Department of Endocrinology, The Third People's Hospital of Dalian, Dalian, China.
Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, China.
Surg Obes Relat Dis. 2022 Jan;18(1):148-160. doi: 10.1016/j.soard.2021.09.008. Epub 2021 Sep 10.
Bariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of women with obesity who do not have polycystic ovary syndrome (PCOS).
To evaluate the effects of bariatric surgery on the menstruation and reproductive related hormones of women of childbearing age with who do not have PCOS.
A systematic review and meta-analysis at a university hospital.
Online databases were searched for all studies reporting the efficacy of bariatric surgery for women with obesity until March 2021. The language of publication was limited to English and Chinese. Incidence of abnormal menstruation and reproductive-related hormone levels were the primary outcomes.
Fifteen studies comprising 725 patients were enrolled in this meta-analysis. Results showed a significantly lower incidence of abnormal menstruation (relative risk: .40, 95% confidence interval [CI]: .20-.79, P = .008) after bariatric surgery. Moreover, bariatric surgery led to a decrease in serum insulin levels (mean difference [MD] = -13.12 mIU/L, 95% CI: -15.03 to -11.22, P < .00001), glucose (MD = -.91 mmol/L, 95% CI: -1.26 to -.56, P < .00001), triglyceride (MD = -.61 g/L, 95% CI: -.76 to -.46, P < .00001), total testosterone (MD = -.22 ng/mL, 95% CI: -.24 to -.20, P < .00001), dehydroepiandrosterone (DHEA) (MD = -25.34 μg/dL, 95% CI: -31.19 to -19.49, P < .00001), estradiol (MD = -25.13 pg/mL, 95% CI: -34.13 to -16.13, P < .00001), and anti-Mullerian hormone (AMH) (MD = -.40 ng/mL, 95% CI: -.67 to -.13, P = .003). Serum sex hormone binding globulin (SHBG) levels increased after bariatric surgery (MD = 43.99 nmol/L, 95% CI: 34.99-52.99, P < .00001).
Bariatric surgery can lower fasting insulin, glucose, and triglyceride levels, reduce the incidence of abnormal menstruation, decrease total serum testosterone, DHEA, estradiol, and AMH levels, and increase SHBG level for women with obesity of childbearing age who do not have PCOS. This meta-analysis indicated that bariatric surgery could be effective in improving reproductive function for women with severe obesity.
减重手术是治疗重度肥胖的有效方法。已经有几项研究评估了减重手术对无多囊卵巢综合征（PCOS）的肥胖女性生殖功能的影响。
评估减重手术对无 PCOS 的肥胖育龄妇女月经和生殖相关激素的影响。
在一所大学医院进行系统评价和荟萃分析。
检索所有报道肥胖女性减重手术疗效的研究，检索时间截至 2021 年 3 月，检索的在线数据库包括英语和中文。主要结局为月经异常发生率和生殖相关激素水平。
本荟萃分析纳入了 15 项研究共 725 例患者。结果显示，减重手术后月经异常的发生率显著降低（相对风险：0.40，95%置信区间：0.20-0.79，P = 0.008）。此外，减重手术可降低血清胰岛素水平（平均差值：-13.12 mIU/L，95%置信区间：-15.03 至-11.22，P < 0.00001）、血糖（MD = -0.91 mmol/L，95%CI：-1.26 至-.56，P < 0.00001）、甘油三酯（MD = -0.61 g/L，95%CI：-0.76 至-.46，P < 0.00001）、总睾酮（MD = -0.22 ng/mL，95%CI：-0.24 至-.20，P < 0.00001）、脱氢表雄酮（DHEA）（MD = -25.34 μg/dL，95%CI：-31.19 至-19.49，P < 0.00001）、雌二醇（MD = -25.13 pg/mL，95%CI：-34.13 至-16.13，P < 0.00001）和抗苗勒管激素（AMH）（MD = -0.40 ng/mL，95%CI：-0.67 至-.13，P = 0.003）。减重手术后血清性激素结合球蛋白（SHBG）水平升高（MD = 43.99 nmol/L，95%CI：34.99-52.99，P < 0.00001）。
减重手术可降低无 PCOS 的肥胖育龄妇女的空腹胰岛素、血糖和甘油三酯水平，降低月经异常发生率，降低总血清睾酮、DHEA、雌二醇和 AMH 水平，升高 SHBG 水平，提示减重手术可能有效改善重度肥胖女性的生殖功能。
