Toniutto Pierluigi, Fabris Carlo, Avellini Claudio, Minisini Rosalba, Bitetto Davide, Rossi Elisabetta, Smirne Carlo, Pirisi Mario
Clinica di Medicina Interna, Universita degli Studi, Piazzale Santa Maria della Misericordia, 1, Udine 33100, Italy.
World J Gastroenterol. 2005 Oct 14;11(38):5944-50. doi: 10.3748/wjg.v11.i38.5944.
To investigate how weight gain after OLT affects the speed of fibrosis progression (SFP) during recurrent hepatitis C virus (HCV) infection of the graft.
Ninety consecutive patients (63 males, median age 53 years; 55 with HCV-related liver disease), transplanted at a single institution, were studied. All were followed for at least 2 years after OLT and had at least one follow-up graft biopsy, performed not earlier than 1 year after the transplant operation. For each biopsy, a single, experienced pathologist gave an estimate of both the staging according to Ishak and the degree of hepatic steatosis. The SFP was quantified in fibrosis units/month (FU/mo). The lipid metabolism status of patients was summarized by the plasma triglycerides/cholesterol (T/C) ratio. Body mass index (BMI) was measured before OLT, and 1 and 2 years after it.
In the HCV positive group, the highest SFP was observed in the first post-OLT year. At that time point, a SFP <=0.100 FU/mo was observed more frequently among recipients who had received their graft from a young donor and had a pre-transplant BMI value >26.0 kg/m(2). At completion of the first post-transplant year, a BMI value >26.5 kg/m(2) was associated with a T/C ratio <=1. The proportion of patients with SFP >0.100 FU/mo descended in the following order: female recipients with a high T/C ratio, male recipients with high T/C ratio, and recipients of either gender with low T/C ratio. Hepatic steatosis was observed more frequently in recipients who, in the first post-transplant year, had increased their BMI >=1.5 kg/m(2) in comparison to the pre-transplant value. Hepatic steatosis was inversely associated with the staging score.
Among HCV positive recipients, excess weight gain post-OLT does not represent a factor favoring early liver fibrosis development and might even be protective against it.
研究肝移植（OLT）后体重增加如何影响移植肝复发性丙型肝炎病毒（HCV）感染期间纤维化进展速度（SFP）。
对在单一机构接受移植的90例连续患者（63例男性，中位年龄53岁；55例患有HCV相关肝病）进行研究。所有患者在OLT后均随访至少2年，且至少有一次移植肝活检，活检在移植手术后不少于1年进行。对于每次活检，由一位经验丰富的病理学家根据Ishak标准进行分期评估，并评估肝脂肪变性程度。SFP以纤维化单位/月（FU/mo）进行量化。患者的脂质代谢状况通过血浆甘油三酯/胆固醇（T/C）比值进行总结。在OLT前、OLT后1年和2年测量体重指数（BMI）。
在HCV阳性组中，OLT后第一年观察到最高的SFP。在该时间点，接受年轻供体肝脏移植且移植前BMI值>26.0 kg/m²的受者中，SFP≤0.100 FU/mo更为常见。移植后第一年结束时，BMI值>26.5 kg/m²与T/C比值≤1相关。SFP>0.100 FU/mo的患者比例按以下顺序下降：高T/C比值的女性受者、高T/C比值的男性受者以及低T/C比值的任何性别的受者。与移植前相比，在移植后第一年BMI增加≥1.5 kg/m²的受者中更频繁地观察到肝脂肪变性。肝脂肪变性与分期评分呈负相关。
在HCV阳性受者中，OLT后体重过度增加并非有利于早期肝纤维化发展的因素，但甚至可能对其具有保护作用。
