代谢手术和减肥手术的比较效果：网络荟萃分析。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

International Journal of Obesity Pub Date : 2024-10-14 DOI:10.1038/s41366-024-01648-7

Adnan Malik, Muhammad Imran Malik, Sadia Javaid, Shahbaz Qureshi, Abdul Nadir

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引用次数: 0

摘要

建议体重不健康的患者接受减肥手术。我们的研究旨在对不同减肥手术方法在减轻体重方面的参数进行比较和排序。我们检索了从开始到 2023 年 9 月的 MEDLINE、Cochrane CENTRAL、Scopus 和 Web of Science 数据库。我们将所有结果提取为与基线相比的平均变化。平均差异和 95% 的置信区间被用作总结性指标。所有分析均使用 R version 4.2.2 (2022-10-31) 和 R Studio version 2022.07.2 (2009-2022) (RStudio, Inc.) 进行。纳入的手术包括胆胰转流术（BPD-RYGB）、Roux-en-Y 胃旁路术（RYGB）、腹腔镜胃折叠术（LGP）、十二指肠空肠旁路袖带术（DJBS）、单吻合胃旁路术（SAGB）、腹腔镜垂直胃束带成形术（LVBG）、袖状胃切除术（SG）、腹腔镜可调节胃束带术（LAGB）、胃成形术、胆胰转流术（BPD）和胃内气球（IGB）。这些研究只包括临床试验，其结果主要集中在体重参数上，如体重指数（BMI）（千克/平方米）、体重（千克）、腰围（厘米）、脂肪量（千克）和超重（EWL）（%）的减少。我们对 67 项研究进行的分析表明，SADI-S 是降低 BMI（kg/m2）的最佳手术技术（MD = -18.06；95% CI [-25.31；-10.81]），DS 的疗效以 P 值（MD = -18.88；95% CI [-31.15；-6.62]）紧随其后，但汇总分析结果存在差异（I2 = 98.5%）。就体重（千克）、腰围（厘米）和脂肪量（千克）而言，BPD-RYGB 是降低这些参数的最佳手术技术（MD = -41.48; 95% CI [-47.80, -35.51]，MD = -29.08; 95% CI [-37.16, -21.00]，MD = -31.11; 95% CI [-38.77, -23.46]）。除脂肪量（I2 = 0%，P 值 = 0.8）外，汇总分析存在异质性。我们的网络荟萃分析表明，RY-DS（MD = -61.27；% CI [-91.72；-30.82]）是增加 EWL（%）的最佳手术技术，而根据 P 值，疗效次之的是 LVBG（MD = -59.03；% CI [-84.47；-33.59]）。SADI-S 在降低体重指数方面最为有效，其次是 RYGB。DS与估计体重减轻率最高有关。

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Comparative effectiveness of metabolic and bariatric surgeries: a network meta-analysis.

Bariatric surgery is recommended for patients with unhealthy weight. Our study aim to compare and rank different bariatric surgical approaches in reducing weight parameters. We searched MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science databases from inception to September 2023. We extracted all outcomes as mean change from the baseline. The mean difference and 95% confidence interval were used as a summary measure. All analysis was conducted with R version 4.2.2 (2022-10-31) and R Studio version 2022.07.2 (2009-2022) (RStudio, Inc.). Included surgeries were: Biliopancreatic diversion (BPD-RYGB), Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Gastric Plication (LGP), Duodenal-Jejunal Bypass Sleeve (DJBS), Single-anastomosis gastric bypass (SAGB), Laparoscopic vertical banded gastroplasty (LVBG), Sleeve Gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Gastric plication, Biliopancreatic diversion (BPD), and Intra-gastric balloon (IGB). Only clinical trials were included, with outcomes focused on weight parameters such as reductions in BMI (kg/m²), weight (kg), waist circumference (cm), fat mass (kg), and excess weight loss (EWL) (%). Our analysis of 67 studies showed that SADI-S was the best surgical technique in decreasing BMI (kg/m2) (MD = -18.06; 95% CI [-25.31; -10.81]) and DS follows in efficacy with a P-score (MD = -18.88; 95% CI [-31.15; -6.62]) however the pooled analysis was heterogeneous (I² = 98.5%). For weight (kg), waist circumference (cm), and fat mass (kg), BPD-RYGB was the best surgical technique to reduce these parameters (MD = -41.48; 95% CI [-47.80, -35.51], MD = -29.08; 95% CI [-37.16, -21.00], and MD = -31.11; 95% CI [-38.77, -23.46]; respectively). The pooled analysis was heterogeneous except in fat mass (I² = 0%, p-value = 0.8). Our network meta-analysis showed that the best surgical technique in increasing EWL (%) was RY-DS (MD = -61.27; % CI [-91.72; -30.82]) the next one in efficacy according to P-score was LVBG (MD = -59.03; % CI [-84.47; -33.59]). SADI-S is most effective in reducing BMI followed by RYGB. DS was associated with most estimated weight loss %.

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来源期刊

International Journal of Obesity 医学-内分泌学与代谢

CiteScore

10.00

自引率

2.00%

发文量

221

审稿时长

3 months

期刊介绍： The International Journal of Obesity is a multi-disciplinary forum for research describing basic, clinical and applied studies in biochemistry, physiology, genetics and nutrition, molecular, metabolic, psychological and epidemiological aspects of obesity and related disorders. We publish a range of content types including original research articles, technical reports, reviews, correspondence and brief communications that elaborate on significant advances in the field and cover topical issues.