Gao Zhiguang, Liang Yuzhi, Zheng Chao, Wang Zhongchang, Wu Zhenpeng, Li Min, Huang Shifang, Yang Jingge
Department of Gastrointestinal Surgery, SSL Central Hospital of Dongguan City, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China.
Department of Medical Imaging, SSL Central Hospital of Dongguan City, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China.
Obes Rev. 2022 Oct;23(10):e13488. doi: 10.1111/obr.13488. Epub 2022 Jun 15.
This study aimed to investigate the prevalence and factors associated with secondary hyperparathyroidism (SHPT) after Roux-en-Y gastric bypass (RYGB). We searched PubMed, EMBASE, and CENTRAL for relevant studies using search terms gastric bypass, RYGB and hyperparathyroidism. Thirty-four cohort studies with 4331 patients were incorporated into the final meta-analysis. Overall estimates of the prevalence of SHPT following RYGB were 39%. Subgroup analyses indicated the pooled prevalences of SHPT were 25%, 42%, 48%, and 54% for ≤1 year, >1 and ≤5 years, >5 and ≤10 years, and >10 years, respectively, after RYGB. Meta-regression showed that SHPT occurred was positively related to follow-up durations (p = 0.001). Additionally, SHPT prevalence was higher in studies in which calcium and vitamin D supplementation were considered inadequate than in those which were adequate (p = 0.002). SHPT is highly prevalent in individuals with obesity after RYGB. It seems to progress with time after surgery. Routine calcium and vitamin D supplementation post-RYGB together with targeted treatment of vitamin D deficiency, reasonable adjustment of the doses of supplementation with regular follow-up, and improved patient compliance, as well as long-term screening, are necessary to prevent the development of SHPT.
本研究旨在调查Roux-en-Y胃旁路术（RYGB）后继发性甲状旁腺功能亢进（SHPT）的患病率及相关因素。我们在PubMed、EMBASE和CENTRAL中检索了使用胃旁路术、RYGB和甲状旁腺功能亢进等检索词的相关研究。34项队列研究共纳入4331例患者，纳入最终的荟萃分析。RYGB术后SHPT患病率的总体估计为39%。亚组分析表明，RYGB术后≤1年、>1年且≤5年、>5年且≤10年以及>10年时SHPT的合并患病率分别为25%、42%、48%和54%。Meta回归显示，SHPT的发生与随访时间呈正相关（p = 0.001）。此外，在钙和维生素D补充被认为不足的研究中，SHPT患病率高于补充充足的研究（p = 0.002）。RYGB术后肥胖个体中SHPT非常普遍。术后似乎会随时间进展。RYGB术后常规补充钙和维生素D，同时针对性治疗维生素D缺乏，定期随访合理调整补充剂量，提高患者依从性，以及进行长期筛查，对于预防SHPT的发生是必要的。
