减重手术与多种健康相关结局：一项伞状评价

doi:10.12114/j.issn.1007-9572.2021.01.213

摘要/Abstract

摘要： 背景　减重手术的数量在世界范围内迅速增加。减重手术对于促进肥胖患者的体质量减少具有显著效果，且有助于改善糖尿病、高血压等疾病情况。但是减重手术也可能增加自杀等不良事件风险。因此需要全面、系统的研究来评估减重手术对多种健康相关结局的影响。目的　确定减重手术除减轻体质量外，对各种健康相关结局的影响。方法　计算机检索PubMed、Web of Science、EMBase、The Cochrane Library数据库，筛选有关减重手术和健康相关结局之间关联的系统回顾性研究或荟萃分析，检索时间为建库到2020-09-20，每项研究均由两名研究者独立根据纳入和排除标准进行评估，通过AMSTAR对纳入研究的方法学质量进行评估。结果　共纳入25篇荟萃分析，通过AMSTAR对纳入研究的方法学质量进行评估，包括11个评分项目，AMSTAR评分中位数为10（7，11）分。从25项荟萃分析中提取54项结局指标进行分析，发现减重手术与多种癌症的风险、癌症死亡率、全因死亡率和心血管死亡率的降低相关。此外，减重手术对健康质量和多种慢性疾病有改善作用，特别是2型糖尿病、心血管疾病、尿失禁、非酒精性脂肪性肝病。一些功能性指标，包括性功能、肺功能、肾功能和体能活动在减重手术后均得到改善。然而，减重手术也增加了自杀、自残、情绪化进食和围生期不良事件的风险。结论　大多数与健康相关的结局指标在减重手术后得到改善，同时，也应注意减重手术可能会增加不良精神问题和围生期不良事件的风险。由于本研究纳入的某些系统评价与荟萃分析的方法学质量以及部分健康相关结局指标的证据质量较低，未来仍需更多高质量的临床研究与系统评价进行验证。

关键词: 肥胖症, 减重手术, 健康相关结局, 伞状评价, Meta分析

Abstract: Background　The number of bariatric surgeries is increasing rapidly worldwide，which may significantly promote weight loss in obese patients，and help to improve diabetes，hypertension and other diseases，but may also increase the risk of suicide and other adverse events. Therefore，comprehensive and systematic studies are needed to assess the impact of bariatric surgery on multiple health-related outcomes. Objective　To examine the influence of bariatric surgery on various health-related outcomes other than weight loss. Methods　We searched databases of PubMed，Web of Science，EMBase，and The Cochrane Library from the inception to September 20，2020，for systematic reviews/meta-analyses of the associations between bariatric surgery and health-related outcomes. Each study was screenedby two authors separately based on the inclusion and exclusion criteria. The 11-item AMSTAR was used for methodological quality assessment. Results　Twenty-five meta-analyses were included. The median AMSTAR score for the meta-analyses was 10（7，11）. Among the 54 outcomes in these meta-analyses，bariatric surgery was found to be associated with a lower risk of multiple cancers，and decreased cancer mortality，all-cause mortality，and cardiovascular mortality. Besides，bariatric surgery improved health quality and multiple chronic diseases，particularly type 2 diabetes，cardiovascular diseases，urinary incontinence，and nonalcoholic fatty liver disease. Several functional outcomes including sexual function，pulmonary function，renal function，and physical activity were also improved after bariatric surgery. However，bariatric surgery also increased the risk of suicide，self-harm，emotional eating，and adverse perinatal outcomes. Conclusion　The majority of health-related outcomes are improved after bariatric surgery，but it should be cautious that bariatric surgery might increase the risk of adverse mental and perinatal problems. Because the methodological quality of some includ meta-analyses and the evidence quality of some health-related outcomes are comparatively low，more high-quality clinical studies and systematic reviews are still needed in the future.

Key words: Obesity, Bariatric surgery, Health-related outcomes, Umbrella review, Meta-analysis

胥媚,张铭烜,张倩,等. 减重手术与多种健康相关结局：一项伞状评价[J]. 中国全科医学, 2021, 24(29): 3742-3750. DOI: 10.12114/j.issn.1007-9572.2021.01.213.
XU Mei,ZHANG Mingxuan,ZHANG Qian, et al. Bariatric Surgery and Multiple Health-related Outcomes：an Umbrella Review　[J]. Chinese General Practice, 2021, 24(29): 3742-3750. DOI: 10.12114/j.issn.1007-9572.2021.01.213.

参考文献

［1］FRüHBECK G，BUSETTO L，DICKER D，et al. The ABCD of obesity：an EASO position statement on a diagnostic term with clinical and scientific implications［J］. Obes Facts，2019，12（2）：131-136. DOI：10.1159/000497124.
［2］BLüHER M. Obesity：global epidemiology and pathogenesis［J］. Nat Rev Endocrinol，2019，15（5）：288-298. DOI：10.1038/s41574-019-0176-8.
［3］PASQUALI R，CASANUEVA F，HALUZIK M，et al. European society of endocrinology clinical practice guideline：endocrine work-up in obesity［J］. Eur J Endocrinol，2020，182（1）：G1-32. DOI：10.1530/EJE-19-0893.
［4］FORCE U P S T，CURRY S J，KRIST A H，et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults：US preventive services task force recommendation statement［J］. JAMA，2018，320（11）：1163-1171. DOI：10.1001/jama.2018.13022.
［5］CHANG S H，STOLL C R，SONG J，et al. The effectiveness and risks of bariatric surgery：an updated systematic review and meta-analysis，2003—2012［J］. JAMA Surg，2014，149（3）：275-287. DOI：10.1001/jamasurg.2013.3654.
［6］ARTERBURN D E，TELEM D A，KUSHNER R F，et al. Benefits and risks of bariatric surgery in adults：a review［J］. JAMA，2020，324（9）：879-887. DOI：10.1001/jama.2020.12567.
［7］O'BRIEN P E，HINDLE A，BRENNAN L，et al. Long-term outcomes after bariatric surgery：a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding［J］. Obes Surg，2019，29（1）：3-14. DOI：10.1007/s11695-018-3525-0.
［8］CLAPP B，WYNN M，MARTYN C，et al. Long term（7 or more years）outcomes of the sleeve gastrectomy：a meta-analysis［J］. Surg Obes Relat Dis，2018，14（6）：741-747. DOI：10.1016/j.soard.2018.02.027.
［9］WIGGINS T，GUIDOZZI N，WELBOURN R，et al. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level：a systematic review and meta-analysis［J］. PLoS Med，2020，17（7）：e1003206. DOI：10.1371/journal.pmed.1003206.
［10］CASTANEDA D，POPOV V B，WANDER P，et al. Risk of suicide and self-harm is increased after bariatric surgery-a systematic review and meta-analysis［J］. Obes Surg，2019，29（1）：322-333. DOI：10.1007/s11695-018-3493-4.
［11］XU J，WU Q，ZHANG Y，et al. Effect of bariatric surgery on male sexual function：a meta-analysis and systematic review［J］. Sex Med，2019，7（3）：270-281. DOI：10.1016/j.esxm.2019.06.003.
［12］LI Y J，HAN Y，HE B. Effects of bariatric surgery on obese polycystic ovary syndrome：a systematic review and meta-analysis［J］. Surg Obes Relat Dis，2019，15（6）：942-950. DOI：10.1016/j.soard.2019.03.032.
［13］AGHILI R，MALEK M，TANHA K，et al. The effect of bariatric surgery on peripheral polyneuropathy：a systematic review and meta-analysis［J］. Obes Surg，2019，29（9）：3010-3020. DOI：10.1007/s11695-019-04004-1.
［14］AROMATARIS E，FERNANDEZ R，GODFREY C M，et al. Summarizing systematic reviews：methodological development，conduct and reporting of an umbrella review approach［J］. Int J Evid Based Healthc，2015，13（3）：132-140. DOI：10.1097/XEB.0000000000000055.
［15］IOANNIDIS J P. Integration of evidence from multiple meta-analyses：a primer on umbrella reviews，treatment networks and multiple treatments meta-analyses［J］. CMAJ，2009，181（8）：488-493. DOI：10.1503/cmaj.081086.
［16］SHEA B J，HAMEL C，WELLS G A，et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews［J］. J Clin Epidemiol，2009，62（10）：1013-1020. DOI：10.1016/j.jclinepi.2008.10.009.
［17］SHEA B J，GRIMSHAW J M，WELLS G A，et al. Development of AMSTAR：a measurement tool to assess the methodological quality of systematic reviews［J］. BMC Med Res Methodol，2007，7：10. DOI：10.1186/1471-2288-7-10.
［18］VERONESE N，DEMURTAS J，CELOTTO S，et al. Is chocolate consumption associated with health outcomes? An umbrella review of systematic reviews and meta-analyses［J］. Clin Nutr，2019，38（3）：1101-1108. DOI：10.1016/j.clnu.2018.05.019.
［19］XIA L，ZHAO R，WAN Q，et al. Sarcopenia and adverse health-related outcomes：an umbrella review of meta-analyses of observational studies［J］. Cancer Med，2020，9（21）：7964-7978. DOI：10.1002/cam4.3428.
［20］GUYATT G，OXMAN A D，AKL E A，et al. GRADE guidelines：1. Introduction—GRADE evidence profiles and summary of findings tables［J］. J Clin Epidemiol，2011，64（4）：383-394. DOI：10.1016/j.jclinepi.2010.04.026.
［21］SOLMI M，K?HLER C A，STUBBS B，et al. Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity：an umbrella review of meta-analyses of cohort studies and randomized controlled trials［J］. Eur J Clin Invest，2018，48（12）：e12982. DOI：10.1111/eci.12982.
［22］WAN Q，LI N，DU L，et al. Allium vegetable consumption and health：an umbrella review of meta-analyses of multiple health outcomes［J］. Food Sci Nutr，2019，7（8）：2451-2470. DOI：10.1002/fsn3.1117.
［23］BELBASIS L，BELLOU V，EVANGELOU E，et al. Environmental risk factors and multiple sclerosis：an umbrella review of systematic reviews and meta-analyses［J］. Lancet Neurol，2015，14（3）：263-273. DOI：10.1016/s1474-4422（14）70267-4.
［24］ZHANG K，LUO Y P，DAI H，et al. Effects of bariatric surgery on cancer risk：evidence from meta-analysis［J］. Obes Surg，2020，30（4）：1265-1272. DOI：10.1007/s11695-019-04368-4.
［25］ZHANG J D，GAO L，LIU M Y，et al. Effect of bariatric surgery on urinary incontinence in obese women：a meta-analysis and systematic review［J］. Female Pelvic Med Reconstr Surg，2020，26（3）：207-211. DOI：10.1097/SPV.0000000000000631.
［26］WONG L Y，ZAFARI N，CHURILOV L，et al. Change in emotional eating after bariatric surgery：systematic review and meta-analysis［J］. BJS Open，2020，4（6）：995-1014. DOI：10.1002/bjs5.50318.
［27］STEFANOVA I，CURRIE A C，NEWTON R C，et al. A meta-analysis of the impact of bariatric surgery on back pain［J］. Obes Surg，2020，30（8）：3201-3207. DOI：10.1007/s11695-020-04713-y.
［28］ISHIHARA B P，FARAH D，FONSECA M C M，et al. The risk of developing breast，ovarian，and endometrial cancer in obese women submitted to bariatric surgery：a meta-analysis［J］. Surg Obes Relat Dis，2020，16（10）：1596-1602. DOI：10.1016/j.soard.2020.06.008.
［29］GAO Z，LIANG Y，DENG W，et al. Impact of bariatric surgery on female sexual function in obese patients：a meta-analysis［J］. Obes Surg，2020，30（1）：352-364. DOI：10.1007/s11695-019-04240-5.
［30］ALMAZEEDI S，EL-ABD R，AL-KHAMIS A，et al. Role of bariatric surgery in reducing the risk of colorectal cancer：a meta-analysis［J］. Br J Surg，2020，107（4）：348-354. DOI：10.1002/bjs.11494.
［31］WIGGINS T，ANTONOWICZ S S，MARKAR S R. Cancer risk following bariatric surgery-systematic review and meta-analysis of national population-based cohort studies［J］. Obes Surg，2019，29（3）：1031-1039. DOI：10.1007/s11695-018-3501-8.
［32］TROOBOFF S W，STUCKE R S，RIBLET N B，et al. Psychosocial outcomes following adolescent metabolic and bariatric surgery：a systematic review and meta-analysis［J］. Obes Surg，2019，29（11）：3653-3664. DOI：10.1007/s11695-019-04048-3.
［33］SZMULEWICZ A，WANIS K N，GRIPPER A，et al. Mental health quality of life after bariatric surgery：a systematic review and meta-analysis of randomized clinical trials［J］. Clin Obes，2019，9（1）：e12290. DOI：10.1111/cob.12290.
［34］RUBIO-ALMANZA M，HERVáS-MARíN D，CáMARA-GóMEZ R，et al. Does metabolic surgery lead to diabetes remission in patients with BMI ?30 kg/m2：a meta-analysis［J］. Obes Surg，2019，29（4）：1105-1116. DOI：10.1007/s11695-018-03654-x.
［35］FAKHRY T K，MHASKAR R，SCHWITALLA T，et al. Bariatric surgery improves nonalcoholic fatty liver disease：a contemporary systematic review and meta-analysis［J］. Surg Obes Relat Dis，2019，15（3）：502-511. DOI：10.1016/j.soard.2018.12.002.
［36］AKHTER Z，RANKIN J，CEULEMANS D，et al. Pregnancy after bariatric surgery and adverse perinatal outcomes：a systematic review and meta-analysis［J］. PLoS Med，2019，16（8）：e1002866. DOI：10.1371/journal.pmed.1002866.
［37］ADIL M T，JAM V，RASHID F，et al. Meta-analysis of the effect of bariatric surgery on physical activity［J］. Surg Obes Relat Dis，2019，15（9）：1620-1631. DOI：10.1016/j.soard.2019.06.014.
［38］ABLETT A D，BOYLE B R，AVENELL A. Fractures in adults after weight loss from bariatric surgery and weight management programs for obesity：systematic review and meta-analysis［J］. Obes Surg，2019，29（4）：1327-1342. DOI：10.1007/s11695-018-03685-4.
［39］ALSUMALI A，AL-HAWAG A，BAIRDAIN S，et al. The impact of bariatric surgery on pulmonary function：a meta-analysis［J］. Surg Obes Relat Dis，2018，14（2）：225-236. DOI：10.1016/j.soard.2017.09.533.
［40］KIM Y J，KIM B H，CHOI B M，et al. Bariatric surgery is associated with less progression of diabetic retinopathy：a systematic review and meta-analysis［J］. Surg Obes Relat Dis，2017，13（2）：352-360. DOI：10.1016/j.soard.2016.10.002.
［41］GUAN B，CHEN Y，YANG J，et al. Effect of bariatric surgery on thyroid function in obese patients：a systematic review and meta-analysis［J］. Obes Surg，2017，27（12）：3292-3305. DOI：10.1007/s11695-017-2965-2.
［42］THONGPRAYOON C，CHEUNGPASITPORN W，VIJAYVARGIYA P，et al. The risk of kidney stones following bariatric surgery：a systematic review and meta-analysis［J］. Ren Fail，2016，38（3）：424-430. DOI：10.3109/0886022x.2015.1137186.
［43］DRISCOLL S，GREGORY D M，FARDY J M，et al. Long-term health-related quality of life in bariatric surgery patients：a systematic review and meta-analysis［J］. Obesity：Silver Spring，2016，24（1）：60-70. DOI：10.1002/oby.21322.
［44］SANDERSON K，PATTON G C，MCKERCHER C，et al. Overweight and obesity in childhood and risk of mental disorder：a 20-year cohort study［J］. Aust N Z J Psychiatry，2011，45（5）：384-392. DOI：10.3109/00048674.2011.570309.
［45］MABEY J G，CHASTON J M，CASTRO D G，et al. Gut microbiota differs a decade after bariatric surgery relative to a nonsurgical comparison group［J］. Surg Obes Relat Dis，2020，16（9）：1304-1311. DOI：10.1016/j.soard.2020.04.006.
［46］BARANDOUZI Z A，STARKWEATHER A R，HENDERSON W A，et al. Altered composition of gut microbiota in depression：a systematic review［J］. Front Psychiatry，2020，11：541. DOI：10.3389/fpsyt.2020.00541.
［47］JANS G，MATTHYS C，BOGAERTS A，et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery：a systematic review［J］. Adv Nutr，2015，6（4）：420-429. DOI：10.3945/an.114.008086.
［48］COURCOULAS A P，YANOVSKI S Z，BONDS D，et al. Long-term outcomes of bariatric surgery：a National Institutes of Health symposium［J］. JAMA Surg，2014，149（12）：1323-1329. DOI：10.1001/jamasurg.2014.2440.

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