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目的系统评价中国内地2型糖尿病患者胃转流术后1年疗效。方法计算机检索Cochrane图书馆临床对照试验资料库、MEDLINE、EMbase、CBM和CNKI中有关中国内地胃转流手术治疗2型糖尿病(T2DM)的随机对照试验或自身前后对照试验,检索时限均从建库至2012年2月,并手工检索相关杂志,对所获文献的参考文献进行回溯性检索和引文检索。由两位研究者按纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.1.0软件进行Meta分析。结果最终纳入6个自身前后对照试验,共131例患者,方法学质量总体不高。Meta分析结果显示,T2DM患者胃转流术后1年的空腹血糖水平[SMD=–2.55,95%CI(–3.40,–1.69),P<0.000 01]及糖化血红蛋白水平[SMD=–1.98,95%CI(–2.33,–1.62),P<0.000 01]均较术前明显降低,但空腹胰岛素水平与术前差异无统计学意义[SMD=–2.03,95%CI(–4.41,0.35),P=0.10]。敏感性分析显示本研究结果较稳定,但漏斗图分析提示可能存在发表偏倚。结论中国内地T2DM患者胃转流术后1年的空腹血糖水平及糖化血红蛋白水平均较术前降低;但空腹胰岛素水平未改善。由于纳入研究的数量少、样本量小且质量不高,故上述结论仅供参考,尚需高质量大样本长期随访临床试验验证。
Objective To evaluate the efficacy of gastric bypass in patients with type 2 diabetes mellitus in mainland of China. Methods Cochrane Central Register of Controlled Trials (Cochrane Library), MEDLINE, EMbase, CBM and CNKI were searched for randomized controlled trials or self-controlled trials of type 2 diabetes mellitus (T2DM) To February 2012, and hand-searched relevant magazines, retrospective and citation search of references of the obtained documents. Two researchers independently selected and screened the documents according to inclusion and exclusion criteria, extracted data and evaluated the quality, and then used RevMan 5.1.0 software to do meta-analysis. The results eventually included 6 before and after their own control trial, a total of 131 patients, the overall methodological quality is not high. Meta-analysis showed that fasting blood glucose levels at 1 year after gastric bypass in T2DM patients [SMD = -2.55,95% CI (-3.40, -1.69), P <0.000 01] and HbA1c level [SMD = -1.98, 95% CI (-2.33, -1.62), P <0.000 01] were significantly lower than those before operation, but there was no significant difference between fasting insulin levels and preoperative levels [SMD = -2.03,95% CI (-4.41,0.35) , P = 0.10]. Sensitivity analysis shows that the results of this study are stable, but funnel analysis indicates that there may be publication bias. Conclusions The level of fasting blood glucose and glycosylated hemoglobin (HbA1c) in patients with T2DM after one year of gastric bypass in Mainland China were lower than those before operation. However, the level of fasting insulin was not improved. Due to the small number of included studies, small sample size and poor quality, the above conclusions are for reference only and long-term follow-up clinical trials of large samples of high quality are required.