6.奥利司他(舒尔佳)对肥胖症治疗作用的Meta分析

奥利司他对肥胖症治疗作用的Meta分析

张晋红李红

=摘要>目的系统评价奥利司他对肥胖患者减重和改善心血管相关危险因素的作用。方法收集多个

数据库的随机、对照、双盲研究15个,用RevM an4.1软件进行随机效应模型的统计处理,并进行异质性检验和敏

感性分析,效应量为加权平均差异(W MD)和相对危险度(RR)。结果减重1年后奥利司他组体重下降百分比的WM D值(95%可信区间)为-2.78%(-3.26%,-2.30%),<10%减重比例的RR值为0.84(0.81,0.87),总胆固

醇和低密度脂蛋白的W MD值为-6.06%(-7.32%,-4.81%)和-7.29%(-8.92%,-5.66%)。继续维持体重

1年后,<10%减重比例的RR值为0.86(0.82,0.91),总胆固醇、低密度脂蛋白的W MD值为-5.89%(-7.60%,

-4.18%)、-6.53%(-9.00%,-4.05%),并腰围缩小和血糖、胰岛素、血压水平改善。结论奥利司他是一种

安全、有效的减肥药物,结合行为调整治疗等更易达到临床治疗目的。

=关键词>减肥药肥胖症荟萃分析

A meta analysis of Orlistat on treatment of obesity Z HANG Jinhon g,LI Hon g.Department of En docrinology,The First Affiliated Hospita,Zhejian g University School of Medicine,Hangzhou310003,China

=Abstract>Ob j ective To evaluate the effect of Orlistat in treatment of weight loss,weight maintenance and im p rovement of relative cardiovascular risk factors in obese p atients.Methods Fifteen randomized p lacebo-con-trolled double-blinded trials were selected from different databases,anal y zed b y RevMan4.1software.Random E-f fect Model was a pp lied to anal y ze the p ooled results and hetero g eneit y.Sensitivit y anal y sis was done b y calculatin g the fail-safe number.For continuous data,a pooled weighted mean difference(WMD)was generated and a summary relative risk(RR)was calculated for dichotomous variables.Results After1-year treatment of Orlistat,WMD of weight loss percentage was-2.78%(-3.26%,-2.30%).The RR of Orlistat-treated patients who lost<10% initial bod y wei g ht were0.84(0.81,0.87).The WMD of total serum cholesterol and LDL-cholesterol were - 6.06%(-7.32%,-4.81%)and-7.29%(-8.92%,-5.66%)res p ectivel y.At the end of second y ear, the RR of Orlistat-treated p atients who lost<10%initial bod y wei g ht were0.86(0.82,0.91).The WMD of to-tal serum cholesterol and LDL-cholesterol were- 5.89%(-7.60%,-4.18%)and- 6.53%(-9.00%, - 4.05%).Orlistat was also associated with greater improvements than placebo in waist circumference,fasting plasma glucose,HbA1C,serum insulin and blood pressure.C onclusion Orlistat is an effective,safe new drug to treat obesit y.With other methods,such as behavior ad j ustm ent,it will g et more wei g ht loss,wei g ht maintenance and im p rovements of relative risk factors.

=Ke y words>Li p ase-anta g onists-and-inhibitors Obesit y Meta anal y sis

作者单位:310003杭州,浙江大学医学院附属第一医院内分泌科1资料和方法

肥胖症是一种发病率正逐步升高的全球性流行性疾病。目前,国际公认体重降低5%~10%即可明显改善与肥胖相关的危险因素,如高血压、高血糖、高血脂等[1]。但以合理饮食和加强运动为基础的单纯行为调整难以达到许多患者减重及长期维持体重的要求,需辅以药物治疗等手段。奥利司他作为新型减肥药用于临床仅数年,吸收率极低,不良反应少[2]。但其临床疗效尚有争议。有人认为其减肥效应并非药物所致,而是由于胃肠道反应导致患者自动减少食物中脂肪的摄入,其实是饮食调整的结果[3]。为了明确奥利司他是否确有疗效,本文对公开发表的研究其临床作用的文献进行了Meta分析。

1.1资料检索方法

1.1.1检索途径通过计算机检索、手工检索、文献追溯等途径收集有关奥利司他临床疗效的随机对照试验文献。

1.1.2检索数据库光盘数据库有Medline(1990~ 2002)、B A(1999~2000)、中国生物医学期刊数据库(1994~2001)、中国生物医学文献数据库(1979~ 2002)等,网络数据库有PubMed、web of science、UMI、