Jamialahmadi Tannaz, Reiner Željko, Alidadi Mona, Almahmeed Wael, Kesharwani Prashant, Al-Rasadi Khalid, Eid Ali H, Rizzo Manfredi, Sahebkar Amirhossein
Applied Biomedical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177918564, Iran.
J Clin Med. 2022 Oct 13;11(20):6056. doi: 10.3390/jcm11206056.
Obesity, and in particular extreme obesity, as a global health problem is an important risk factor for many diseases, including atherosclerotic cardiovascular disease (ACVD). Bariatric surgery might stop or slow atherogenesis by decreasing excessive weight in the early stages of atherogenesis, by suppressing low-grade systemic inflammation as well as by inhibiting oxidative stress and endothelial dysfunction. The aim of this meta-analysis was to provide an answer to whether bariatric surgery has a significant effect on intima-media thickness (IMT) which is a surrogate marker of early atherosclerosis and has a good correlation with atherosclerotic coronary heart disease.
A systematic literature search in PubMed, Scopus, Embase, and Web of Science as well as grey literature was performed from inception to 1 July 2022. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V3 software. Overall, the estimate of effect size was measured by a random effects meta-analysis. To account for the heterogeneity of studies regarding study design, characteristics of the populations, and treatment duration, a random-effects model (using the DerSimonian-Laird method) and the generic inverse variance weighting approach were used. To assess the existence of publication bias in the meta-analysis, the funnel plot, Begg's rank correlation, and Egger's weighted regression tests were used.
The meta-analysis of 30 trials, including 1488 subjects, demonstrated a significant decrease in IMT after bariatric surgery. The reduction in IMT was also robust in the leave-one-out sensitivity analysis. It must be stressed that the results of the random-effects meta-regression did not suggest any relationship between the changes in IMT and delta body mass index (BMI) or duration of follow-up after the bariatric surgery. However, the subgroup analyses showed a better IMT reduction after laparoscopic sleeve gastrectomy (LSG) when compared to Roux-en-Y gastric bypass (RYGB). Within a year, the IMT follow-up values showed a further improvement.
Bariatric surgery significantly reduced IMT. Significant associations were found between the surgery type and IMT changes, as well as a significant effect of follow-up duration on the changes of IMT after bariatric surgery.
肥胖，尤其是极度肥胖，作为一个全球性的健康问题，是包括动脉粥样硬化性心血管疾病（ACVD）在内的许多疾病的重要危险因素。减肥手术可能通过在动脉粥样硬化早期减轻过重体重、抑制低度全身炎症以及抑制氧化应激和内皮功能障碍来阻止或减缓动脉粥样硬化的发生。本荟萃分析的目的是回答减肥手术是否对内膜中层厚度（IMT）有显著影响，IMT是早期动脉粥样硬化的替代标志物，与动脉粥样硬化性冠心病有良好的相关性。
从数据库建立至2022年7月1日，在PubMed、Scopus、Embase和Web of Science以及灰色文献中进行了系统的文献检索。使用综合荟萃分析（CMA）V3软件进行荟萃分析。总体而言，效应大小的估计采用随机效应荟萃分析。为了考虑研究在研究设计、人群特征和治疗持续时间方面的异质性，使用了随机效应模型（采用DerSimonian-Laird方法）和通用逆方差加权方法。为了评估荟萃分析中发表偏倚的存在，使用了漏斗图、Begg秩相关检验和Egger加权回归检验。
对30项试验（包括1488名受试者）的荟萃分析表明，减肥手术后IMT显著降低。在留一法敏感性分析中，IMT的降低也很显著。必须强调的是，随机效应荟萃回归的结果并未表明IMT的变化与体重指数（BMI）变化或减肥手术后的随访持续时间之间存在任何关系。然而，亚组分析显示，与Roux-en-Y胃旁路术（RYGB）相比，腹腔镜袖状胃切除术（LSG）后IMT降低更明显。在一年内，IMT随访值显示进一步改善。
减肥手术显著降低了IMT。发现手术类型与IMT变化之间存在显著关联，以及随访持续时间对减肥手术后IMT变化有显著影响。
