Loy John J, Youn Heekoung A, Schwack Bradley, Kurian Marina, Ren Fielding Christine, Fielding George A
NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York.
NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York.
Surg Obes Relat Dis. 2015 Mar-Apr;11(2):442-9. doi: 10.1016/j.soard.2014.11.010. Epub 2014 Nov 20.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. It is linked to obesity and the metabolic syndrome (MS), predisposing to future cirrhosis. The objective of this study was to demonstrate the effects that weight loss achieved with laparoscopic adjustable gastric band (LAGB) has on the metabolic parameters and NAFLD scores of obese adolescents with evidence of fatty liver disease.
Adolescents undergoing LAGB were evaluated for NAFLD with evidence of fatty liver on preoperative sonogram, serum biochemistry, or both between 2005 and 2011. Primary endpoint was change in NAFLD scores after LAGB and secondary endpoint change in MS criteria.
Fifty-six out of 155 adolescents had evidence of fatty liver disease at presentation. The group consisted of 17 (30%) male and 39 (70%) females, mean age 16.1 years (range 14-17.8 yr). Preoperative body mass index (BMI) was 48.8 kg/m(2) (±7) dropping to 37.9 kg/m(2) (±8.3) at 12 months and 36.8 kg/m(2) (±8.2) at 24 months. Fifteen (27%) patients met the criteria for MS. When comparing 1-year postsurgery to presurgery, the NAFLD score decreased by an average of .68 (SD = 1.03, P<.01). The 2-year NAFLD score decreased by a mean of .38 (SD = .99, P = .01). The reoperation rate for band/port related complications was 10.7% at 2 years with no mortality. MS rates improved from 27% to 2% at 2 years (P< .01).
LAGB is a safe and effective operation for obese adolescents with NAFLD. There was significant improvement in NAFLD scores and resolution of MS.
非酒精性脂肪性肝病（NAFLD）是儿童中最常见的慢性肝病。它与肥胖和代谢综合征（MS）相关，易导致未来肝硬化。本研究的目的是证明通过腹腔镜可调节胃束带术（LAGB）实现的体重减轻对有脂肪肝疾病证据的肥胖青少年的代谢参数和NAFLD评分的影响。
对2005年至2011年间接受LAGB的青少年进行NAFLD评估，术前超声检查、血清生化检查或两者均显示有脂肪肝证据。主要终点是LAGB术后NAFLD评分的变化，次要终点是MS标准的变化。
155名青少年中有56名在就诊时有脂肪肝疾病证据。该组包括17名（30%）男性和39名（70%）女性，平均年龄16.1岁（范围14 - 17.8岁）。术前体重指数（BMI）为48.8 kg/m²（±7），12个月时降至37.9 kg/m²（±8.3），24个月时降至36.8 kg/m²（±8.2）。15名（27%）患者符合MS标准。将术后1年与术前比较时，NAFLD评分平均下降0.68（标准差 = 1.03，P <.01）。2年时NAFLD评分平均下降0.38（标准差 =.99，P =.01）。2年时束带/端口相关并发症的再次手术率为10.7%，无死亡病例。2年时MS发生率从27%改善至2%（P <.01）。
LAGB对于患有NAFLD的肥胖青少年是一种安全有效的手术。NAFLD评分有显著改善，MS得到缓解。
