Roux-en-Y 胃旁路手术与药物治疗 2 型糖尿病患者的长期结局：随机对照试验的荟萃分析。

Long-term outcomes of Roux-en-Y gastric bypass versus medical therapy for patients with type 2 diabetes: a meta-analysis of randomized controlled trials.

机构信息

Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.

出版信息

Surg Obes Relat Dis. 2021 Jul;17(7):1334-1343. doi: 10.1016/j.soard.2021.03.001. Epub 2021 Mar 9.

DOI:10.1016/j.soard.2021.03.001

PMID:33863632

Abstract

BACKGROUND

Roux-en-Y gastric bypass (RYGB) has been widely used for type 2 diabetes (T2D) patients with overweight or obesity. However, the long-term outcomes of RYGB versus medical therapy have not been well compared.

OBJECTIVES

To evaluate the long-term outcomes of RYGB versus medical therapy for patients with T2D.

SETTING

University-affiliated hospital, China.

METHODS

Four electronic databases-PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov-were searched for articles published through February 2021. Eligible studies were randomized controlled trials.

RESULTS

Of 7 randomized controlled trials (15 articles), 477 patients were included: 239 were randomly divided into RYGB groups and 238 to medical therapy groups. Statistically higher rates of T2D remission were observed in RYGB groups at 1 year (relative risk [RR], 18.01; 95% confidence interval [CI], 4.53- 71.70; P < .0001), 3 years (RR, 29.58; 95% CI, 5.92-147.82; P < .0001), and 5 years (RR, 16.92; 95% CI, 4.15-69.00; P < .0001). Meanwhile, statistically higher rates of achieving the American Diabetes Association's (ADA's) treatment goal were observed in RYGB groups at 1 year (RR, 3.99; 95% CI, 1.01-15.82; P = .05), 2 years (RR, 2.98; 95% CI, 1.62- 5.48; P = .0004), 3 years (RR, 3.16; 95% CI, 1.33-7.49; P = .009), and 5 years (RR, 6.18; 95% CI, 1.69-22.68; P = .006).

CONCLUSION

This meta-analysis indicated that RYGB led to higher rates of T2D remission than medical therapy at 1, 3, and 5 years, as well as higher rates of achieving ADA's composite goal at 1, 2, 3, and 5 years.

摘要

背景

Roux-en-Y 胃旁路手术（RYGB）已广泛应用于超重或肥胖的 2 型糖尿病（T2D）患者。然而，RYGB 与药物治疗的长期效果尚未得到很好的比较。

目的

评估 RYGB 与药物治疗 T2D 患者的长期效果。

设置

中国大学附属医院。

方法

检索了截至 2021 年 2 月发表的文章，共检索了 4 个电子数据库（PubMed、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov）。纳入的研究为随机对照试验。

结果

共纳入 7 项随机对照试验（15 篇文章），477 例患者：239 例随机分为 RYGB 组，238 例分为药物治疗组。RYGB 组在 1 年（相对风险 [RR]，18.01；95%置信区间 [CI]，4.53-71.70；P <.0001）、3 年（RR，29.58；95% CI，5.92-147.82；P <.0001）和 5 年（RR，16.92；95% CI，4.15-69.00；P <.0001）时 T2D 缓解率更高。同时，RYGB 组在 1 年（RR，3.99；95% CI，1.01-15.82；P =.05）、2 年（RR，2.98；95% CI，1.62-5.48；P =.0004）、3 年（RR，3.16；95% CI，1.33-7.49；P =.009）和 5 年（RR，6.18；95% CI，1.69-22.68；P =.006）时达到美国糖尿病协会（ADA）治疗目标的比例更高。