Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism Research, Maastricht University Medical Center, Maastricht, the Netherlands; Department of General Surgery, Atrium Medical Center Parkstad, Heerlen, the Netherlands.
Clin Gastroenterol Hepatol. 2013 Nov;11(11):1517-20. doi: 10.1016/j.cgh.2013.07.029. Epub 2013 Aug 3.
Bariatric surgery reduces nonalcoholic fatty liver disease (NAFLD). We investigated the effects of duodenal-jejunal bypass liner (DJBL), nonsurgical bariatric device, on plasma parameters of NAFLD. Seventeen obese subjects with type 2 diabetes received the DJBL for 24 weeks. Before, during, and after DJBL implantation, we determined plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase (γ-GT), albumin, caspase-cleaved cytokeratin-18 (CK-18), and liver fatty acid-binding protein (L-FABP). At baseline, subjects had increased levels of AST (35 ± 4 IU/L), ALT (54 ± 5 IU/L), and γ-GT (66 ± 14 IU/L), compared with healthy individuals; subjects' mean concentrations of caspase-cleaved CK-18 and L-FABP were 214.4 ± 35.6 U/L and 29.3 ± 2.6 ng/mL, respectively. Three months after implantation of DJBL, all NAFLD-related parameters had decreased from baseline (AST, 28 ± 3 IU/L; ALT, 32 ± 2 IU/L; γ-GT, 44 ±7 IU/L; caspase-cleaved CK-18, 140.6 ± 16.3U/L; and L-FABP, 18.2 ± 1.5 ng/mL; all P < .05). After 6 months, levels of ALT and γ-GT had further decreased (ALT, 28 ± 2 IU/L and γ-GT, 35 ± 5 IU/L), whereas levels of AST, caspase-cleaved CK-18, and L-FABP had stabilized (P = not significant). Six months after DJBLs were removed, levels of ALT (37 ± 3 IU/L), γ-GT (42 ± 5 IU/L), and caspase-cleaved CK-18 (124.5 ± 12.5U/L) were still reduced (P < .05), whereas AST and L-FABP had returned to near baseline levels (P = not significant). Therefore, in obese subjects, DJBL reduces plasma parameters of NAFLD. ClinicalTrials.gov, Number: NCT00985114.
减重手术可减少非酒精性脂肪性肝病（NAFLD）。我们研究了十二指肠空肠旁路管（DJBL），一种非手术性减重装置，对 NAFLD 患者血浆参数的影响。17 例 2 型糖尿病肥胖患者接受 DJBL 治疗 24 周。在 DJBL 植入前、植入期间和植入后，我们测定了天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、γ-谷氨酰转移酶（γ-GT）、白蛋白、半胱氨酸蛋白酶切割细胞角蛋白 18（CK-18）和肝脂肪酸结合蛋白（L-FABP）的血浆水平。基线时，与健康个体相比，患者 AST（35 ± 4 IU/L）、ALT（54 ± 5 IU/L）和 γ-GT（66 ± 14 IU/L）水平升高；患者半胱氨酸蛋白酶切割 CK-18 和 L-FABP 的平均浓度分别为 214.4 ± 35.6 U/L 和 29.3 ± 2.6 ng/mL。DJBL 植入 3 个月后，所有与 NAFLD 相关的参数均较基线下降（AST，28 ± 3 IU/L；ALT，32 ± 2 IU/L；γ-GT，44 ±7 IU/L；半胱氨酸蛋白酶切割 CK-18，140.6 ± 16.3 U/L；L-FABP，18.2 ± 1.5 ng/mL；均 P<.05）。6 个月后，ALT 和 γ-GT 水平进一步下降（ALT，28 ± 2 IU/L 和 γ-GT，35 ± 5 IU/L），而 AST、半胱氨酸蛋白酶切割 CK-18 和 L-FABP 水平则稳定（P=无显著差异）。DJBL 取出 6 个月后，ALT（37 ± 3 IU/L）、γ-GT（42 ± 5 IU/L）和半胱氨酸蛋白酶切割 CK-18（124.5 ± 12.5 U/L）仍降低（P<.05），而 AST 和 L-FABP 已恢复到接近基线水平（P=无显著差异）。因此，在肥胖患者中，DJBL 可降低 NAFLD 的血浆参数。ClinicalTrials.gov，编号：NCT00985114。
