Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, United Kingdom; Faculty of Public Health, College of Health Sciences, The Saudi Electronic University, Riyadh, Saudi Arabia.
Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, United Kingdom.
Surg Obes Relat Dis. 2021 Apr;17(4):792-798. doi: 10.1016/j.soard.2020.11.015. Epub 2020 Nov 20.
Nonalcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease, with a prevalence estimated to between 20% and 30% of the general population and approximately 70% of stage 2 obese people with type 2 diabetes (T2D) with normal liver enzymes.
To investigate the metabolic and liver-related outcomes of bariatric surgery among patients with insulin-treated T2D and NAFLD who are at high risk of liver fibrosis.
More than 600 locations within the United Kingdom.
The study comprises a retrospective cohort comparison of patients with NAFLD and a fibrosis 4 (Fib-4) score > 1.45 who received a bariatric intervention versus comparable patients who received no bariatric intervention. Metabolic outcomes (glycated hemoglobin [HbA1C] level, weight, body mass index [BMI], and Fib-4 score) and composite liver-related outcomes (cirrhosis, portal hypertension, liver failure, and hepatoma) were compared between groups over a period of 5 years. The outcomes were adjusted for baseline and time-varying covariates.
The study sample included 4108 patients, 45 of whom underwent bariatric surgery. The mean age at baseline was 62.4 ± 12.4 years; 43.8% of patients were female; the mean weight was 89.5 ± 20.8 kg; the mean BMI was 31.7 ± 7.6 kg/m; and the mean HbA1C level was 68.4 ± 16.7 mmol/mol. In addition, the median Fib-4 score was 2.3 (interquartile range, 1.7-4.2). During the 5 years during which follow-up outcomes were recorded, the weight and BMI reductions were significantly lowered compared with baseline in the bariatric surgery group. Similarly, the HbA1C levels were lower in the bariatric surgery group, with statistically significant differences observed in the first and second postintervention years (bariatric surgery versus non-bariatric surgery patient levels at 1 year, 63.1 mmol/mol versus 68.1 mmol/mol, respectively [P = .042], and at 2 years, 62.7 mmol/mol versus 68.1 mmol/mol, respectively [P = .028]). No significant difference was observed between groups in the proportion of patients with liver fibrosis or the likelihood of developing composite liver disease during the follow-up period (bariatric surgery group, 8.9%; non-bariatric surgery group, 4.7%; X = 1.75; P = .18).
Bariatric surgery amongst patients with insulin-treated T2D with NAFLD who were at high risk of liver fibrosis was associated with significant improvements in metabolic outcomes. No significant adverse effects were observed with regards to liver-related outcomes.
非酒精性脂肪性肝病（NAFLD）已成为最常见的慢性肝病病因，其在一般人群中的患病率估计为 20%至 30%，在伴有正常肝酶的 2 型糖尿病（T2D）且肥胖程度为 2 级的人群中约为 70%。
研究对处于高纤维化风险的接受胰岛素治疗的 T2D 合并 NAFLD 患者进行减重手术的代谢和肝脏相关结局。
英国 600 多个地点。
本研究采用回顾性队列比较，比较了接受减重干预的 NAFLD 患者和 Fib-4 评分>1.45 的纤维化 4 分（Fib-4）患者与未接受减重干预的可比患者。比较两组患者在 5 年内的代谢结局（糖化血红蛋白[HbA1C]水平、体重、体重指数[BMI]和 Fib-4 评分）和复合肝脏相关结局（肝硬化、门静脉高压、肝功能衰竭和肝癌）。根据基线和随时间变化的协变量对结局进行了调整。
研究样本包括 4108 名患者，其中 45 名接受了减重手术。基线时的平均年龄为 62.4±12.4 岁；43.8%的患者为女性；平均体重为 89.5±20.8kg；平均 BMI 为 31.7±7.6kg/m；平均 HbA1C 水平为 68.4±16.7mmol/mol。此外，中位数 Fib-4 评分为 2.3（四分位距 1.7-4.2）。在记录随访结局的 5 年内，与基线相比，减重手术组的体重和 BMI 降低更为显著。同样，减重手术组的 HbA1C 水平也更低，在术后第 1 年和第 2 年有统计学意义（减重手术组患者水平分别为 63.1mmol/mol 和 62.7mmol/mol，与非减重手术组相比，差异分别为 68.1mmol/mol[P=0.042]和 68.1mmol/mol[P=0.028]）。在随访期间，两组患者肝纤维化的比例或发生复合肝脏疾病的可能性均无显著差异（减重手术组 8.9%；非减重手术组 4.7%；X2=1.75；P=0.18）。
对于处于高纤维化风险的接受胰岛素治疗的 T2D 合并 NAFLD 患者，减重手术与代谢结局的显著改善相关。未观察到与肝脏相关结局相关的显著不良影响。
