外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析_《中国循证医学杂志》

作者：

谢晓峰 ¹ , 张文亮 ² , 李倩 ² , 李娜 ³ ,  王琛 ²

1. 兰州大学基础医学院（兰州 730000）；2. 兰州大学第二医院（兰州 730000）；3. 兰州大学第一医院（兰州 730000）;

关键词：

减重手术 2型糖尿病系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130129

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的疗效。
方法　计算机检索The Cochrane Library（2012年第12期）、PubMed、CNKI、CBM、VIP和WanFang Data，查找外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的随机对照试验，检索时限均为建库至2012年5月。由2名研究员根据纳入与排除标准独立筛选文献、提取资料和评价质量后，采用RevMan 5.1.2软件进行Meta分析。
结果　最终纳入3个RCT，共340例患者。Meta分析结果显示：与传统方法相比，外科减重手术能提高肥胖患者2型糖尿病的缓解率，降低糖化血红蛋白水平，减轻肥胖患者体重，且术后并发症较轻。
结论　当前常用的外科减重手术治疗肥胖患者2型糖尿病的疗效优于传统方法，并发症较轻，值得临床借鉴。受纳入研究质量和数量限制，上述结论尚待进一步研究加以验证。

引用本文： 谢晓峰,张文亮,李倩,李娜,王琛. 外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析. 中国循证医学杂志, 2013, 13(6): 728-734. doi: 10.7507/1672-2531.20130129 复制

1.	李威杰. 全球手术治疗糖尿病最新进展. 中国实用外科杂志, 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.	郑成竹, 张鼎宇. 2型糖尿病的外科治疗. 中华胃肠外科杂志, 2009, 12(6): 545-548.
5.	中华医学会糖尿病学分会, 中华医学会外科学分会. 手术治疗糖尿病专家共识. 中华糖尿病杂志, 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. 从减肥手术谈2型糖尿病的外科治疗. 实用医院临床杂志, 2012, 7(4): 22-24.
20.	王平, 李成林, 崔谚. 减重手术治疗2型糖尿病的进展. 中国现代普通外科, 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.	古应超, 于健春. 胃肠手术治疗2型糖尿病的机制研究进展. 中国医学科学院院报, 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. 全球手术治疗糖尿病最新进展. 中国实用外科杂志, 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. 郑成竹, 张鼎宇. 2型糖尿病的外科治疗. 中华胃肠外科杂志, 2009, 12(6): 545-548.
5. 中华医学会糖尿病学分会, 中华医学会外科学分会. 手术治疗糖尿病专家共识. 中华糖尿病杂志, 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. 从减肥手术谈2型糖尿病的外科治疗. 实用医院临床杂志, 2012, 7(4): 22-24.
20. 王平, 李成林, 崔谚. 减重手术治疗2型糖尿病的进展. 中国现代普通外科, 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. 古应超, 于健春. 胃肠手术治疗2型糖尿病的机制研究进展. 中国医学科学院院报, 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.

《中国循证医学杂志》

外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析

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《中国循证医学杂志》

外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析

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