Department of Surgery, Khoo Teck Puat Hospital, Singapore; Department of Surgery, Min-Sheng General Hospital, Taiwan.
Department of Surgery, Min-Sheng General Hospital, Taiwan; Department of Surgery, Al-Adan Hospital, Kuwait.
Asian J Surg. 2019 Jan;42(1):203-208. doi: 10.1016/j.asjsur.2018.04.010. Epub 2018 May 24.
Nonalcoholic steatohepatitis (NASH) is closely associated with obesity and is one of the important etiologies of hepatocellular carcinoma (HCC and liver failure. Bariatric surgery is proven to be effective in causing weight loss and improvement of NASH) but there is limited long term data.
To identify the predictors of NASH in morbidly obese patients and evaluate long term data of bariatric surgery effects on NASH.
308 bariatric patients (mean age 30.2 years old, body mass index (BMI) 45.0 kg/m) with concurrent liver biopsy form 2003 to 2008 were included. We compared the clinical data between the NASH and non-NASH group and identify predictors of NASH in this cohort of patients. Remission of NASH was evaluated using the predictor of NASH.
Prevalence of NASH was 43.8%. At baseline, the NASH and non-NASH groups both had similar age, BMI and sex ratio but the NASH group had significantly worse glycemic control, liver enzymes, triglycerides and uric acid. Highly sensitive-C Reactive Protein (HSCRP) level was identified as the only independent predictor of NASH. Ten years follow up (60.4% loss to follow up) showed good weight loss, resolution of co-morbidities and reduction of HSCRP. Patients with bypass surgery had better weight loss and lower levels of HSCRP. (HSCRP 0.2 ± 0.1 mg/dL vs. 0.8 ± 0.7 mg/dL, p = 0.009). than non-bypass group.
NASH is common in bariatric patients. HSCRP is the only independent predictor of NASH and can be used as a surrogate marker in predicting long term effect of Bariatric Surgery on resolution of non-alcoholic steatohepatitis Bypass procedure was better in resolution of NASH than non-bypass procedure.
非酒精性脂肪性肝炎（NASH）与肥胖密切相关，是肝细胞癌（HCC）和肝功能衰竭的重要病因之一。减重手术已被证明可有效减轻体重并改善 NASH，但长期数据有限。
确定病态肥胖患者中 NASH 的预测因素，并评估减重手术对 NASH 的长期效果。
纳入 2003 年至 2008 年间行肝活检的 308 例病态肥胖患者（平均年龄 30.2 岁，体重指数（BMI）45.0 kg/m²）。我们比较了 NASH 组和非 NASH 组的临床资料，并确定了该患者队列中 NASH 的预测因素。使用 NASH 的预测因子评估 NASH 的缓解情况。
NASH 的患病率为 43.8%。基线时，NASH 组和非 NASH 组的年龄、BMI 和性别比例相似，但 NASH 组的血糖控制、肝酶、甘油三酯和尿酸较差。高敏 C 反应蛋白（hs-CRP）水平被确定为 NASH 的唯一独立预测因子。10 年随访（60.4%失访）显示体重减轻良好、合并症得到解决以及 hs-CRP 降低。旁路手术组的体重减轻和 hs-CRP 水平更低（hs-CRP 0.2±0.1 mg/dL 比 0.8±0.7 mg/dL，p=0.009）。与非旁路手术组相比。
NASH 在肥胖症患者中很常见。hs-CRP 是 NASH 的唯一独立预测因子，可作为预测减重手术对非酒精性脂肪性肝炎缓解的长期效果的替代标志物。旁路手术在缓解 NASH 方面优于非旁路手术。
