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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2014, Vol. 08 ›› Issue (04) : 321 -331. doi: 10.3877/cma.j.issn.1674-0793.2014.04.018

所属专题： 文献；

循证医学

袖状胃切除及胃旁路手术对合并肥胖2型糖尿病近、远期疗效的Meta分析
汤聪1, 梁文丰1,†(), 岑宏1, 陈强1   
  1. 1. 519000　珠海，中山大学附属第五医院普外4科微创中心
  • 收稿日期:2014-04-24 出版日期:2014-08-01
  • 通信作者: 梁文丰

Short- and long-term remission of obese type 2 diabetes mellitus after gastric bypass surgery or sleeve gastrectomy: a Meta analysis

Cong Tang1, Wenfeng Liang1,†(), Hong Cen1, Qiang Chen1   

  1. 1. Department of General Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangzhou 519000, China
  • Received:2014-04-24 Published:2014-08-01
  • Corresponding author: Wenfeng Liang
  • About author:
    Corresponding author: Liang Wenfeng, Email:
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引用本文：

汤聪, 梁文丰, 岑宏, 陈强. 袖状胃切除及胃旁路手术对合并肥胖2型糖尿病近、远期疗效的Meta分析[J]. 中华普通外科学文献(电子版), 2014, 08(04): 321-331.

Cong Tang, Wenfeng Liang, Hong Cen, Qiang Chen. Short- and long-term remission of obese type 2 diabetes mellitus after gastric bypass surgery or sleeve gastrectomy: a Meta analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2014, 08(04): 321-331.

目的

探讨袖状胃切除术（SG）及胃转流术（GBP）对2型糖尿病（T2DM）的近、长期疗效的循证支持。

方法

检索Cochrane图书馆、Medline及EMbase数据库关于SG及GBP手术治疗合并肥胖的T2DM患者疗效的文献，设立纳入与排除标准筛选文献，进行质量评价、提取数据和数据统计分析。

结果

纳入Meta分析标准的文章有34篇，其中8篇为RCT，26项研究涉及GBP，27项研究涉及SG。术前GBP及SG手术患者的基础BMI（kg/m2）分别为44.8±5.2、46.68±7.3；术前指标糖化血红蛋白（%）分别为7.86±0.73、7.91±0.98；空腹血糖水平（mg/dl，1mg/dl=0.055 5 mmol/L）分别为158.0±18.1、167.7±41.6。随访1年GBP和SG术后T2DM缓解率分别为77%、74%，3年缓解率则为74%、85%，5年及以上缓解率分别为77%、74%。8篇RCT文献中行GBP与SG手术治疗T2DM效果的Meta分析，RR=1.26，95% CI=1.10~1.44，GBP术后T2DM缓解率较SG高。

结论

GBP及SG手术均是治疗肥胖合并T2DM的有效措施，其近、远期疗效随随访时间无明显下降。GBP治疗T2DM的疗效优于SG手术。

关键词: 袖状胃切除术, 胃转流手术, 2型糖尿病, 远期疗效, 缓解率
Objective

To analyze the evidence-based study of short-term and long-term remission of type 2 diabetes mellitus(T2DM) after sleeve gastrectomy(SG) or gastric bypass surgery(GBP).

Methods

Related articles were systematically retrieved by searching Medline, Embase database, and Cochrane library. Inclusion and exclusion criteria to select literatures were set up. The data were qualitatively evaluated and analyzed by STATA or SPSS software.

Results

Thirty-four articles were involved including 8 randomized controlled trials (RCTs). Among them, 26 studies were on GBP surgeries and 27 on SG. The preoperative BMI of GBP and SG group were (44.8±5.2) kg/m2 and (46.68±7.3) kg/m2, preoperative glycosylated hemoglobin index were (7.86±0.73)% and (7.91±0.98)%, preoperative fasting plasma glucose were (158.0±18.1) mg/dl and (167.7±41.6)mg/dl, retrospectively. After 1 year of follow-up, the remission rate of T2DM was 77% and 74% in GBP and SG groups, while the remission rate was 74% and 85% in follow-up of 3 years. In follow-up of 5 or more years, the remission rate of SG surgery was 77%, while that of GBP group was 74% according to the Meta analysis. Comparing the remission rate of T2DM in GBP and SG group from the 8 RCTs, the RR was 1.26, 95% CI=1.10-1.44. The difference between the two groups was statistically significant (P<0.01).

Conclusion

Both SG and GBP surgeries are effective treatments for obese T2DM. The remission rate of GBP surgery is higher than SG.

Key words: Sleeve gastrectomy(SG), Gastric bypass surgery(GBP), Type 2 diabetes mellitus, Long-term efficacy, Remission
表1 纳入文章质量评分标准
分类 内容 评分
选择偏倚 连续或者有代表性的研究（包括随机非随机临床试验或） 1
失访偏倚 随访率>80% 1
实施偏倚 组间实施及干预相同 1
检出偏倚 随机或者前瞻性临床研究 1
双盲或者独立临床试验 1
验证/客观结果 1
图1 研究纳入筛选流程图
表2 纳入研究的合并肥胖的糖尿病患者基本特征
项目 胃旁路手术（GBP） 袖状胃切除术（SG）
病例数 1 325 1 165
糖尿病患病时间（年） 6.24±1.59 6.56±2.7
年龄（岁） 45.1±4.9 44.1±1.9
基础体重指数（BMI，kg/m2） 44.8±5.2 46.68±7.3
糖化血红蛋白（HbA1c，%） 7.86±0.73 7.91±0.98
空腹血糖（FPG，mg/dl） 158.0±18.1 167.7±41.6
图2 袖状胃切除术（SG）后随访1年，T2DM缓解率的单个率Meta分析，n：研究手术患者例数，合并随访1年的T2DM缓解率为74%
图3 胃转流（GBP）术后随访1年，糖尿病缓解率的单个率Meta分析图，合并缓解率为77%，n为手术例数
图4 袖状胃切除术（SG）术后随访3年，T2DM缓解率进行单个率的Meta分析图，合并缓解率为85%
图5 胃转流术（GBP）术后3年随访，T2DM缓解率的单个率Meta分析，合并完全缓解率为74%
图6 袖状胃切除术（SG）术后随访5年，T2DM缓解率的单个率Meta分析，合并的缓解率为77%
图7 胃转流术（GBP）术后随访5年至11.4年，T2DM缓解率Meta分析，合并的缓解率为74%。n为手术例数
表3 SG术后随访5年2型糖尿病完全缓解率
文献，出版年 患病时间（年） 血糖水平（mg/dl） HbA1c（%） 例数 年龄（岁） BMI（kg/m2） T2DM术后5年缓解率（%）
Abbatini等，2013[15] - 143.2 7.30 13 49.3 52.1 76.9
Brethauer等，2013[50] 10.5 137 7.8 23 57.7 50.7 74
Zachariah等，2013[29] - - - 3 34.6 37.42 66.66
Rawlins等，2013[51] - - - 19 44 65 100
Catheline等，2013[52] - - - 13 41.8 49.91 61.5
Sieber等，2014[53] - - - 20 43 46 85
表4 T2DM患者GBP术后5年及5年以上缓解率
研究，出版年 例数 缓解率（%） 随访时间（年） BMI（kg/m2）
Aftab等，2014[54] 49 67.35 5 46± 5
Davies等，2014[55] 70 60.00 5 52±10
DiGiorgi等，2010[56] 42 64.00 5 51.4±8.7
Adams等，2012[57] 87 62.00 6 47.3±7.7
Cohen等，2012[58] 66 88.00 6 30-35
Obeid等，2012l[59] 77 82.00 6.3 46
Pajecki等，2007[60] 17 76.50 7.2 56.7
Davies等，2014[55] 48 44.00 10 52±10
Edholm等，2013[61] 18 72.00 11.4 44.5
图8 胃转流术（GBP）与袖状胃切除术（SG）治疗T2DM之间缓解率的Meta分析
表5 8项随机对照试验的详细数据
研究者，出版年 例数 BMI（kg/m2） HBA1c（%） 缓解率% 随访时间（月） 质量评分
GBP SG GBP SG GBP SG GBP SG
Schauer等，2012[30] 38 51 37.0 36.2 9.3 9.5 78 51 12 6
Ramón等，2012[2] 2 2 44.2 43.5 - - 100 100 12 4
Paluszkiewicz等，2012[24] al.2012[64] 14 10 48.6 46.1 - - 64.3 40 12 5
Nocca等，2011[11] 35 33 48 50.6 8.2 7.8 68.5 72 12 6
Lee等，2011[34] 30 30 30.3 30.3 10.0 10.0 93 47 12 6
Kehagias等，2011[62] 5 5 45.8 44.9 - - 80 80 36 5
Helmi?等，2012[63]，2014[64] al.2012,2014[66,67] 50 51 44.6 44.6 - - 51.0 41.0 6 6
Boza等，2012[12] 43 32 38 37.9 - - 86.6 90.9 36 5
图9 SG与GBP术后，随访时间分别在6,12,36,60个月及以上时间点时，T2DM完全缓解率的比较图。*表示经χ2检验两者差别有统计学意义（P<0.01）
图10 纳入关于LSG术后随访研究中，4项研究记录不同时间点随访缓解率变化情况。（LSG腹腔镜下袖状胃切除术）
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