Roux-en-Y胃转流术对肥胖及其合并疾病疗效的Meta分析

Efficacy of Roux-en-Y Gastric Bypass for Obesity and Its Comorbidities: A Meta-Analysis

目的系统评价Roux-en-Y胃转流术对肥胖及其合并疾病的治疗效果。方法计算机检索Pub Med、EMbase、h e Cochrane Library(2013年第11期)、CBM、CNKI、VIP和Wan Fang Data等数据库,检索时限均截至2013年11月,纳入所有Roux-en-Y胃转流术对肥胖及其合并疾病治疗效果的研究。由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,使用Rev Man 5.3软件进行Meta分析。结果最终纳入25个自身前后对照试验,共2 966例超重或肥胖患者。Meta分析结果显示:与术前比较,Roux-en-Y胃转流术后超重或肥胖患者的体重指数明显下降[MD=–16.40,95%CI(–17.42,–15.38),P<0.000 01],2型糖尿病[RR=0.23,95%CI(0.17,0.31),P<0.000 01]和高血压[RR=0.34,95%CI(0.26,0.43),P<0.000 01]患病率明显降低,空腹血糖、血压和血脂水平均明显改善(P均<0.000 01)。结论 Roux-en-Y胃转流术能明显减轻肥胖患者体重,降低其合并2型糖尿病和心血管疾病的发生率。但因纳入研究在设计上的局限性,本研究结论尚需进一步开展大样本、高质量的随机对照试验加以验证。

Objective To systematically review the efficacy of Roux-en-Y gastric bypass for obesity and its comor- bidities. Methods Such databases as PubMed, EMbase, The Cochrane Library （Issue 11, 2013）, CBM, CNKI, VIP and WanFang Data, etc. were electronically searched from inception to November 2013, for including all studies on Roux- en-Y gastric bypass for obesity and its comorbidities. According to inclusion and exclusion criteria, two reviewers inde pendently screened literature, extracted data, and evaluated methodological quality of included studies. And then meta analysis was performed using RevMan 5.3 software. Results A total of 25 before and after self-control studies involving 2 966 cases with overweight or obesity were included. The results of meta-analysis showed that： after Roux-en-Y gastric bypass operation, the patients had significant reduction in BMI （MD= -16.40, 95%CI -17.42 to -15.38, P〈0.000 01）, type 2 diabetes mellitus prevalence （RR=0.23, 95%CI 0.17 to 0.31, P〈0.000 01）, and hypertension prevalence （RR=0.34, 95%CI 0.26 to 0.43, P〈0.000 01）; besides, fasting glucose, blood pressure and serum lipid levels obviously decreased （P〈0.O00 01）. Condusion Roux-en-Y gastric bypass for obesity patients is effective in reducing weight loss, type 2 diabetes mellitus incidence and cardiovascular disease incidence. Due to the limitation of the design of the included studies, the conclusion needs to be verified by further conducting high quality randomized controlled trials with large sample-size.