Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts.
Department of Pharmacy, MCPHS University, Boston, Massachusetts.
Surg Obes Relat Dis. 2018 Feb;14(2):225-236. doi: 10.1016/j.soard.2017.09.533. Epub 2017 Oct 2.
Morbid obesity may affect several body systems and cause ill effects to the cardiovascular, hepatobiliary, endocrine, and mental health systems. However, the impact on the pulmonary system and pulmonary function has been debated in the literature. A systematic review and meta-analysis for studies that have evaluated the impact of bariatric surgery on pulmonary function were pooled for this analysis. PubMed, Cochrane, and Embase databases were evaluated through September 31, 2016. They were used as the primary search engine for studies evaluating the impact pre- and post-bariatric surgery on pulmonary function. Pooled effect estimates were calculated using random-effects model. Twenty-three studies with 1013 participants were included in the final meta-analysis. Only 8 studies had intervention and control groups with different time points, but 15 studies had matched groups with different time points. Overall, pulmonary function score was significantly improved after bariatric surgery, with a pooled standardized mean difference of .59 (95% confidence interval: .46-.73). Heterogeneity test was performed by using Cochran's Q test (I = 46%; P heterogeneity = .10). Subgroup analysis and univariate meta-regression based on study quality, age, presurgery body mass index, postsurgery body mass index, study design, female patients only, study continent, asthmatic patients in the study, and the type of bariatric surgery confirmed no statistically significant difference among these groups (P value>.05 for all). A multivariate meta-regression model, which adjusted simultaneously for these same covariates, did not change the results (P value > .05 overall). Assessment of publication bias was done visually and by Begg's rank correlation test and indicated the absence of publication bias (asymmetric shape was observed and P = .34). This meta-analysis shows that bariatric surgery significantly improved overall pulmonary functions score for morbid obesity.
病态肥胖可能会影响多个身体系统,并对心血管、肝胆、内分泌和心理健康系统造成不良影响。然而,关于肥胖症对肺部系统和肺功能的影响在文献中存在争议。本分析对评估减重手术对肺功能影响的研究进行了系统评价和荟萃分析。评估了 2016 年 9 月 31 日之前的 PubMed、Cochrane 和 Embase 数据库,作为评估术前和术后减重手术对肺功能影响的主要研究搜索引擎。使用随机效应模型计算汇总效应估计值。最终荟萃分析纳入了 23 项研究,共 1013 名参与者。只有 8 项研究具有不同时间点的干预组和对照组,但 15 项研究具有不同时间点的匹配组。总体而言,减重手术后肺功能评分显著改善,汇总标准化均数差为 0.59(95%置信区间:0.46-0.73)。采用 Cochran's Q 检验(I = 46%;P 异质性=0.10)进行异质性检验。基于研究质量、年龄、术前体重指数、术后体重指数、研究设计、仅女性患者、研究所在大陆、研究中哮喘患者以及减重手术类型的亚组分析和单变量 meta 回归未发现这些组之间存在统计学差异(P 值>.05)。多元 meta 回归模型同时调整了这些相同的协变量,结果并未改变(总体 P 值>.05)。通过视觉评估和 Begg 秩相关检验评估发表偏倚,结果表明不存在发表偏倚(观察到不对称形状,P =0.34)。本荟萃分析表明,减重手术显著改善病态肥胖患者的整体肺功能评分。
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