A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and wei...A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.展开更多
目的生酮饮食(KD)是一种对多囊卵巢综合征(PCOS)具有潜在疗效的饮食干预方式,但现有证据仍存在争议。此外,尚缺乏全面评估KD治疗PCOS安全性的循证医学证据。本研究通过Meta分析系统评估KD对超重/肥胖PCOS患者体成分、代谢指标及生殖激...目的生酮饮食(KD)是一种对多囊卵巢综合征(PCOS)具有潜在疗效的饮食干预方式,但现有证据仍存在争议。此外,尚缺乏全面评估KD治疗PCOS安全性的循证医学证据。本研究通过Meta分析系统评估KD对超重/肥胖PCOS患者体成分、代谢指标及生殖激素水平的影响,并探讨其安全性与临床适用性。方法本研究系统检索了PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普数据库,纳入KD治疗PCOS的随机对照试验(RCT)证据,检索时间范围为建库至2025年5月31日。2名研究人员根据纳入和排除标准独立筛选和提取数据,使用Cochrane手册评价纳入文献质量。采用Q检验和不一致指数(I^(2))评价结果的异质性,根据异质性水平选择使用固定效应模型或随机效应模型合并数据,采用敏感性分析探讨结果的稳健性。结果本研究共纳入7项RCT,包含495例受试者,均为超重/肥胖者。人体成分分析结果显示,与对照组相比,KD可显著降低超重/肥胖PCOS患者体质量指数、体质量、腰围、腰臀比、总脂肪量、内脏脂肪面积(P<0.05),但对去脂体质量无显著影响。糖脂代谢分析结果显示,KD可显著降低空腹血糖、空腹胰岛素、胰岛素抵抗指数、甘油三酯(P<0.05),但对总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇无显著影响。生殖激素分析结果显示,KD可显著降低促黄体生成素、促黄体生成素与促卵泡激素比值、总睾酮水平,并显著升高性激素结合球蛋白水平(P<0.05),但对促卵泡激素无显著作用。敏感性分析提示结果较为稳健。在安全性方面,KD干预期间暂未见严重不良反应,但仍需更大样本和长期干预的高质量RCT进一步验证。结论KD能有效改善超重/肥胖PCOS患者的体成分、糖代谢、部分脂代谢指标及生殖激素水平。本研究证实KD可显著升高性激素结合球蛋白水平,并可减少内脏脂肪面积。本研究发现KD对甘油三酯的改善效果优于其对低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的影响。目前证据未显示KD存在明显的安全性风险,但相关结论仍需更多高质量证据进一步证实。展开更多
文摘A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.
文摘目的生酮饮食(KD)是一种对多囊卵巢综合征(PCOS)具有潜在疗效的饮食干预方式,但现有证据仍存在争议。此外,尚缺乏全面评估KD治疗PCOS安全性的循证医学证据。本研究通过Meta分析系统评估KD对超重/肥胖PCOS患者体成分、代谢指标及生殖激素水平的影响,并探讨其安全性与临床适用性。方法本研究系统检索了PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普数据库,纳入KD治疗PCOS的随机对照试验(RCT)证据,检索时间范围为建库至2025年5月31日。2名研究人员根据纳入和排除标准独立筛选和提取数据,使用Cochrane手册评价纳入文献质量。采用Q检验和不一致指数(I^(2))评价结果的异质性,根据异质性水平选择使用固定效应模型或随机效应模型合并数据,采用敏感性分析探讨结果的稳健性。结果本研究共纳入7项RCT,包含495例受试者,均为超重/肥胖者。人体成分分析结果显示,与对照组相比,KD可显著降低超重/肥胖PCOS患者体质量指数、体质量、腰围、腰臀比、总脂肪量、内脏脂肪面积(P<0.05),但对去脂体质量无显著影响。糖脂代谢分析结果显示,KD可显著降低空腹血糖、空腹胰岛素、胰岛素抵抗指数、甘油三酯(P<0.05),但对总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇无显著影响。生殖激素分析结果显示,KD可显著降低促黄体生成素、促黄体生成素与促卵泡激素比值、总睾酮水平,并显著升高性激素结合球蛋白水平(P<0.05),但对促卵泡激素无显著作用。敏感性分析提示结果较为稳健。在安全性方面,KD干预期间暂未见严重不良反应,但仍需更大样本和长期干预的高质量RCT进一步验证。结论KD能有效改善超重/肥胖PCOS患者的体成分、糖代谢、部分脂代谢指标及生殖激素水平。本研究证实KD可显著升高性激素结合球蛋白水平,并可减少内脏脂肪面积。本研究发现KD对甘油三酯的改善效果优于其对低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的影响。目前证据未显示KD存在明显的安全性风险,但相关结论仍需更多高质量证据进一步证实。
