CAJ | 학술논문

组织构建%组织构建循证医学%胃转流术%2型糖尿病%非肥胖%空腹血糖%糖化血红蛋白%胰岛素抵抗指数%疗效%随访%系统评价%Meta分析組織構建%組織構建循證醫學%胃轉流術%2型糖尿病%非肥胖%空腹血糖%糖化血紅蛋白%胰島素牴抗指數%療效%隨訪%繫統評價%Meta分析
조직구건%조직구건순증의학%위전류술%2형당뇨병%비비반%공복혈당%당화혈홍단백%이도소저항지수%료효%수방%계통평개%Meta분석
tissue construction%evidence-based medicine of tissue construction%gastric bypass%type 2 diabetes mellitus%non-obese%fasting plasma glucose%glycated hemoglobin%insulin resistance index%efficacy%follow-up%systematic review%meta-analysis

背景:目前中国内地采用减肥手术治疗肥胖型2型糖尿病患者的疗效较好,但对非肥胖型2型糖尿病患者的疗效尚无明确报道. 目的:以胃转流术为主,系统评价中国内地采用减肥手术治疗非肥胖型2型糖尿病的疗效. 方法:计算机检索 Cochrane 图书馆临床对照试验资料库(2012年第2期)、MEDLINE(1990年至2012年2月)、EMbase(1990年至2012年2月)、CBMdisc(1990年至2012年2月)、CNKI(1990年至2012年2月),手工检索相关文献,选择中国内地采用减肥手术治疗非肥胖型2型糖尿病的报道.评估文献质量,提取相应信息后,采用RevMan 5.1.0软件进行Meta分析. 结果与结论:初检出30篇文献,经筛选最终纳入7篇文献,包括307例患者.文献总体质量不高,均为 C 级.各资料间存在异质性,采用随机效应模型进行合并计算.结果表明,行减肥手术非肥胖型2型糖尿病患者术后3,6个月空腹血糖水平[MD=-2.84,95%CI(-3.60,-2.08),P<0.00001;MD=-3.79,95%CI(-4.56,-3.02),P<0.00001]、术后3,6个月糖化血红蛋白水平[MD=–1.52,95%CI(–2.14,-0.89),P<0.00001;MD=-1.90,95%CI(-2.46,-1.34),P<0.00001]、术后6个月胰岛素抵抗指数[MD=–1.80,95%CI(-2.68,-0.91),P<0.0001]均明显低于术前,敏感性分析显示合并性结果稳定可靠,倒漏斗图分析提示纳入的文献可能存在发表偏倚.提示中国内地采用减肥手术治疗非肥胖型2型糖尿病疗效较好,但由于文献质量不高,尚需高质量大样本长期随访研究进一步验证.
배경:목전중국내지채용감비수술치료비반형2형당뇨병환자적료효교호,단대비비반형2형당뇨병환자적료효상무명학보도. 목적:이위전류술위주,계통평개중국내지채용감비수술치료비비반형2형당뇨병적료효. 방법:계산궤검색 Cochrane 도서관림상대조시험자료고(2012년제2기)、MEDLINE(1990년지2012년2월)、EMbase(1990년지2012년2월)、CBMdisc(1990년지2012년2월)、CNKI(1990년지2012년2월),수공검색상관문헌,선택중국내지채용감비수술치료비비반형2형당뇨병적보도.평고문헌질량,제취상응신식후,채용RevMan 5.1.0연건진행Meta분석. 결과여결론:초검출30편문헌,경사선최종납입7편문헌,포괄307례환자.문헌총체질량불고,균위 C 급.각자료간존재이질성,채용수궤효응모형진행합병계산.결과표명,행감비수술비비반형2형당뇨병환자술후3,6개월공복혈당수평[MD=-2.84,95%CI(-3.60,-2.08),P<0.00001;MD=-3.79,95%CI(-4.56,-3.02),P<0.00001]、술후3,6개월당화혈홍단백수평[MD=–1.52,95%CI(–2.14,-0.89),P<0.00001;MD=-1.90,95%CI(-2.46,-1.34),P<0.00001]、술후6개월이도소저항지수[MD=–1.80,95%CI(-2.68,-0.91),P<0.0001]균명현저우술전,민감성분석현시합병성결과은정가고,도루두도분석제시납입적문헌가능존재발표편의.제시중국내지채용감비수술치료비비반형2형당뇨병료효교호,단유우문헌질량불고,상수고질량대양본장기수방연구진일보험증.
@@@@BACKGROUND:Bariatric surgery for obese type 2 diabetes mel itus has obtained better effects in Mainland China, but there is no clear report about bariatric surgery for non-obese type 2 diabetes mel itus. @@@@OBJECTIVE:To assess the clinical effectiveness of bariatric surgery for non-obese type 2 diabetes mel itus in Mainland China. @@@@METHODS:We searched the Cochrane Central Register of Control ed Trials (Issue 2, 2012), MEDLINE (1990 to February 2012), EMbase (1990 to February 2012), CBMdisc (1990 to February 2012) and CNKI (1990 to February 2012). Manual search of relevant journals and conference proceedings was also performed. Clinical trials in which bariatric surgery (gastric bypass) was used to treat patients with type 2 diabetes mel itus in Mainland China were col ected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 5.1.0 software. @@@@RESULTS AND CONCLUSION:A total of 30 articles were found and seven articles involving 307 patients were final y included. Al these articles were regarded as low quality (grade C). We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with bariatric surgery, there were significant reductions in fasting plasma glucose [3 months:mean difference (MD)=-2.84, 95%confidence interval (CI) (-3.60,–2.08), P<0.000 01;6 months:MD=-3.79, 95%CI (–4.56,–3.02), P<0.000 01], glycated hemoglobin [3 months:MD=-1.52, 95%CI (-2.14, -0.89), P<0.000 01;6 months:MD=-1.90, 95%CI (-2.46,-1.34), P<0.000 01] and insulin resistance index [6 months:MD=–1.80, 95%CI (–2.68,–0.91), P<0.000 1]. Sensitivity analysis indicates that results were credible and stable. Funnel-plots display non-symmetrical figures, indicating publication bias. Bariatric surgery is effective for non-obese type 2 diabetes mel itus in Mainland China. However, due to lack of quality in the included studies, more studies with high-quality large-size samples should be conducted.