奥利司他对肥胖症治疗作用的Meta分析

A meta analysis of Orlistat on treatment of obesity

目的 系统评价奥利司他对肥胖患者减重和改善心血管相关危险因素的作用。 方法 收集多个数据库的随机、对照、双盲研究15个 ,用RevMan4.1软件进行随机效应模型的统计处理 ,并进行异质性检验和敏感性分析 ,效应量为加权平均差异(WMD)和相对危险度(RR)。 结果 减重1年后奥利司他组体重下降百分比的WMD值(95 %可信区间 )为 -2.78%( -3.26%,-2.30%) ,<10 %减重比例的RR值为0.84(0.81,0.87) ,总胆固醇和低密度脂蛋白的WMD值为 -6.06%( -7.32%,-4.81 %)和 -7.29 %( -8.92%,-5.66%)。继续维持体重1年后,<10 %减重比例的RR值为0.86(0.82,0.91) ,总胆固醇、低密度脂蛋白的WMD值为 -5.89 %( -7.60%,-4.18 %)、-6.53 %( -9.00%,-4.05%) ,并腰围缩小和血糖、胰岛素、血压水平改善。 结论 奥利司他是一种安全、有效的减肥药物 ,结合行为调整治疗等更易达到临床治疗目的。

Objective To evaluate the effect of Orlistat in treatment of weight loss,weight maintenance and improvement of relative cardiovascular risk factors in obese patients.Methods Fifteen randomized placebo-con-trolled double-blinded trials were selected from different databases,analyzed by RevMan4.1software.Random Ef-fect Model was applied to analyze the pooled results and heterogeneity.Sensitivity analysis was done by calculating the fail-safe number.For continuous data,a pooled weighted mean difference(WMD)was generated and a summary relative risk(RR)was calculated for dichotomous variables.Results After1-year treatment of Orlistat,WMD of weight loss percentage was-2.78%(-3.26%,-2.30%).The RR of Orlistat-treated patients who lost<10% initial body weight were0.84(0.81,0.87).The WMD of total serum cholesterol and LDL-cholesterol were -6.06%(-7.32%,-4.81%)and-7.29%(-8.92%,-5.66%)respectively.At the end of second year,the RR of Orlistat-treated patients who lost<10%initial body weight were0.86(0.82,0.91).The WMD of to-tal serum cholesterol and LDL-cholesterol were-5.89%(-7.60%,-4.18%)and-6.53%(-9.00%,-4.05%).Orlistat was also associated with greater improvements than placebo in waist circumference,fasting plasma glucose,HbA 1C ,serum insulin and blood pressure.Conclusion Orlistat is an effective,safe new drug to treat obesity.With other methods,such as behavior adjustment,it will get more weight loss,weight maintenance and improvements of relative risk factors.