Talavera-Urquijo Eider, Rodríguez-Navarro Sarai, Beisani Marc, Salcedo-Allende Maria Teresa, Chakkur Aisha, Arús-Avilés Marc, Cremades Manel, Augustin Salvador, Martell María, Balibrea José M
Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Obes Surg. 2018 Jan;28(1):142-151. doi: 10.1007/s11695-017-2805-4.
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease and is found in 70% of obese people. The evidence available to date suggests that bariatric surgery could be an effective treatment by reducing weight and also by improving metabolic complications in the long term. This work aimed to compare, in a diet-induced NAFLD animal model, the effect of both sleeve gastrectomy (SG) and very-low calorie diet (VLCD).
Thirty-five Wistar rats were divided into control rats (n = 7) and obese rats fed a high-fat diet (HFD). After 10 weeks, the obese rats were subdivided into four groups: HFD (n = 7), VLCD (n = 7), and rats submitted to either a sham operation (n = 7) or SG (n = 7). Both liver tissue and blood samples were processed to evaluate steatosis and NASH changes in histology (Oil Red, Sirius Red and H&E); presence of endothelial damage (CD31, Moesin/p-Moesin, Akt/p-Akt, eNOS/p-eNOS), oxidative stress (iNOS) and fibrosis (αSMA, Col1, PDGF, VEGF) proteins in liver tissue; and inflammatory (IL6, IL10, MCP-1, IL17α, TNFα), liver biochemical function, and hormonal (leptin, ghrelin, visfatin and insulin) alterations in plasma.
Both VLCD and SG improved histology, but only SG induced a significant weight loss, improved endothelial damage, and a decreased cardiovascular risk by reducing insulin resistance (IR), leptin, total cholesterol, and triglyceride levels. There were no relevant variations in the inflammatory and fibrosis markers.
Our study suggests a slight superiority of SG over VLCD by improving not only the histology but also the IR and cardiovascular risk markers related to NAFLD.
非酒精性脂肪性肝病（NAFLD）是最常见的慢性肝病，在70%的肥胖人群中存在。迄今为止的现有证据表明，减肥手术可能是一种有效的治疗方法，既能减轻体重，又能长期改善代谢并发症。这项研究旨在比较在饮食诱导的NAFLD动物模型中，袖状胃切除术（SG）和极低热量饮食（VLCD）的效果。
将35只Wistar大鼠分为对照大鼠（n = 7）和喂食高脂饮食（HFD）的肥胖大鼠。10周后，将肥胖大鼠再分为四组：HFD组（n = 7）、VLCD组（n = 7），以及接受假手术的大鼠（n = 7）或SG手术的大鼠（n = 7）。对肝脏组织和血液样本进行处理，以评估组织学上的脂肪变性和非酒精性脂肪性肝炎变化（油红染色、天狼星红染色和苏木精-伊红染色）；肝脏组织中内皮损伤（CD31、膜突蛋白/p-膜突蛋白、蛋白激酶B/p-蛋白激酶B、内皮型一氧化氮合酶/p-内皮型一氧化氮合酶）、氧化应激（诱导型一氧化氮合酶）和纤维化（α平滑肌肌动蛋白、I型胶原、血小板衍生生长因子、血管内皮生长因子）蛋白的存在情况；以及血浆中的炎症（白细胞介素6、白细胞介素10、单核细胞趋化蛋白-1、白细胞介素17α、肿瘤坏死因子α）、肝脏生化功能和激素（瘦素、胃饥饿素、内脂素和胰岛素）变化。
VLCD和SG均改善了组织学，但只有SG导致显著体重减轻，改善了内皮损伤，并通过降低胰岛素抵抗（IR）、瘦素、总胆固醇和甘油三酯水平降低了心血管风险。炎症和纤维化标志物没有相关变化。
我们的研究表明，SG在改善组织学的同时，还能改善与NAFLD相关的IR和心血管风险标志物，略优于VLCD。
