外科減重手術與傳統方法比較治療肥胖患者2型糖尿病的Meta分析_《中國循證醫學雜志》

作者：

謝曉峰 ¹ , 張文亮 ² , 李倩 ² , 李娜 ³ ,  王琛 ²

1. 蘭州大學基礎醫學院（蘭州 730000）；2. 蘭州大學第二醫院（蘭州 730000）；3. 蘭州大學第一醫院（蘭州 730000）;

關鍵詞：

減重手術 2型糖尿病系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130129

視頻：

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目的　系統評價外科減重手術與傳統方法比較治療肥胖患者2型糖尿病的療效。
方法　計算機檢索The Cochrane Library（2012年第12期）、PubMed、CNKI、CBM、VIP和WanFang Data，查找外科減重手術與傳統方法比較治療肥胖患者2型糖尿病的隨機對照試驗，檢索時限均為建庫至2012年5月。由2名研究員根據納入與排除標準獨立篩選文獻、提取資料和評價質量后，采用RevMan 5.1.2軟件進行Meta分析。
結果　最終納入3個RCT，共340例患者。Meta分析結果顯示：與傳統方法相比，外科減重手術能提高肥胖患者2型糖尿病的緩解率，降低糖化血紅蛋白水平，減輕肥胖患者體重，且術后并發癥較輕。
結論　當前常用的外科減重手術治療肥胖患者2型糖尿病的療效優于傳統方法，并發癥較輕，值得臨床借鑒。受納入研究質量和數量限制，上述結論尚待進一步研究加以驗證。

引用本文： 謝曉峰,張文亮,李倩,李娜,王琛. 外科減重手術與傳統方法比較治療肥胖患者2型糖尿病的Meta分析. 中國循證醫學雜志, 2013, 13(6): 728-734. doi: 10.7507/1672-2531.20130129 復制

1.	李威杰. 全球手術治療糖尿病最新進展. 中國實用外科雜志, 2010, 30(7): 571-573.
2.	Yang W, Lu J, Weng J, et al. Prewalence of diabetes among men and women in China. N Engl J Med, 2010(12), 362: 1090-1101.
3.	Zimmer P, Albefti KG, Shaw J. G1obal and societal implications of the diabetes epidemic. Nature, 2001, 414(6865): 782-787.
4.	鄭成竹, 張鼎宇. 2型糖尿病的外科治療. 中華胃腸外科雜志, 2009, 12(6): 545-548.
5.	中華醫學會糖尿病學分會, 中華醫學會外科學分會. 手術治療糖尿病專家共識. 中華糖尿病雜志, 2011, 3(3): 205-208.
6.	Tuner RC, Cull CA, Frighi V. Glycemic control with diet, sulphonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UK-PDS49). UK Prospective Diabetes Study (UKPDS) Group. JAMA, 1999, 281 (21): 2005-2012.
7.	Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it, An operati on proves to be the most effective therapy for adult onset diabetes mellitus. Ann Surg, 1995, 222(3): 339-350.
8.	Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. N Engl J Med, 2004, 351(26): 2683-2693.
9.	Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index < 35 kg/m2. Diabetes, Obes Metab, 2012, 14(3): 262-270.
10.	Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care, 2002, 25(2): 358-363.
11.	Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg, 2004, 14(10): 1335-1342.
12.	Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg, 2003, 238(4): 467-485.
13.	Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass induced weight loss. Ann Surg, 2003, 237(6): 751-758.
14.	Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care, 2009, 32(11): 2133-2135.
15.	Higgins JPT, Green SJ (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. Available from: www.cochranehandbook.org.
16.	Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery vs. conventional medical therapy for type 2 diabetes. N Engl J Med, 2012, 366(17): 1577-1585.
17.	Schauer PR, Kashyap SR, Wolski K, et al. Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med, 2012, 366(17):1567-1576.
18.	Dixon JB, O’Brien PE, Playfair J, et al. Adjust able gastric banding and conventional the rapy for type 2 diabetes: a randomized controlled trial. JAMA, 2008, 299(3): 616-323.
19.	肖竹, 程中, 田浩明. 從減肥手術談2型糖尿病的外科治療. 實用醫院臨床雜志, 2012, 7(4): 22-24.
20.	王平, 李成林, 崔諺. 減重手術治療2型糖尿病的進展. 中國現代普通外科, 2011, 14(17): 875-879.
21.	Salinari S, Bertuzzi A, Asnaghi S, et al. Firstphase insulin secretion restoration and differential response to glucose load depending on the route of administration in type 2 diabetic subjects after bariatric surgery. Diabetes Care, 2009, 32(3): 375-380.
22.	古應超, 于健春. 胃腸手術治療2型糖尿病的機制研究進展. 中國醫學科學院院報, 2011, 33(3): 262-264.
23.	Iaconelli A, Panunzi S, De Gaetano A, et al. Effects of biliopancreatic diversion on diabetic complications: a 10-year follow up. Diabetes Care, 2011, 34(3): 561-567.
24.	Hoerger Tj, Zhang P, Segel JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care, 2010, 33(9): 1933-1939.
25.	Keating CL, Dixon JB, Moodie ML, et al. Cost efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care, 2009, 32(4): 580-584.
26.	Sovik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med, 2011, 155(9): 281-291.
27.	The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. N Engl J Med, 2009, 361(5): 445-454.

1. 李威杰. 全球手術治療糖尿病最新進展. 中國實用外科雜志, 2010, 30(7): 571-573.
2. Yang W, Lu J, Weng J, et al. Prewalence of diabetes among men and women in China. N Engl J Med, 2010(12), 362: 1090-1101.
3. Zimmer P, Albefti KG, Shaw J. G1obal and societal implications of the diabetes epidemic. Nature, 2001, 414(6865): 782-787.
4. 鄭成竹, 張鼎宇. 2型糖尿病的外科治療. 中華胃腸外科雜志, 2009, 12(6): 545-548.
5. 中華醫學會糖尿病學分會, 中華醫學會外科學分會. 手術治療糖尿病專家共識. 中華糖尿病雜志, 2011, 3(3): 205-208.
6. Tuner RC, Cull CA, Frighi V. Glycemic control with diet, sulphonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UK-PDS49). UK Prospective Diabetes Study (UKPDS) Group. JAMA, 1999, 281 (21): 2005-2012.
7. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it, An operati on proves to be the most effective therapy for adult onset diabetes mellitus. Ann Surg, 1995, 222(3): 339-350.
8. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. N Engl J Med, 2004, 351(26): 2683-2693.
9. Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index < 35 kg/m2. Diabetes, Obes Metab, 2012, 14(3): 262-270.
10. Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care, 2002, 25(2): 358-363.
11. Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg, 2004, 14(10): 1335-1342.
12. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg, 2003, 238(4): 467-485.
13. Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass induced weight loss. Ann Surg, 2003, 237(6): 751-758.
14. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care, 2009, 32(11): 2133-2135.
15. Higgins JPT, Green SJ (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. Available from: www.cochranehandbook.org.
16. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery vs. conventional medical therapy for type 2 diabetes. N Engl J Med, 2012, 366(17): 1577-1585.
17. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med, 2012, 366(17):1567-1576.
18. Dixon JB, O’Brien PE, Playfair J, et al. Adjust able gastric banding and conventional the rapy for type 2 diabetes: a randomized controlled trial. JAMA, 2008, 299(3): 616-323.
19. 肖竹, 程中, 田浩明. 從減肥手術談2型糖尿病的外科治療. 實用醫院臨床雜志, 2012, 7(4): 22-24.
20. 王平, 李成林, 崔諺. 減重手術治療2型糖尿病的進展. 中國現代普通外科, 2011, 14(17): 875-879.
21. Salinari S, Bertuzzi A, Asnaghi S, et al. Firstphase insulin secretion restoration and differential response to glucose load depending on the route of administration in type 2 diabetic subjects after bariatric surgery. Diabetes Care, 2009, 32(3): 375-380.
22. 古應超, 于健春. 胃腸手術治療2型糖尿病的機制研究進展. 中國醫學科學院院報, 2011, 33(3): 262-264.
23. Iaconelli A, Panunzi S, De Gaetano A, et al. Effects of biliopancreatic diversion on diabetic complications: a 10-year follow up. Diabetes Care, 2011, 34(3): 561-567.
24. Hoerger Tj, Zhang P, Segel JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care, 2010, 33(9): 1933-1939.
25. Keating CL, Dixon JB, Moodie ML, et al. Cost efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care, 2009, 32(4): 580-584.
26. Sovik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med, 2011, 155(9): 281-291.
27. The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. N Engl J Med, 2009, 361(5): 445-454.

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外科減重手術與傳統方法比較治療肥胖患者2型糖尿病的Meta分析

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《中國循證醫學雜志》

外科減重手術與傳統方法比較治療肥胖患者2型糖尿病的Meta分析

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