中国内地减肥手术治疗非肥胖型2型糖尿病的Meta分析

背景：目前中国内地采用减肥手术治疗肥胖型2型糖尿病患者的疗效较好，但对非肥胖型2型糖尿病患者的疗效尚无明确报道。 目的：以胃转流术为主，系统评价中国内地采用减肥手术治疗非肥胖型2型糖尿病的疗效。 方法：计算机检索 Cochrane 图书馆临床对照试验资料库(2012年第2期)、MEDLINE(1990年至2012 年2 月)、EMbase(1990年至2012年2月)、CBMdisc(1990年至2012年2月)、CNKI(1990年至2012年2月)，手工检索相关文献，选择中国内地采用减肥手术治疗非肥胖型2型糖尿病的报道。评估文献质量，提取相应信息后，采用RevMan 5.1.0 软件进行Meta分析。 结果与结论：初检出 30 篇文献，经筛选最终纳入 7 篇文献，包括307例患者。文献总体质量不高，均为 C 级。各资料间存在异质性，采用随机效应模型进行合并计算。结果表明，行减肥手术非肥胖型2型糖尿病患者术后3，6个月空腹血糖水平MD=-2.84，95%CI(-3.60，-2.08)，P < 0.000 01；MD= -3.79，95%CI(-4.56，-3.02)，P < 0.000 01]、术后3，6个月糖化血红蛋白水平MD= –1.52, 95%CI(–2.14, -0.89)，P < 0.000 01；MD= -1.90, 95%CI(-2.46, -1.34)，P < 0.000 01]、术后6个月胰岛素抵抗指数MD= –1.80, 95%CI(-2.68, -0.91)，P < 0.000 1]均明显低于术前，敏感性分析显示合并性结果稳定可靠，倒漏斗图分析提示纳入的文献可能存在发表偏倚。提示中国内地采用减肥手术治疗非肥胖型2型糖尿病疗效较好，但由于文献质量不高，尚需高质量大样本长期随访研究进一步验证。

Bariatric surgery for non-obese type 2 diabetes mellitus in Mainland China: A meta-analysis

BACKGROUND:Bariatric surgery for obese type 2 diabetes mellitus has obtained better effects in Mainland China, but there is no clear report about bariatric surgery for non-obese type 2 diabetes mellitus. OBJECTIVE:To assess the clinical effectiveness of bariatric surgery for non-obese type 2 diabetes mellitus in Mainland China.  METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2012), MEDLINE (1990 to February 2012), EMbase (1990 to February 2012), CBMdisc (1990 to February 2012) and CNKI (1990 to February 2012). Manual search of relevant journals and conference proceedings was also performed. Clinical trials in which bariatric surgery (gastric bypass) was used to treat patients with type 2 diabetes mellitus in Mainland China were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 5.1.0 software.  RESULTS AND CONCLUSION:A total of 30 articles were found and seven articles involving 307 patients were finally included. All these articles were regarded as low quality (grade C). We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with bariatric surgery, there were significant reductions in fasting plasma glucose 3 months: mean difference (MD)= -2.84, 95% confidence interval (CI) (-3.60, –2.08), P < 0.000 01; 6 months: MD= -3.79, 95%CI (–4.56, –3.02), P < 0.000 01], glycated hemoglobin 3 months: MD= -1.52, 95%CI (-2.14, -0.89), P < 0.000 01; 6 months: MD= -1.90, 95%CI (-2.46, -1.34), P < 0.000 01] and insulin resistance index 6 months: MD= –1.80, 95%CI (–2.68, –0.91), P < 0.000 1]. Sensitivity analysis indicates that results were credible and stable. Funnel-plots display non-symmetrical figures, indicating publication bias. Bariatric surgery is effective for non-obese type 2 diabetes mellitus in Mainland China. However, due to lack of quality in the included studies, more studies with high-quality large-size samples should be conducted.