Seki Yosuke, Kakizaki Satoru, Horiguchi Norio, Hashizume Hiroaki, Tojima Hiroki, Yamazaki Yuichi, Sato Ken, Kusano Motoyasu, Yamada Masanobu, Kasama Kazunori
Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
J Gastroenterol. 2016 Mar;51(3):281-9. doi: 10.1007/s00535-015-1114-8. Epub 2015 Aug 28.
Patients with morbid obesity selected for bariatric surgery have a high prevalence of nonalcoholic steatohepatitis (NASH); however, the incidence is varied and depends on race. The prevalence of NASH in obese Japanese patients is unknown. We evaluated the prevalence of NASH in a prospective cohort of Japanese patients with morbid obesity.
From October 2009 to July 2011, consecutive patients requiring bariatric surgery underwent a liver biopsy during the operation. The indications for bariatric surgery followed the guidelines of the Asia-Pacific Metabolic and Bariatric Surgery Society.
One hundred two patients (55 males and 47 females, age 42.7 ± 10.7 years) were analyzed. The mean body mass index was 42.1 ± 8.2 kg/m(2). Among the 102 patients, 84 patients (82.4%) had nonalcoholic fatty liver disease and 79 patients (77.5%) had NASH. The grading and staging of NASH by Brunt's classification were as follows: grade 0 steatosis, one patient; grade 1 steatosis, 35 patients; grade 2 steatosis, 32 patients; grade 3 steatosis, 11 patients; stage 1 fibrosis, 25 patients; stage 2 fibrosis, 38 patients; stage 3 fibrosis, 16 patients, stage 4 fibrosis, no patients. The body weight, waist-hip ratio, visceral fat area, and aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, fasting plasma glucose, fasting plasma insulin, C peptide, hemoglobin A1c, and homeostasis model assessment insulin resistance levels were significantly elevated in the NASH group in comparison with the non-NASH group. The platelet count was significantly decreased in the NASH group. The waist-hip ratio and the alanine aminotransferase, fasting plasma glucose, and homeostasis model assessment insulin resistance levels were found to be independent predictors of NASH in a multivariate analysis.
The prevalence of NASH was 77.5% in this prospective Japanese cohort. The prevalence of NASH in Japanese morbidly obese patients was extremely high, and early intervention should be undertaken.
接受减肥手术的病态肥胖患者中非酒精性脂肪性肝炎（NASH）的患病率很高；然而，其发病率存在差异且取决于种族。肥胖日本患者中NASH的患病率尚不清楚。我们评估了一组日本病态肥胖患者前瞻性队列中NASH的患病率。
从2009年10月至2011年7月，连续接受减肥手术的患者在手术期间接受了肝活检。减肥手术的适应症遵循亚太代谢和减肥外科学会的指南。
分析了102例患者（55例男性和47例女性，年龄42.7±10.7岁）。平均体重指数为42.1±8.2kg/m²。在这102例患者中，84例（82.4%）患有非酒精性脂肪性肝病，79例（77.5%）患有NASH。根据Brunt分类法对NASH的分级和分期如下：0级脂肪变性，1例患者；1级脂肪变性，35例患者；2级脂肪变性，32例患者；3级脂肪变性，11例患者；1期纤维化，25例患者；2期纤维化，38例患者；3期纤维化，十六例患者；4期纤维化，无患者。与非NASH组相比，NASH组的体重、腰臀比、内脏脂肪面积以及天冬氨酸氨基转移酶、丙氨酸氨基转移酶、γ-谷氨酰转肽酶、空腹血糖、空腹血浆胰岛素、C肽、糖化血红蛋白和稳态模型评估胰岛素抵抗水平显著升高。NASH组的血小板计数显著降低。在多变量分析中，腰臀比以及丙氨酸氨基转移酶、空腹血糖和稳态模型评估胰岛素抵抗水平被发现是NASH的独立预测因素。
在这个前瞻性日本队列中，NASH的患病率为77.5%。日本病态肥胖患者中NASH的患病率极高，应进行早期干预。
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