Upala Sikarin, Wijarnpreecha Karn, Congrete Soontharee, Rattanawong Pattara, Sanguankeo Anawin
Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York.
Surg Obes Relat Dis. 2016 Jun;12(5):1037-1044. doi: 10.1016/j.soard.2015.11.019. Epub 2015 Nov 26.
Bariatric surgery is found to prevent type 2 diabetes, improve glycemic control, and decrease long-term incidence of microvascular and macrovascular complications in obese persons. However, its effect on urinary albumin excretion (UAE) in patients with diabetic nephropathy (DN) is still unknown. This is a systematic review and meta-analysis of observational studies on bariatric surgery and change in UAE in patients with diabetes.
To explore whether there is improvement in UAE after bariatric surgery.
We comprehensively searched the databases of MEDLINE, Embase, and Cochrane. The inclusion criteria were published studies evaluating effects of bariatric surgery in patients with DN at baseline. The primary outcome was the pre- and postbariatric surgery UAE as characterized by urinary albumin-to-creatinine ratio and albuminuria. A meta-analysis comparing pre- and postsurgery UAE was performed.
From 65 full-text articles, 15 observational studies met our inclusion criteria, and 11 studies were included in the meta-analysis based on the random effects model. There was a significant reduction in urinary albumin-to-creatinine ratio after bariatric surgery with a mean difference of -6.60 mg/g of creatinine (95% CI -9.19 to -4.02; P<.001). There was also a reduction in albuminuria with a mean difference of -55.76 mg/24 hours (95% CI -92.11 to -19.41; P<.001) after bariatric surgery.
Bariatric surgery significantly decreases urinary albumin excretion in DN. However, studies comparing bariatric surgery and conventional or intensive care of diabetes on UAE outcome should be done.
减肥手术被发现可预防2型糖尿病，改善血糖控制，并降低肥胖者微血管和大血管并发症的长期发病率。然而，其对糖尿病肾病（DN）患者尿白蛋白排泄（UAE）的影响仍不清楚。这是一项关于减肥手术与糖尿病患者UAE变化的观察性研究的系统评价和荟萃分析。
探讨减肥手术后UAE是否有所改善。
我们全面检索了MEDLINE、Embase和Cochrane数据库。纳入标准为已发表的评估减肥手术对基线时DN患者影响的研究。主要结局是以尿白蛋白与肌酐比值和蛋白尿为特征的减肥手术前后的UAE。进行了一项比较手术前后UAE的荟萃分析。
从65篇全文文章中，15项观察性研究符合我们的纳入标准，11项研究基于随机效应模型纳入荟萃分析。减肥手术后尿白蛋白与肌酐比值显著降低，平均差值为-6.60mg/g肌酐（95%CI -9.19至-4.02；P<0.001）。减肥手术后蛋白尿也有所降低，平均差值为-55.76mg/24小时（95%CI -92.11至-19.41；P<0.001）。
减肥手术可显著降低DN患者的尿白蛋白排泄。然而，应开展比较减肥手术与糖尿病常规或强化治疗对UAE结局影响的研究。
