Grenoble Alpes University Hospital, Pole DIGIDUNE, Digestive Surgery Department, Grenoble, France; Hypoxia PathoPhysiology (HP2), INSERM U1042, University Grenoble Alpes, Grenoble, France.
Grenoble Alpes University Hospital, Pole DIGIDUNE, Digestive Surgery Department, Grenoble, France.
Surg Obes Relat Dis. 2017 Oct;13(10):1780-1786. doi: 10.1016/j.soard.2017.07.032. Epub 2017 Aug 14.
Nonalcoholic fatty liver disease (NAFLD) is a metabolic complication of obesity that encompasses a spectrum of conditions, including hepatic steatosis, nonalcoholic steatohepatitis (NASH), cirrhosis, and end-stage liver disease. Screening for NAFLD is important to limit progression, allow early detection of carcinoma, and follow the need for liver transplantation. Although noninvasive markers exist, hepatic histologic evaluation remains the gold standard for diagnosis. To reduce the risk of complications after liver biopsy but increase the accuracy of NAFLD diagnosis, hepatic tissue can be sampled during bariatric surgery. This practice raises the question whether liver biopsies should be systematically carried out intraoperatively to screen for NAFLD or limited to patients who have positive results for noninvasive markers of NASH. The aim of this systematic review was to determine the prevalence of NASH in patients with obesity undergoing bariatric surgery, the performance of noninvasive markers of NASH and complications of intraoperative liver biopsy. Meta-analysis found an overall NASH prevalence of .25 (95% confidence interval, .12-.39), with a high level of heterogeneity (I2 = 97%) across studies. The review showed that each noninvasive marker alone was unable to discriminate between patients with a normal liver and others. Conversely, intraoperative biopsy was related to some complications. Results from a clinical practices questionnaire in specialized centers for obesity care in France showed a large degree of heterogeneity. A prospective study would be interesting to evaluate an algorithm based on noninvasive markers for clinical decision making to determine the pertinence of liver biopsy during bariatric surgery.
非酒精性脂肪性肝病（NAFLD）是肥胖的一种代谢并发症，它包含了一系列病症，包括肝脂肪变性、非酒精性脂肪性肝炎（NASH）、肝硬化和终末期肝病。筛查非酒精性脂肪性肝病对于限制其进展、早期发现肝癌以及跟踪是否需要进行肝移植非常重要。虽然存在非侵入性标志物，但肝组织学评估仍然是诊断的金标准。为了降低肝活检后的并发症风险，但提高非酒精性脂肪性肝病诊断的准确性，可以在减肥手术期间采集肝组织样本。这种做法提出了一个问题，即是否应该在手术中系统地进行肝活检，以筛查非酒精性脂肪性肝病，还是仅限于非侵入性 NASH 标志物检测结果阳性的患者。本系统评价的目的是确定接受减肥手术的肥胖患者中 NASH 的患病率、NASH 的非侵入性标志物的表现以及术中肝活检的并发症。荟萃分析发现，总体 NASH 患病率为.25（95%置信区间，.12-.39），各研究间存在高度异质性（I2 = 97%）。本综述表明，单独使用每种非侵入性标志物都无法区分正常肝脏和其他肝脏的患者。相反，术中活检与一些并发症有关。法国肥胖症治疗专业中心的临床实践调查问卷结果显示存在很大程度的异质性。一项前瞻性研究将评估基于非侵入性标志物的临床决策算法，以确定在减肥手术中进行肝活检的相关性，这将是很有趣的。
