瞬时弹性成像（fibroscan）的实用性和减重手术对病态肥胖患者非酒精性脂肪性肝病（NAFLD）的影响。

Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients.

机构信息

Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

出版信息

Surg Obes Relat Dis. 2018 Jan;14(1):81-91. doi: 10.1016/j.soard.2017.09.005. Epub 2017 Sep 11.

DOI:10.1016/j.soard.2017.09.005

PMID:29126863

Abstract

BACKGROUND

Controlled attenuation parameter (CAP) is a novel, noninvasive technique for assessing hepatic steatosis. However, its role in morbidly obese individuals is unclear. The effect of bariatric surgery on inflammation and fibrosis needs to be explored.

OBJECTIVES

To assess the utility of CAP for assessment of hepatic steatosis in morbidly obese individuals and evaluate the effect of bariatric surgery on hepatic steatosis and fibrosis.

SETTING

A tertiary care academic hospital.

METHODS

Baseline details of anthropometric data, laboratory parameters, FibroScan (XL probe), and liver biopsy were collected. Follow-up liver biopsy was done at 1 year.

RESULTS

Of the 124 patients screened, 76 patients were included; mean body mass index was 45.2 ± 7.1 kg/m. FibroScan success rate was 87.9%. The median liver stiffness measurement (LSM) and CAP were 7.0 (5.0-9.5) kPa and 326.5 (301-360.5) dB/m, respectively. On liver histopathology, severe steatosis and nonalcoholic steatohepatitis were present in 5.3% and 15.8%; significant fibrosis (≥stage 2) and cirrhosis in 39.5% and 2.6%, respectively. Area under receiver operator characteristic curve of LSM for prediction of significant fibrosis (F2-4 versus F0-1) and advanced fibrosis (F3-4 versus F0-2) was .65 (95% confidence interval [CI]: .52-.77) and .83 (95% CI: .72-.94), respectively. The area under receiver operator characteristic curve of CAP for differentiating moderate hepatic steatosis (S2-3 versus S0-1) and severe hepatic steatosis (S3 versus S0-2) was .74 (95% CI: .62-.86) and .82 (95% CI: .73-.91), respectively. At 1-year follow-up, 32 patients underwent liver biopsy. In these patients, there was significant improvement in hepatic steatosis (P = .001), lobular inflammation (P = .033), ballooning (P<.001), and fibrosis (P = .003). Nonalcoholic steatohepatitis was resolved in 3 of 4 (75%) patients. LSM and CAP significantly declined.

CONCLUSIONS

LSM and CAP are feasible and accurate at diagnosing advanced fibrosis and severe hepatic steatosis in morbidly obese individuals. Bariatric surgery is associated with significant improvement in LSM, CAP, steatohepatitis, and fibrosis.

摘要

背景

受控衰减参数（CAP）是一种评估肝脂肪变性的新型无创技术。然而，其在病态肥胖个体中的作用尚不清楚。减重手术对炎症和纤维化的影响需要进一步研究。

目的

评估 CAP 评估病态肥胖个体肝脂肪变性的效用，并评估减重手术对肝脂肪变性和纤维化的影响。

地点

一家三级保健学术医院。

方法

收集基线人体测量数据、实验室参数、FibroScan（XL 探头）和肝活检的详细信息。在 1 年时进行了后续肝活检。

结果

在筛选的 124 名患者中，76 名患者被纳入研究；平均体重指数为 45.2 ± 7.1 kg/m。FibroScan 成功率为 87.9%。中位肝硬度测量值（LSM）和 CAP 分别为 7.0（5.0-9.5）kPa 和 326.5（301-360.5）dB/m。在肝组织病理学上，5.3%存在严重脂肪变性和非酒精性脂肪性肝炎，15.8%存在显著纤维化（≥F2-4 期）和肝硬化（≥F3-4 期）。LSM 预测显著纤维化（F2-4 与 F0-1）和晚期纤维化（F3-4 与 F0-2）的受试者工作特征曲线下面积分别为 0.65（95%置信区间[CI]：0.52-0.77）和 0.83（95%CI：0.72-0.94）。CAP 预测中重度肝脂肪变性（S2-3 与 S0-1）和重度肝脂肪变性（S3 与 S0-2）的受试者工作特征曲线下面积分别为 0.74（95%CI：0.62-0.86）和 0.82（95%CI：0.73-0.91）。在 1 年随访时，32 名患者进行了肝活检。在这些患者中，肝脂肪变性（P =.001）、肝小叶炎症（P =.033）、气球样变（P<.001）和纤维化（P =.003）均显著改善。4 名患者中的 3 名（75%）非酒精性脂肪性肝炎得到缓解。LSM 和 CAP 显著下降。