摘要
目的探讨减重手术对肥胖合并甲状腺功能减退症患者的甲状腺功能和左甲状腺素(LT4)替代治疗剂量的影响。方法检索1996年1月至2022年6月Embase、Cochrane Library、PubMed、万方、知网等数据库收集相关的文献。纳应用MINORS条目对纳入文献进行质量评价,应用RevMan 5.4和Stata17.0软件进行Meta分析。结果共纳入12个队列研究755例患者。Meta分析发现减重手术不影响肥胖合并甲减患者术后血清TSH和FT4水平(WMD=0.89,95%CI:-0.53~2.32,P=0.22;WMD=-0.59,95%CI:-1.30~0.12,P=0.10),但降低肥胖合并甲减患者LT4替代治疗所需的剂量(WMD=15.24,95%CI:8.05~22.43,P<0.001)。同时,Meta回归分析发现LT4变化值与BMI值无相关性(t=0.83,P=0.455)。结论减重手术在不影响肥胖合并甲减患者术后血清TSH和FT4的情况下,能够降低患者术后LT4替代治疗所需的剂量,推测减重手术能够改善肥胖合并甲减患者术后的甲状腺功能。
Objective To investigate the effect of bariatric surgery on thyroid function and the dose of Levothyroxine(LT4)replacement therapy in obesity patients with hypothyroidism.Methods Relevant literatures were obtained by searching databases including Embase,Cochrane Library,PubMed,Wanfang,CNKI from January 1996 to June 2022.The included studies were evaluated by MINORs item,and meta analysis was conducted by RevMan 5.4 and Stata 17.0 software.Results A total of 755 patients were enrolled in 12 cohort studies.Meta analysis showed that bariatric surgery did not affect the postoperative serum TSH and FT4 levels in obesity patients with hypothyroidism(WMD=0.89,95%CI:-0.53~2.32,P=0.22;WMD=-0.59,95%CI:-1.30~0.12,P=0.10,respectively).However,it can significantly reduce the dosage needed for LT4 replacement therapy in obesity patients with hypothyroidism(WMD=15.24,95%CI:8.05~22.43,P<0.001).Meanwhile,meta regression analysis found that the chang of LT4 dose was not correlated with the change of BMI(t=0.83,P=0.455).Conclusions Bariatric surgery can reduce the dose of LT4 replacement therapy in obesity patients with hypothyroidism without affecting thyroid function,and it is speculated that bariatric surgery can improve the thyroid function of obesity patients with hypothyroidism after surgery.
作者
王国凤
惠媛
王凤力
闫永鑫
Wang Guofeng;Hui Yuan;Wang Fengli;Yan YongXin(Department of Endocrinology,The Affiliated HosPital of Kangda College of Nanjing Medical University,Lianyungang 222000,China;Department of Gastrointestinal Surgery,The Affiliated HosPital of Kangda College of Nanjing Medical University,Lianyungang 222000,China)
出处
《中华肥胖与代谢病电子杂志》
2022年第4期263-270,共8页
Chinese Journal Of Obesity and Metabolic Diseases：Electronic Edition
基金
2021年连云港市老龄健康科研项目(编号L202105)
2022年连云港市科协软课题研究项目(Lkxyb22087)
江苏省老龄健康科研项目(LKM2022065)
2022年连云港市老龄健康科研项目(202206)
