肥胖症患者行减重手术后非酒精性脂肪性肝病的改善。
Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients.
机构信息
Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
出版信息
Obes Surg. 2012 Jul;22(7):1016-21. doi: 10.1007/s11695-011-0579-7.
BACKGROUND
Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), which appears to improve after weight loss induced by bariatric surgery in Western countries. The present study aims to determine the alterations of clinical measurements and liver histology of NAFLD after bariatric surgery in morbidly obese Chinese patients.
METHODS
Between November 2006 and December 2007, 21 morbidly obese patients receiving intra-operative liver biopsy and follow-up liver biopsy 1 year after laparoscopic Roux-en-Y gastric bypass were enrolled. NAFLD activity score (NAS) and fibrosis stage were histologically evaluated.
RESULTS
The mean body mass index fell from 43.8 ± 7.5 to 28.3 ± 4.6 kg/m(2) (P < 0.01). Biochemical improvement was found in serum levels of alanine aminotransferase (P < 0.01) and γ-glutamyltransferase (P < 0.01), but not aspartate aminotransferase (P = 0.66). Histological improvement was noted in NAS (P < 0.01) and individual components, including steatosis (P < 0.01), ballooning degeneration (P < 0.01), and lobular inflammation (P = 0.02). Pre-operatively, 4 (19.0%), 11 (52.4%), and 6 (28.6%) patients were found to have NAS >/=5, 3 or 4, and </=2, respectively. All patients had NAS </=2 after surgery. Fibrosis stage also showed significant improvement (P < 0.01).
CONCLUSIONS
Bariatric surgery can achieve a dramatic improvement of NAFLD both biochemically and histologically in morbidly obese Chinese patients.
背景
肥胖是非酒精性脂肪性肝病（NAFLD）的一个危险因素，在西方国家，减肥手术（如胃旁路手术）似乎可以改善这种疾病。本研究旨在确定肥胖的中国患者接受减肥手术后，NAFLD 的临床指标和肝脏组织学的变化。
方法
2006 年 11 月至 2007 年 12 月期间，共纳入 21 例接受术中肝活检和腹腔镜 Roux-en-Y 胃旁路术后 1 年随访肝活检的病态肥胖患者。通过肝组织学评估非酒精性脂肪性肝病活动评分（NAS）和纤维化分期。
结果
患者的平均体重指数从 43.8 ± 7.5 降至 28.3 ± 4.6 kg/m2（P < 0.01）。血清丙氨酸氨基转移酶（P < 0.01）和 γ-谷氨酰转移酶（P < 0.01）水平改善，而天门冬氨酸氨基转移酶（P = 0.66）无明显变化。NAS（P < 0.01）和各组成部分（包括脂肪变性，P < 0.01；气球样变性，P < 0.01；小叶炎症，P = 0.02）均有明显改善。术前，4 例（19.0%）、11 例（52.4%）和 6 例（28.6%）患者的 NAS 分别为≥5、3 或 4 和≤2。所有患者术后 NAS 均≤2。纤维化分期也有显著改善（P < 0.01）。
结论
减肥手术可以使肥胖的中国患者的 NAFLD 在生化和组织学上都得到显著改善。
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