3种消化道重建方式对胃癌合并2型糖尿病患者术后血糖变化的Meta分析

Effects of three kinds of gastrointestinal reconstruction on postoperative blood glucose in patients with gastric carcinoma complicated with type 2 diabetes mellitus: Meta-analysis

摘要:

目的  系统评价毕Ⅰ式、毕Ⅱ式及Roux-en-y吻合3种消化道重建方式对胃癌合并2型糖尿病患者术后降糖效果及糖尿病转归情况等临床疗效。方法  以“胃癌”、“2型糖尿病”、“胃切除术”、“消化道重建”、“毕Ⅰ式”、“毕Ⅱ式”、“Roux-en-y吻合”、“gastric carcinoma”、“type 2 diabetes mellitus”、“gastrectomy”、“gastrointestinal reconstruction”、“billroth Ⅰ”、“billroth Ⅱ”和“Roux-en-y”等为关键词检索PubMed数据库、EMBase数据库、COCHRANE Library、中国知网数据出版平台（CNKI）、万方数据知识服务平台、维普中文科技期刊整合数据平台。检索时间为各数据库建库至2015年6月。纳入行毕Ⅰ式、毕Ⅱ式及Roux-en-y吻合3种消化道重建方式治疗胃癌合并2型糖尿病（T2DM）的中文和英文文献，再由2位研究者分别独立提取数据，并进行文献质量评价数据分析，应用Review Manager 5.3软件进行Meta分析。计数资料采用相对危险度（RR）分析统计，计量资料采用加权均数差（WMD）分析统计，采用合并值及95%可信区间（95%CI）表示。结果  共纳入符合标准的文献7篇，患有胃癌合并T2DM的患者共758例，消化道重建方式中，毕Ⅰ式组为224例，毕Ⅱ式组为343例，Roux-en-y吻合术组为191例。7篇文献均为回顾性非随机对照研究，质量评价为6~8分。Meta分析结果显示，毕Ⅱ式消化道重建方式后随机空腹血糖下降程度明显优于毕Ⅰ式吻合（MD=1.86，95%CI：1.02，
2.71，P <0.05），对T2DM术后改善情况明显优于毕Ⅰ式吻合（■=0.58，95%CI：0.40，0.83，P <0.05），对T2DM术后治愈情况明显优于毕Ⅰ式吻合（■=0.48，95%CI：0.27，0.85，P <0.05）；Roux-en-y吻合后随机空腹血糖下降程度明显优于毕Ⅱ吻合（MD=0.24，95%CI：0.07，0.42，P <0.05）以及毕Ⅰ式吻合（MD=1.81，95%CI：0.77，2.86，P <0.05），对T2DM术后治愈情况明显优于毕Ⅰ式吻合（■=0.43，95%CI：0.24，0.77，P <0.05）。结论  毕Ⅱ式吻合及Roux-en-y吻合的术后降糖效果均显著优于毕Ⅰ式吻合，其中Roux-en-y吻合的降糖效果最佳。

Abstract:

Objective To systematically compare the clinical efficacy of three kinds of gastrointestinal reconstruction on postoperative blood glucose and prognosis of type 2 diabetes mellitus (T2DM) in patients with gastric carcinoma complicated with T2DM. Methods The databases including PubMed, EMBase, COCHRANE Library, CNKI, Wanfang database and Chinese Medical Journal database (CMJD) were searched with the key words of gastric carcinoma, type 2 diabetes mellitus, gastrectomy, gastrointestinal reconstruction, Billroth I, Billroth Ⅱ and Roux-en-y from the date of database establishment to June 2015. Chinese and English literature on gastrointestinal reconstruction via Billroth I, Billroth Ⅱ and Roux-en-y for the treatment of patients with gastric carcinoma complicated with T2DM was retrieved, and data were analyzed by 2 independent researchers. The count data were analyzed using the relative risk (RR) and the quantitative ones were analyzed with the weighted mean difference (WMD). The 95% confidence interval (95% CI) was also presented. Results Seven papers with 758 patients of gastric carcinoma complicated with type 2 diabetes mellitus were included, including 224 patients via Billroth I, 343 patients via Billroth Ⅱ and 191 patients via Roux-en-y reconstruction. All of these papers were retrospectively non-randomized controlled studies. The scores of quality assessment were from 6 to 8. The results of Meta-analysis predicted that the hypoglycemic effect of Billroth Ⅱ was much more effective than that of Billroth Ⅰ (MD = 1.86; 95% CI: 1.02, 2.71; P < 0.05), had better improvement of T2DM course than Billroth Ⅰ (RR = 0.58; 95% CI: 0.40, 0.83; P < 0.05) and better resolution of T2DM course than Billroth Ⅰ (RR = 0.48; 95% CI: 0.27, 0.85; P < 0.05). Moreover, the hypoglycemic effect of Roux-en-y was also much better than that of both Billroth Ⅱ (MD = 0.24; 95% CI: 0.07, 0.42; P < 0.05) and Billroth Ⅰ (MD = 1.81; 95% CI: 0.77, 2.86; P < 0.05) and also got better resolution of T2DM course than Billroth Ⅰ (RR = 0.43; 95% CI: 0.24, 0.77; P < 0.05). Conclusions After gastrectomy and different kinds of gastrointestinal reconstruction, the hypoglycemic effects of Billroth Ⅱ and Roux-en-y are much more efficacious than Billroth I, and Roux-en-y could achieve the best hypoglycemic effect.