Graduate Program on Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
Graduate Program on Genetics and Molecular Biology, UFRGS, Porto Alegre, RS, Brazil.
Obes Surg. 2020 Oct;30(10):3839-3846. doi: 10.1007/s11695-020-04722-x.
Obesity is a major risk factor for nonalcoholic fatty liver disease (NAFLD), affecting 25% of the worldwide population. Weight loss through bariatric surgery can improve much of the liver steatosis, inflammation, and fibrosis. However, it is not known whether there is reversal of the elastic fiber deposition process, triggered by hepatic damage and related to worse prognosis.
Individuals submitted to bariatric surgery at our institution, from March 2016 to June 2017, with intraoperative liver biopsy confirming NAFLD were approached. Those who consented were submitted to a second liver biopsy 1 year later and were included. Specimens were sliced and stained with hematoxylin-eosin and Sirius red for histological assessment according to Brunt's criteria and with orcein for digital analysis morphometrics using ImageJ®. Quantification of elastic fibers was accomplished by corrected integrated density.
Thirty-seven patients were included. Body mass index, metabolic markers, NAFLD activity score, and fibrosis improved 1 year after the procedure. The elastic fiber density showed a significant decrease: 239.3 × 10 absorbance micrometer (141.08-645.32) to 74.62 × 10 absorbance micrometer (57.42-145.17), p = 0.007.
Liver elastic fiber density decreases with the reversal of NAFLD through weight loss.
肥胖是导致非酒精性脂肪性肝病（NAFLD）的一个主要危险因素，影响了全球 25%的人口。通过减重手术减肥可以改善大部分肝脂肪变性、炎症和纤维化。然而，尚不清楚是否存在肝损伤引发的弹性纤维沉积过程的逆转，而这种过程与更差的预后有关。
我们机构于 2016 年 3 月至 2017 年 6 月期间对接受减重手术的个体进行了研究，并对术中肝活检证实为 NAFLD 的个体进行了评估。对同意进行第二次肝活检的个体，在 1 年后进行了第二次肝活检并纳入研究。对切片进行苏木精-伊红和天狼猩红染色，根据 Brunt 标准进行组织学评估，并使用 ImageJ®对奥辛进行数字分析形态计量学。弹性纤维的定量通过校正积分密度来完成。
共纳入 37 例患者。术后 1 年，体重指数、代谢标志物、NAFLD 活动评分和纤维化均得到改善。弹性纤维密度显著下降：239.3×10 吸光度微米（141.08-645.32）降至 74.62×10 吸光度微米（57.42-145.17），p=0.007。
通过减肥逆转 NAFLD 时，肝弹性纤维密度会下降。
