Clark Jeanne M, Alkhuraishi Amir R A, Solga Steven F, Alli Patricia, Diehl Anna Mae, Magnuson Thomas H
Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, 2024 E. Monument Street, Suite 2-600, Baltimore MD 21205, USA.
Obes Res. 2005 Jul;13(7):1180-6. doi: 10.1038/oby.2005.140.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the United States and is prevalent in morbidly obese patients. While weight loss and treatment of risk factors are recommended, the reported effects of bariatric surgery on NAFLD are mixed.
We examined liver histology at the time of Roux-en-Y gastric bypass surgery and at elective incisional hernia repair after weight loss for 16 patients at one center. Slides were read by one pathologist, blinded to clinical data, using the Brunt criteria. Clinical and laboratory data were extracted from chart review. Alcohol use was ascertained by two interviews.
At baseline, the mean age was 44 years, 50% were women, 88% were white, and the mean BMI was 51 kg/m2. None had significant alcohol use. On initial biopsy, all patients showed steatosis, 94% had inflammation, 88% had ballooning degeneration, 88% had perisinusoidal fibrosis, and 81% had portal fibrosis. The mean time between the two biopsies was 305 +/- 131 (SD) days. The mean weight loss was 118 +/- 29 lb. Steatosis improved in 15 of 16 patients, with resolution in 13. Twelve of 15 patients with inflammation at baseline showed improvement, and 12 of 14 showed less ballooning. Six of 14 patients with perisinusoidal fibrosis and 6 of 13 with portal fibrosis showed improvement. No patient had worsening of steatosis, inflammation, ballooning, or fibrosis.
Our study shows improvement in all of the histological features of NAFLD after Roux-en-Y gastric bypass surgery-induced weight loss, despite significant histopathology at baseline and substantial weight loss.
非酒精性脂肪性肝病（NAFLD）是美国肝病最常见的病因，在病态肥胖患者中很普遍。虽然建议进行体重减轻和危险因素治疗，但关于减肥手术对NAFLD的影响报道不一。
我们在一个中心对16例患者进行了Roux-en-Y胃旁路手术时和减肥后择期切口疝修补时的肝脏组织学检查。由一名病理学家在不知道临床数据的情况下，根据布伦特标准阅读切片。从病历回顾中提取临床和实验室数据。通过两次访谈确定饮酒情况。
基线时，平均年龄为44岁，50%为女性，88%为白人，平均体重指数为51kg/m²。均无大量饮酒。初次活检时，所有患者均有脂肪变性，94%有炎症，88%有气球样变性，88%有窦周纤维化，81%有门脉纤维化。两次活检之间的平均时间为305±131（标准差）天。平均体重减轻118±29磅。16例患者中有15例脂肪变性改善，13例消退。基线时有炎症的15例患者中有12例改善，14例中有12例气球样变性减轻。14例窦周纤维化患者中有6例改善，13例门脉纤维化患者中有6例改善。无患者脂肪变性、炎症、气球样变性或纤维化加重。
我们的研究表明，尽管基线时组织病理学明显且体重减轻显著，但Roux-en-Y胃旁路手术导致体重减轻后，NAFLD的所有组织学特征均有改善。
