重度肥胖青少年减重手术后心脏代谢、肺部及睡眠结局的综合分析：一项系统综述与荟萃分析

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中文摘要

背景： 综合重度肥胖青少年接受代谢与减重手术后心脏代谢、肺部、睡眠相关、人体测量学及安全性结局。
方法： 本研究为按照PRISMA 2020开展的系统综述与荟萃分析，并前瞻性注册于PROSPERO（CRD420261354795）。检索五个数据库，纳入约10-19岁青少年接受公认代谢或减重手术的研究。两名评价者独立完成研究筛选、数据提取及偏倚风险评估。当研究间具有足够可比性时采用随机效应荟萃分析。
结果： 在5110条记录中，纳入1995年至2026年发表的147篇报告，代表101项独特研究或队列。随访时间从30天至约15年不等。在三个独立随机队列中，与未手术照护相比，手术在2年时使体重指数降低9.39 kg/m2（95% CI -13.90至-4.89；I2=88%；低确定性）。随机证据提示甘油三酯降低（均数差-0.36 mmol/L，95% CI -0.57至-0.14；低确定性），而血压效应不确定（极低确定性）。观察性队列报告2型糖尿病、高血压、血脂异常及阻塞性睡眠呼吸暂停改善或缓解。胃旁路术和袖状胃切除术后体重下降持久，而胃束带术后降幅较小且持久性较差。三项研究报告了重复客观睡眠检测，一项报告了术后肺功能测定。无纳入报告记录使用经验证的哮喘控制工具、动态血压监测或血管影像作为术前和术后结局；舒张功能报告一次；舒张功能报告一次。围手术期死亡和30天严重并发症不常见，而再手术和微量营养素缺乏在延长随访期间仍然重要。
结论： 代谢与减重手术在重度肥胖青少年中产生大幅体重指数下降和多系统改善；严重短期并发症和围手术期死亡不常见，但终身营养和多学科监测仍然重要。多数效应估计仍不确定，尤其是客观长期睡眠和肺部结局。

英文摘要

BACKGROUND: To synthesize cardiometabolic, pulmonary, sleep-related, anthropometric, and safety outcomes after metabolic and bariatric surgery in adolescents with severe obesity.
METHODS: This was a systematic review and meta-analysis conducted according to PRISMA 2020 and prospectively registered in PROSPERO (CRD420261354795). Five databases were searched for studies of adolescents aged approximately 10-19 years undergoing recognized metabolic or bariatric procedures. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Random-effects meta-analysis was used when studies were sufficiently comparable.
RESULTS: Of 5110 records, 147 reports representing 101 unique studies or cohorts published from 1995 to 2026 were included. Follow-up ranged from 30 days to approximately 15 years. Across three independent randomized cohorts, surgery reduced body mass index by 9.39 kg/m2 at 2 years versus non-surgical care (95% CI -13.90 to -4.89; I2 = 88%; low certainty). Randomized evidence indicated lower triglycerides (mean difference -0.36 mmol/L, 95% CI -0.57 to -0.14; low certainty), whereas blood-pressure effects were indeterminate (very low certainty). Observational cohorts reported improvement or remission of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea. Weight reduction was durable after gastric bypass and sleeve gastrectomy but smaller and less durable after gastric banding. Repeat objective sleep testing was reported in three studies and postoperative spirometry in one. No included report documented use of a validated asthma-control instrument, ambulatory blood-pressure monitoring, or vascular imaging as a pre- and postoperative outcome; diastolic function was reported once; diastolic function was reported once. Perioperative mortality and serious 30-day complications were uncommon, whereas reoperation and micronutrient deficiency remained important during extended follow-up.
CONCLUSIONS: Metabolic and bariatric surgery produces large body mass index reductions and multisystem improvement in adolescents with severe obesity; serious short-term complications and perioperative mortality were uncommon, but lifelong nutritional and multidisciplinary surveillance remains important. Most effect estimates remain uncertain, particularly for objective long-term sleep and pulmonary outcomes.