腹腔镜Roux-en-Y胃旁路术对肥胖患者多项微量营养素水平影响的Meta分析

Meta-analysis of effects of laparoscopic Roux-en-Y gastric bypass on multiple micro-nutrient levels in obese patients

目的系统评估肥胖患者腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)术后7种营养素水平的变化趋势。方法检索中国知网、万方、Pubmed、Web of Science和Cochrane数据库,按纳入和排除标准筛选文献,提取数据,采用Stata11.0软件进行Meta分析。结果共纳入37篇文献,包含3282例肥胖患者。Meta分析结果显示,与术前相比,LRYGB术后患者血清维生素A(SMD-0.56,95%CI-0.82~-0.31,P<0.001)、血浆锌(SMD-0.45,95%CI-0.89~-0.01,P=0.047)和血清铁(SMD-0.44,95%CI-0.81~-0.07,P=0.021)水平显著下降,差异有统计学意义;血清叶酸(SMD 0.81,95%CI 0.32~1.30,P=0.001)和血清维生素D(SMD 0.35,95%CI 0.11~0.58,P=0.004)水平显著升高,差异有统计学意义;而血清维生素B12(SMD-0.22,95%CI-0.65~0.21,P=0.309)和血清钙(SMD-0.13,95%CI-0.47~0.22,P=0.470)水平未见显著变化,差异无统计学意义。结论LRYGB术后肥胖患者血清多项营养素指标变化趋势并不一致,其中维生素A、铁和锌水平显著降低,维生素D和叶酸水平显著升高,而钙和维生素B12无改变,因此,术后应严密监测患者营养指标,合理服用营养素补充剂,以预防术后营养缺乏症发生。

Objective To systematically evaluate the postoperative changes in several nutrient levels in obese patients who received laparoscopic Roux-en-Y gastric bypass(LRYGB).Methods CNKI,Wan Fang,Pubmed,Web of Science and Cochrane library databases were systematically searched and studies were included based on inclusion and exclusion criteria.The Stata 11.0 was used for meta-analysis.Results A total of 37 studies including 3282 individuals with obesity were eligible for analysis.A significant decrease was observed after LRYGB in serum vitamin A(SMD=-0.56,95%CI:-0.82 to-0.31,P<0.001),zinc(SMD=-0.45,95%CI:-0.89 to-0.01,P=0.047)and iron(SMD=-0.44,95%CI:-0.81 to 0.62,P=0.021).A significant increase in serum folic acid(SMD=0.81,95%CI:0.32 to 1.30,P=0.001)and vitamin D(SMD=0.35,95%CI:0.11 to 0.58,P=0.004)was found after laparoscopic RYGB.No significant changes in serum vitamin B12(SMD=-0.22,95%CI:-0.65 to 0.21,P=0.309)and calcium(SMD=-0.13,95%CI:-0.47 to 0.22,P=0.470)were observed.Conclusions The changes in serum nutrient indicators in obese patients after LRYGB were not consistent in trend.The levels of vitamin A,serum iron and serum zinc were significantly decreased,while the levels of vitamin D and folic acid were significantly increased.Levels of calcium and vitamin B12 showed no significant changes.Therefore,close monitoring of the nutritional indicators and appropriate use of nutrient supplements are recommended,in order to prevent postoperative nutritional deficiencies.