肥胖指数、代谢健康和脂肪组织炎症对减重手术患者非酒精性脂肪性肝病严重程度的影响：一项前瞻性研究。
Effect of Body Mass Index, Metabolic Health and Adipose Tissue Inflammation on the Severity of Non-alcoholic Fatty Liver Disease in Bariatric Surgical Patients: a Prospective Study.
机构信息
Centre for Obesity Research and Education, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia.
Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
出版信息
Obes Surg. 2019 Jan;29(1):99-108. doi: 10.1007/s11695-018-3479-2.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD), driven by the obesity epidemic, has become the most common form of liver disease. Despite this, there is controversy regarding the prevalence and severity of NAFLD in obesity. Obesity-related factors, such as increasing adiposity, metabolic disease and inflammation, may influence prevalence. We therefore prospectively measured NAFLD prevalence in obesity and studied factors associated with NAFLD.
MATERIALS AND METHODS
We recruited consecutive bariatric patients. Intraoperative liver biopsies were taken. The liver, adipose tissue and serum were collected to measure inflammation. Adipocyte cell size was measured. NAFLD severity was correlated to body mass index (BMI), metabolic health and adipose characteristics.
RESULTS
There were 216 participants; BMI 45.9 ± 8.9 kg/m, age 44.4 ± 12.1 years, 75.5% female. Overall NAFLD prevalence was 74.1%, with 17.1% having non-alcoholic steatohepatitis (NASH) and/or steatofibrosis. Odds of NASH/steatofibrosis increased independently with BMI category (odds ratio (OR) 2.28-3.46, all p < 0.05) and metabolic disease (OR 3.79, p = 0.003). These odds markedly increased when both super obesity (BMI > 50) and metabolic disease were present (OR 9.71, p < 0.001). NASH/steatofibrosis prevalence was significantly greater with diabetes, hypertension and dyslipidemia. Although greater visceral adipocyte hypertrophy was evident in NASH/steatofibrosis, there was no significant association between adipose inflammation and NASH/steatofibrosis.
CONCLUSION
NAFLD remains endemic in obesity; however, NASH/steatofibrosis are less common than previously reported. Worsening obesity and metabolic disease increase odds of NAFLD independently, with substantially compounded effect with both. These observations may help with risk stratification in obese populations. We were unable to delineate clear associations between adipose inflammation and NASH/steatofibrosis in this obese population.
TRIAL REGISTRATION
Australian Clinical Trials Registry ( ACTRN12615000875505 ).
背景
非酒精性脂肪性肝病（NAFLD）是由肥胖症流行所驱动的，已成为最常见的肝病形式。尽管如此，NAFLD 在肥胖症中的患病率和严重程度仍存在争议。肥胖相关因素，如脂肪组织增加、代谢疾病和炎症，可能会影响患病率。因此，我们前瞻性地测量了肥胖症中的 NAFLD 患病率，并研究了与 NAFLD 相关的因素。
材料与方法
我们连续招募了肥胖症患者。术中采集肝活检标本。收集肝脏、脂肪组织和血清以测量炎症。测量脂肪细胞大小。将 NAFLD 严重程度与体重指数（BMI）、代谢健康和脂肪特征相关联。
结果
共有 216 名参与者，BMI 为 45.9±8.9kg/m，年龄为 44.4±12.1 岁，75.5%为女性。总体上，NAFLD 的患病率为 74.1%，其中 17.1%患有非酒精性脂肪性肝炎（NASH）和/或脂肪性肝纤维化。NASH/脂肪性肝纤维化的发生几率随着 BMI 类别（比值比（OR）2.28-3.46，均 p<0.05）和代谢疾病（OR 3.79，p=0.003）的独立增加而增加。当超级肥胖（BMI>50）和代谢疾病同时存在时，这种几率明显增加（OR 9.71，p<0.001）。糖尿病、高血压和血脂异常患者中 NASH/脂肪性肝纤维化的患病率显著更高。尽管 NASH/脂肪性肝纤维化患者的内脏脂肪细胞肥大更明显，但脂肪组织炎症与 NASH/脂肪性肝纤维化之间无显著关联。
结论
NAFLD 在肥胖症中仍然普遍存在；然而，NASH/脂肪性肝纤维化的发病率比之前报道的要低。肥胖症和代谢疾病的恶化会独立增加 NAFLD 的发生几率，两者同时存在会产生更大的复合效应。这些观察结果可能有助于对肥胖人群进行风险分层。在肥胖人群中，我们无法确定脂肪组织炎症与 NASH/脂肪性肝纤维化之间的明确关联。
试验注册
澳大利亚临床试验注册处（ACTRN12615000875505）。
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