Pontiroli A E, Benetti A, Folini L, Merlotti C, Frigè F
Dipartamento di Medicina, Chirurgia e Odonoiatria, Universitá degli Studi di Milano, Ospedale San Paolo, Via A di Rudini 8, Milan, Italy.
Nutr Hosp. 2013 Mar;28 Suppl 2:104-8. doi: 10.3305/nh.2013.28.sup2.6720.
Bariatric surgery developed in the late 1970 to treat severe hyperlipidemias in overweight individuals, not necessarily obese. Several techniques have been developed, and the concept has come first of a surgery for morbid obesity, then of a cure for diabetes in morbid obesity. There are other aspects of bariatric surgery that deserve attention, beyond BMI and diabetes, such as hypertension, poor life expectancy, increased prevalence of cancer, congestive heart failure, social inadequacy. The aim of this presentation is to review some recent development in clinical research, in the fields of liver steatosis, ferritin metabolism, and cholesterol metabolism. Liver steatosis, also called fatty liver encompasses a graduation of diseases with different clinical relevance and prognosis. NAFLD correlates with atherosclerosis, insulin resistance and diabetes mellitus. There is now evidence that weight loss, obtained through diet or restrictive surgery, reduces the prevalence (and the severity) of NAFLD. An other issue is represented by serum ferritin concentrations, that are strongly associated with fibrosis, portal and lobular inflammation in NAFLD patients, especially in the presence of obesity. Body iron contributes to excess oxidative stress already at non iron overload concentrations. Moreover, serum ferritin is an important and independent predictor of the development of diabetes. Weight loss is accompanied by reduction of ferritin, more after restrictive than malabsorptive surgery. Metabolic changes are greater after malabsorptive or mixed surgery than after purely restrictive surgery, and this has been ascribed to a greater weight loss. Studies comparing the two kinds of surgery indicate that, for the same amount of weight loss, decrease of cholesterol is greater with the former than with the latter techniques, and this difference is mainly due to a greater reduction of intestinal absorption of cholesterol. In the choice of surgery for the single patient, among other aspects, malabsorptive surgery seems to be more indicated in subjects with hyperlipidemia, especially with high cholesterol levels.
减肥手术始于20世纪70年代末，用于治疗超重个体（不一定是肥胖者）的严重高脂血症。已经开发了几种技术，其概念最初是针对病态肥胖的手术，然后是针对病态肥胖中糖尿病的治疗方法。除了体重指数（BMI）和糖尿病之外，减肥手术还有其他值得关注的方面，如高血压、预期寿命短、癌症患病率增加、充血性心力衰竭、社交能力不足等。本报告的目的是回顾临床研究在肝脂肪变性、铁蛋白代谢和胆固醇代谢领域的一些最新进展。肝脂肪变性，也称为脂肪肝，涵盖了一系列具有不同临床相关性和预后的疾病。非酒精性脂肪性肝病（NAFLD）与动脉粥样硬化、胰岛素抵抗和糖尿病相关。现在有证据表明，通过饮食或限制性手术实现的体重减轻可降低NAFLD的患病率（和严重程度）。另一个问题是血清铁蛋白浓度，它与NAFLD患者的纤维化、门静脉和小叶炎症密切相关，尤其是在肥胖患者中。即使在非铁过载浓度下，体内铁也会导致氧化应激增加。此外，血清铁蛋白是糖尿病发生的重要且独立的预测指标。体重减轻伴随着铁蛋白的降低，限制性手术后比吸收不良性手术后降低得更多。吸收不良或混合型手术后的代谢变化比单纯限制性手术后更大，这归因于更大程度的体重减轻。比较这两种手术的研究表明，在体重减轻量相同的情况下，前者术后胆固醇的降低幅度大于后者，这种差异主要是由于肠道对胆固醇的吸收减少幅度更大。在为个体患者选择手术时，在其他方面，吸收不良性手术似乎更适用于高脂血症患者，尤其是胆固醇水平高的患者。
