/肥胖合并2型糖尿病患者糖化血红蛋白(hemoglobin A1c,HbA1c)的影响。方法计算机检索PubMed、EMbase、The Cochrane Library、ClinicalTrials.gov、CNKI、VIP和WanFang Data数据库,搜集减重手术治疗超重/肥胖合并2型糖尿病患者的随机对照试验(randomized controlled trial,RCT),检索时限均从建库至2019年2月20日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.0和R 3.6.2软件进行网状Meta分析。结果共纳入24个RCT。与非手术治疗相比,9种术式中有5种能显著降低HbA1c水平,概率排序依次为:袖状胃切除并双路转运术(sleeve gastrectomy with transit bipartition,SGTB)[MD=-3.60%,95%CI(-5.89,-1.31),P=0.002]、迷你胃旁路术(mini-gastric bypass,MGB)[MD=-2.36%,95%CI(-4.13,-0.58),P=0.009]、十二指肠空肠旁路衬垫术(duodenal-jejunal bypass liner,DJBL)[MD=-1.85%,95%CI(-2.75,-1.96),P<0.000 01]、袖状胃切除术(sleeve gastrectomy,SG)[MD=-1.48%,95%CI(-2.49,-0.47),P=0.004]和Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RYGB)[MD=-1.31%,95%CI(-2.02,-0.59),P=0.003]。胆胰分流十二指肠开关术和胃底折叠术降HbA1c作用尚不确定,可调节胃捆绑术和Roux-en-Y胃空肠吻合术无显著降HbA1c作用。但因纳入研究样本量小且偏倚风险高,SGTB的效果也尚待验证。结论当前证据显示降低HbA1c作用相对较强的术式依次为MGB、DJBL、SG和RYGB。
Objectives To compare the effects of different bariatric surgeries on reducing hemoglobin A1c(HbA1c) in overweight/obese patients with type 2 diabetes. Methods Randomized controlled trials(RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2 019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R3.6.2 software. Results A total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition(SGTB)(MD=-3.60%, 95%CI-5.89 to-1.31, P=0.002), mini-gastric bypass(MGB)(MD=-2.36%, 95%CI-4.13 to-0.58, P=0.009), duodenal-jejunal bypass liner(DJBL)(MD=-1.85%, 95%CI-2.75 to-1.96, P<0.000 01), sleeve gastrectomy(SG)(MD=-1.48%, 95%CI-2.49 to-0.47, P=0.004), and Roux-en-Y gastric bypass(RYGB)(MD=-1.31%,95%CI-2.02 to-0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c.Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation.Conclusions The current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1 c treatment are MGB, DJB, SG and RYGB in sequence.
作者
周旭
朱卫丰
陈晓凡
颜冬梅
聂鹤云
陈建蓉
ZHOU Xu;ZHU Weifeng;CHEN Xiaofan;YAN Dongmei;NIE Heyun;CHEN Jianrong(Evidence-based Medicine Research Center,Jiangxi University of Traditional Chinese Medicine,Nanchang 330004,P.R.China;Department of Endocrinology,the First Affiliated Hospital ofNanchang University,Nanchang 330006,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2020年第9期1059-1068,共10页
Chinese Journal of Evidence-based Medicine
基金
江西中医药大学博士启动基金(编号:2016BS001)
江西中医药大学1050青年人才工程(编号:5142001011)
国家自然科学基金项目(编号:81904057)。
