Choi Catherine, Barajas-Ochoa Aldo, Uppuluri Aditya, Ro Grace, Hashemipour Reza, Jiang Yi, Nasir Umair, Ahlawat Sushil
Internal Medicine, Rutgers New Jersey Medical School.
Rutgers New Jersey Medical School.
Medicine (Baltimore). 2020 Oct 16;99(42):e22446. doi: 10.1097/MD.0000000000022446.
Autoimmune hepatitis (AIH) is a form of liver inflammation in which immune cells target hepatocytes, inducing chronic inflammatory states. Bariatric surgery (BS) was shown to reduce inflammation in severely obese patients. We hypothesize that obese patients with AIH and BS have lower prevalence of liver-related complications and in-patient mortality compared to those without BS.The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with a diagnosis of AIH. Of those, hospitalizations with BS were selected as cases and those with morbid obesity as controls. Case-control 1:2 matching was done based on sex, age, race, and comorbidities. Primary outcomes were prevalence of liver-related complications and in-patient mortality. Independent risk factors of in-patient clinical outcomes were identified using multivariate regression analysis.From 137,834 hospitalizations with a diagnosis of AIH, 688 with BS were selected as cases, and 1295 were matched as controls. The prevalence of ascites was higher in the BS group compared to the control (odds ratio 1.73, 95% confidence interval (CI) 1.27-2.36). The prevalence of cirrhosis (36.8% vs 33.2%), portal hypertension (7.4% vs 10.0%), hepatic encephalopathy (10.6% vs 8.7%), and varices and variceal bleeding (3.9% vs 5.5%) was not statistically different from case controls, (P > .05).BS was an independent risk factor for ascites (adjusted odds ratio (aOR) 1.87; 95% CI 1.36-2.56) and hepatic encephalopathy (aOR 1.42; 95% CI 1.03-1.97) but was an independent protective factor against in-patient mortality (aOR 0.21, 95% CI 0.08-0.55) once adjusted for age, sex, race, and comorbidities.
自身免疫性肝炎（AIH）是一种肝脏炎症形式，其中免疫细胞靶向肝细胞，引发慢性炎症状态。减肥手术（BS）已被证明可减轻重度肥胖患者的炎症。我们假设，与未接受减肥手术的患者相比，患有AIH且接受减肥手术的肥胖患者肝脏相关并发症的患病率和住院死亡率更低。
查询了2007年至2013年的全国住院患者样本，以获取18岁以上诊断为AIH的成年人的住院情况。其中，将接受减肥手术的住院患者选为病例，将病态肥胖患者选为对照。病例对照按1:2的比例根据性别、年龄、种族和合并症进行匹配。主要结局是肝脏相关并发症的患病率和住院死亡率。使用多变量回归分析确定住院临床结局的独立危险因素。
在137,834例诊断为AIH的住院患者中，688例接受减肥手术的患者被选为病例，1295例被匹配为对照。与对照组相比，减肥手术组腹水患病率更高（优势比1.73，95%置信区间（CI）1.27 - 2.36）。肝硬化（36.8%对33.2%）、门静脉高压（7.4%对10.0%）、肝性脑病（10.6%对8.7%）以及静脉曲张和曲张静脉出血（3.9%对5.5%）的患病率与病例对照相比无统计学差异（P>0.05）。
减肥手术是腹水（调整后优势比（aOR）1.87；95%CI 1.36 - 2.56）和肝性脑病（aOR 1.42；95%CI 1.03 - 1.97）的独立危险因素，但在调整年龄、性别、种族和合并症后，是住院死亡率的独立保护因素（aOR 0.21，95%CI 0.08 - 0.55）。
