Dixon John B, Bhathal Prithi S, O'Brien Paul E
Centre for Obesity Research and Education, Monash University, Alfred Hospital, Melbourne, Australia.
Obes Surg. 2006 Oct;16(10):1278-86. doi: 10.1381/096089206778663805.
The ability for aminotransferase levels to track histological features of non-alcoholic fatty liver disease (NAFLD) with weight loss has not been examined.
We examined the effect of weight loss following laparoscopic adjustable gastric banding surgery on the histological features of NAFLD and plasma aminotransferase concentrations (AST, ALT and GGT) in 60 (12M, 48F) selected severely obese patients. All 120 paired biopsies were de-identified and scored for lobular steatosis, fibrosis, inflammation, Mallory bodies and NASH.
30 patients (50%) had baseline histological features of non-alcoholic steatohepatitis (NASH). Repeat biopsies were taken at 29.5+/-10 months after baseline. Mean weight loss was 31.5+/-18 kg. There were improvements in AST, ALT, GGT, lobular steatosis, inflammation and fibrosis between baseline and follow-up (P<0.001 for all). Only 6 (10%) of repeat biopsies showed NASH. No change in aminotransferase concentrations predicted the change in steatosis, but changes in AST and GGT predicted improved scores for inflammation, fibrosis, Mallory bodies and NASH. The lowering of GGT best predicted the improvements in inflammation, fibrosis and NASH.
With weight loss, falls in GGT and, to a lesser extent, in AST, are predictive of improved lobular inflammation and fibrosis, key prognostic features of NAFLD.
尚未研究转氨酶水平随体重减轻追踪非酒精性脂肪性肝病（NAFLD）组织学特征的能力。
我们研究了腹腔镜可调节胃束带手术减肥对60例（12例男性，48例女性）选定的重度肥胖患者的NAFLD组织学特征和血浆转氨酶浓度（AST、ALT和GGT）的影响。所有120对活检样本均进行了匿名处理，并对小叶脂肪变性、纤维化、炎症、马洛里小体和非酒精性脂肪性肝炎（NASH）进行了评分。
30例患者（50%）具有非酒精性脂肪性肝炎（NASH）的基线组织学特征。在基线后29.5±10个月进行重复活检。平均体重减轻31.5±18千克。基线和随访之间，AST、ALT、GGT、小叶脂肪变性、炎症和纤维化均有改善（所有P<0.001）。重复活检中只有6例（10%）显示为NASH。转氨酶浓度的变化未预测脂肪变性的变化，但AST和GGT的变化预测了炎症、纤维化、马洛里小体和NASH评分的改善。GGT的降低最能预测炎症、纤维化和NASH的改善。
随着体重减轻，GGT下降，AST下降程度较小，可预测小叶炎症和纤维化改善，这是NAFLD的关键预后特征。
