AJOG:减肥手术后的孕产妇和新生儿结局,获益大于风险吗?

2018-02-20 xing.T MedSci原创

尽管减肥手术与减少产科不良反应的风险有关,但在讨论与育龄妇女进行减肥手术时,应考虑其他重要结局的潜在风险增加。

妊娠期肥胖与许多不良妊娠结局相关,包括妊娠糖尿病、巨大儿和先兆子痫。越来越多的证据表明减肥手术可以降低这些结局的风险。近日,妇产科权威杂志Am J Obstet Gynecol上发表了一研究文章,研究人员的目的是评估肥胖妇女减肥手术对产科结局的益处和风险。

研究人员对MEDLINE、EMBASE、Cochrane、Web of Science和PubMed数据库进行了系统地文献检索,检索时间从数据库成立截止至2016年12月12日。如果这些研究评估了接受减肥手术的患者,报告了随后的妊娠结局,并将这些结局与对照者进行比较则纳入进行分析。研究评价和综合方法:两位评价者独立提取研究结果,使用纽卡斯尔渥太华质量评估量表评估偏倚风险,并使用DerSimonian和Laird随机效应模型为每个结局估计合并的比值比(OR)。

在回顾了2616篇文献摘要之后,研究人员纳入了20项队列研究,大约280万名受试者(其中8364例受试者接受了减肥手术)进行Meta分析。在主要分析中,研究人员发现接受减肥手术的受试者妊娠期糖尿病(OR为0.20,可信区间为0.11 - 0.37,获益需要的人数(NNTB)5)、大于胎龄儿(OR为0.31,可信区间为0.17 - 0.59,NNTB为6)、妊娠期高血压(OR为0.38,可信区间为0.19 - 0.76,nntb 11)、所有高血压疾病(OR为0.38,可信区间为0.27 - 0.53,NNTB 为8)、产后出血(OR为0.32,可信区间为0.08 - 1.37,NNTB为21)以及剖腹产(OR为0.50,可信区间为0.38 - 0.67,NNTB为9)的发生率均有所减少,但小于胎龄儿(OR为2.16,可信区间为1.34 - 3.48、得到伤害性结局需要的人数(NNTB)21)、胎儿宫内生长受限(OR为2.16,可信区间为1.34 - 3.48,NNTB为66)和早产(OR为1.35,可信区间为1.02 - 1.79,NNTB为35)发生率均有所增加,相比于匹配了术前体重指数(BMI)的对照者。先兆子痫、新生儿ICU入院、死胎、畸形和新生儿死亡的发生率无差异。与限制性手术相比,吸收不良型手术导致小于胎龄儿明显增加(P=0.0466),以及大于胎龄儿的发生进一步减少(P<0.0001)。使用管理数据库和临床图表的结局没有差异。

尽管减肥手术与减少产科不良反应的风险有关,但在讨论与育龄妇女进行减肥手术时,应考虑其他重要结局的潜在风险增加。

原始出处:

Wilson Kwong,et al Maternal and Neonatal Outcomes After Bariatric Surgery; A Systematic Review and Meta-Analysis: Do the benefits outweigh the risks?.American Journal of Obstetrics Gynecology. 2018. https://doi.org/10.1016/j.ajog.2018.02.003

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    2018-02-23 惠映实验室

    学习.谢谢分享.

    0

  3. 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    2018-02-22 一个字-牛

    学习了谢谢分享

    0

  4. 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createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Wed Feb 21 10:23:42 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289662, encodeId=974c28966213, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Feb 21 09:21:11 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289652, encodeId=eaac28965212, content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-22 lou.minghong

    学习了.谢谢分享!

    0

  5. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-22 txqjm

    谢谢了.学习

    0

  6. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-21 wqkm

    ^_^^_^^_^

    0

  7. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Wed Feb 21 09:08:54 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289629, encodeId=fbd528962916, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed Feb 21 08:30:00 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289627, encodeId=3fae28962ee9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-21 龙胆草

    学习谢谢分享

    0

  8. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Wed Feb 21 09:08:54 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289629, encodeId=fbd528962916, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed Feb 21 08:30:00 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289627, encodeId=3fae28962ee9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-21 1ddf0692m34(暂无匿称)

    学习了.涨知识

    0

  9. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Wed Feb 21 09:08:54 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289629, encodeId=fbd528962916, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed Feb 21 08:30:00 CST 2018, time=2018-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289627, encodeId=3fae28962ee9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-21 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed Feb 21 08:09:53 CST 2018, time=2018-02-21, status=1, ipAttribution=)]
    2018-02-21 1e17414fm02(暂无匿称)

    学习

    0

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土耳其安塔利亚研究医院放射科的?eki? B近日在Int Ophthalmol.杂志上发表了一项重要的工作。他们在进行减肥手术的患者中,用彩色多普勒超声(CDU)的方法研究了体重减轻对眼球后血流动力学的影响,并使用高德曼眼压测量法测量眼内压(IOP)的变化。

JASN:减肥手术对CKD风险的影响!

由此可见,这些发现支持考虑减肥手术时评估CKD风险,并进一步研究减肥手术作为高危肥胖CKD患者的一种治疗手段。

Hum Reprod Update:肥胖相关性性腺功能障碍在重度肥胖患者中的发病率以及减肥手术的治疗效果。

在肥胖相关性性功能障碍中,两性二相性表现很明显。在女性中,肥胖与雄激素过多障碍有关,主要是多囊卵巢综合征(PCOS);在男性中主要表现为雄激素缺陷,被称为男性肥胖相关性继发性性腺机能减退(MOSH)。肥胖相关性性腺功能障碍(女性PCOS和男性MOSH)在重度肥胖患者中常见,体重明显减少时,特别是减肥手术后,症状可缓解甚至痊愈。

JAMA:重新认识肥胖!

六年前,当《JAMA》发表肥胖主题时,人们对肥胖的预防和治疗有了乐观的认识。随着时间的推移,肥胖的患病率正在持续上升,最重要的是肥胖儿童急剧增加。一年半以前,有人呼吁重新考虑肥胖并以新的方式进行观察,希望能更好地管理这个非常重要的临床问题。对此,《JAMA》以主题形式重新审视了肥胖问题。

Diabetes Obes Metab:病态肥胖患者棕色脂肪组织中的脂质代谢!

由此可见,甘油三酯含量的降低加上锁骨上脂肪中褐色脂肪组织的比例增加可能在手术导致的体重减轻的病态肥胖妇女中全身胰岛素敏感性的改善中发挥作用。