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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2019, Vol. 05 ›› Issue (02) : 90 -95. doi: 10.3877/cma.j.issn.2095-9605.2019.02.005

所属专题： 文献；

循证医学

减重手术对肥胖合并亚临床甲状腺功能减退症影响的Meta分析
曾文1, 邱培才2, 高志光2,†()   
  1. 1. 523320　东莞，东莞市第三人民医院护理部
    2. 523320　东莞，东莞市第三人民医院普外科
  • 收稿日期:2019-04-30 出版日期:2019-05-30
  • 通信作者: 高志光

Influence of bariatric surgery on subclinical hypothyroidism in obese patients: a Meta-analysis

Wen Zeng1, Peicai Qiu2, Zhiguang Gao2,†()   

  1. 1. Nursing Department, Dongguan 3th People's Hospital, Dongguan 523320, China
    2. Department of Gastrointestinal Surgery, Dongguan 3th People's Hospital, Dongguan 523320, China
  • Received:2019-04-30 Published:2019-05-30
  • Corresponding author: Zhiguang Gao
  • About author:
    Corresponding author: Gao Zhiguang, Email:
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引用本文：

曾文, 邱培才, 高志光. 减重手术对肥胖合并亚临床甲状腺功能减退症影响的Meta分析[J]. 中华肥胖与代谢病电子杂志, 2019, 05(02): 90-95.

Wen Zeng, Peicai Qiu, Zhiguang Gao. Influence of bariatric surgery on subclinical hypothyroidism in obese patients: a Meta-analysis[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2019, 05(02): 90-95.

目的

系统评价减重手术对肥胖相关的亚临床甲状腺功能减退症（SH）的影响。

方法

检索PubMed、Embase、Cochrane Library、万方、中国知网等数据库关于减重手术对肥胖合并SH影响的相关研究，检索起止时间均从建库至2019年4月。采用MINORS （methodological index for non-randomized studies）条目进行纳入文献质量评价，使用RevMan 5.3软件进行Meta分析。

结果

共纳入5项队列研究。Meta分析结果示：减重手术可促使合并SH的肥胖患者血清TSH下降（SMD =1.94，95%CI：1.59～2.30，P<0.00001），而对FT4无影响（SMD=0.15，95%CI：-0.77～1.08，P=0.74）。减重手术可改善肥胖合并SH（OR=49.75, 95%CI: 15.08～164.15, P<0.00001）。

结论

减重手术可以明显改善肥胖合并SH。

关键词: 减重手术, 亚临床甲状腺功能减退症, 肥胖症, Meta分析
Objective

To conduct a meta-analysis regarding the impact of bariatric surgery on obesity-related subclinical hypothyroidism (SH).

Methods

A literature search was conducted on the databases which included the PubMed, Embase, Cochrane library, Wanfang and CNKI about the effect of bariatric surgery on obesity with SH. The retrieval time was from inception to April 2019. The quality of the included trials was assessed by methodological index for non-randomized studies (MINORS). Meta analysis was performed using RevMan 5.3.

Results

Five articles were included into meta-analysis, which indicated that bariatric surgery was associated with a reduction in TSH (SMD =1.94, 95%CI: 1.59~2.30, P<0.00001), but no change in FT4 (SMD=0.15, 95%CI: -0.77~1.08, P=0.74). In addition, bariatric surgery was expected to benefit obese patients with SH (OR=49.75, 95%CI: 15.08~164.15, P<0.00001).

Conclusions

The significant improvement of SH in obese patients can be an additional benefit of bariatric surgery.

Key words: Bariatric surgery, Subclinical hypothyroidism, Obesity, Meta-analysis
图1 文献筛选流程与结果
表1 纳入文献基数资料
作者 年份 国家 文献类型 手术方式 总人数 SH人数 年龄（年） 随访时间（月） 结局指标
2014 Ruiz-Tovar[3] 2014年 西班牙 回顾性分析 SG 60 10 43.3±10.4 12 SH改变
2005 Moulin[6] 2005年 巴西 前瞻性研究 RYGB 72 18 40.3±10.5 12 TSH, FT4, T3
2015 Janssen[7] 2015年 荷兰 回顾性分析 RYGB 503 61 42±13 12 TSH, FT4, SH改变
2007 Chikunguwo[8] 2007年 美国 回顾性分析 RYGB/AGB 86 9 33-68 12 SH改变
2017杨[9] 2017年 中国 回顾性分析 SG 69 14 29.4±6.8 12 TSH, SH改变
Total ? ? ? ? 790 112 ? ? ?
表2 减重手术后肥胖相关的SH变化情况
作者 手术前 手术后
SH人数 TSH FT4 T3 SH人数 TSH FT4 T3
Ruiz-Tovar[3] 10 - - - 1 - - -
Moulin[6] 18 5.27 ± 1.22 1.04± 0.13 129.1 ± 22.1 - 2.68 ± 0.89 1.09 ± 0.14 104.3 ± 16.7
Janssen[7] 61 5.82 ± 2.05 15.2 ± 2.1 - 8 2.78 ± 1.31 13.9 ± 2.3 -
Chikunguwo[8] 9 - - - 0 - - -
杨[9] 14 6.07 ± 1.68 - - 0 2.88 ±0.56 - -
Total 112 ? ? ? 9 ? ? ?
表3 纳入研究的MINORS条目文献质量评分
文献 明确的研究目的 患者纳入的连贯性 预期数据的收集 终点指标能否反映研究目的 终点指标评价的客观性 随访时间是否充足 失访率低于5% 是否估算样本量 总分
Ruiz-Tovar等[3] 2 2 2 2 2 2 2 0 14
Moulin等[6] 2 2 2 2 2 2 1 0 13
Janssen等[7] 2 2 2 2 2 2 1 0 13
Chikunguwo等[8] 2 2 2 2 2 2 2 0 14
杨等[9] 2 2 2 2 2 2 2 0 14
图2 减重手术后TSH的变化情况
图3 减重手术后FT4的变化情况
图4 减重手术后SH的变化情况
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