减重代谢手术对肥胖症患者生活质量影响的Meta分析

doi:10.12114/j.issn.1007-9572.2020.00.167

摘要/Abstract

摘要： 背景　肥胖症已经成为全球流行病，对人类的健康造成了一定的威胁。临床实践证据表明减重代谢手术（MBS）可以有效治疗肥胖症及其相关并发症，提高患者的生活质量。但MBS术后并非所有患者可取得很好的减重疗效和生活质量的提高。目的　系统评价MBS对肥胖症患者生活质量的影响。方法　计算机检索PubMed、CENTRAL、CINAHL、EMBase、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据知识服务平台等数据库，检索时间为建库至2019年6月。检索MBS（MBS组）及非手术治疗（非手术治疗组）对肥胖症患者生活质量影响的随机对照试验（RCT），两名研究者按照纳入及排除标准独立筛选文献、提取资料、质量评价后，使用RevMan 5.3软件进行Meta分析。结果　共纳入7篇文献，共351例体质指数（BMI）≥27.5 kg/m2伴或不伴有2型糖尿病的肥胖症患者。Meta分析结果显示，MBS组患者生理健康评分〔加权标准差（WMD）=19.98，95%CI（11.64，28.31），P<0.000 01〕及其中的生理功能〔WMD=42.20，95%CI（15.37，69.03），P=0.002〕、生理职能〔WMD=27.67，95%CI（16.97，38.37），P<0.000 01〕、躯体疼痛〔WMD=42.94，95%CI（16.60，69.29），P=0.001〕、一般健康状况评分〔WMD=39.52，95%CI（26.60，52.45），P<0.000 01〕高于非手术治疗组；MBS组患者心理健康评分〔WMD=13.89，95%CI（9.09，18.68），P<0.000 01〕及其中的活力〔WMD=23.54，95%CI（17.76，29.31），P<0.000 01〕、社会功能评分〔WMD=55.97，95%CI（45.53，66.42），P<0.000 01〕高于非手术治疗组；MBS组患者生活质量总评分高于非手术治疗组〔标准化均数差（SMD）=1.35，95%CI（0.80，1.90），P<0.000 01〕。结论　MBS可以在一定程度上提高肥胖症患者的生活质量，但在情感职能和精神健康方面没有改善，仍需要通过开展大样本、高质量、长期的RCT予以验证。

关键词: 肥胖症；减重代谢手术；生活质量；糖尿病, 2型；高血压；Meta分析

Abstract: Background　Obesity has become a global epidemic，which poses a certain threat to human health.Clinical evidence shows that the metabolic bariatric surgery （MBS） can treat obesity and its related complications，and improve the quality of life of patients effectively.However，not all patients have achieved good weight-loss effects and improvements in quality of life.Objective　To systematically evaluate the effect of MBS on the quality of life of obese patients.Methods　The randomized controlled trials （RCTs） regarding obese patients receiving MBS compared with those receiving non-surgical treatment in terms of improvement in quality of life were searched in databases of PubMed，CENTRAL，CINAHL，EMBase，CNKI，CBM，Wanfang Data Knowledge Service Platform from inception to June 2019.RCTs screening based on the inclusion and exclusion criteria，data extraction，and quality evaluation were performed by two researchers separately.RevMan 5.3 was used to conduct the meta-analysis.Results　A total of 7 RCTs were included，involving 351 obese patients with BMI≥27.5 kg/m2 together with type 2 diabetes or without.The results of meta-analysis showed that compared with patients with non-surgical treatment，those with MBS had higher mean physical health component score 〔WMD=19.98，95%CI（11.64，28.31），P<0.000 01〕，and higher mean scores of physical functioning 〔WMD=42.20，95%CI（15.37，69.03），P=0.002〕，role physical 〔WMD=27.67，95%CI（16.97，38.37），P<0.000 01〕，bodily pain〔WMD=42.94，95%CI（16.60，69.29），P=0.001〕 and general health perception 〔WMD=39.52，95%CI（26.60，52.45），P<0.000 01〕.Moreover，those with MBS showed higher mean mental health component score 〔WMD=13.89，95%CI（9.09，18.68），P<0.000 01〕，and higher mean scores of vitality 〔WMD=23.54，95%CI（17.76，29.31），P<0.000 01〕，and social functioning 〔WMD=55.97，95%CI（45.53，66.42），P<0.000 01〕.On the whole，patients treated with MBS had better quality of life 〔SMD=1.35，95%CI（0.80，1.90），P<0.000 01〕.Conclusion　MBS may improve the quality of life of obese patients to some extent，but may produce no effects on improving role emotional and mental health，whose effectiveness still needs to be verified by high-quality and long-term RCTs with large sample size.

Key words: Obesity；Metabolic bariatric surgery；Quality of life；Diabetes melliyus, type 2；Hyperfension；Meta-analysis

王迪,王鹏程,李雪,等. 减重代谢手术对肥胖症患者生活质量影响的Meta分析[J]. 中国全科医学, 2020, 23(29): 3729-3734. DOI: 10.12114/j.issn.1007-9572.2020.00.167.
WANG Di1,WANG Pengcheng2,LI Xue1, et al. Quality of Life among Obese Patients Following Metabolic and Bariatric Surgery：a Meta-analysis　[J]. Chinese General Practice, 2020, 23(29): 3729-3734. DOI: 10.12114/j.issn.1007-9572.2020.00.167.

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