Zhou Hui, Luo Ping, Li Pengzhou, Wang Guohui, Yi Xianhao, Fu Zhibing, Sun Xulong, Cui Beibei, Zhu Liyong, Zhu Shaihong
Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
Obes Surg. 2022 Jun;32(6):1872-1883. doi: 10.1007/s11695-022-06011-1. Epub 2022 Apr 6.
Bariatric surgery has been uncovered to relieve nonalcoholic fatty liver disease (NAFLD) in patients with obesity, while current studies have neutral or opposite results. This systematic review and meta-analysis aimed to evaluate the effects of bariatric surgery on NAFLD in patients with obesity.
PubMed, Embase, Cochrane Central, and Web of Science databases were performed to obtain publications containing comparison results of liver biopsy before and after bariatric surgery in obesity. Primary outcomes were biopsy-confirmed remission of NAFLD and NAFLD activity scores. Secondary outcomes were liver function. This study was registered with PROSPERO, CRD42021240346.
Thirty-seven studies were included. After bariatric surgery, a biopsy-confirmed resolution of steatosis was improved in 56% of patients, ballooning degeneration in 49%, inflammation in 45%, and fibrosis in 25%. Bariatric surgery significantly decreased mean NAFLD activity scores. RYGB achieved the most obviously improvements in steatosis, and SG attained the most notably ameliorations in fibrosis. The percentage of patients with improved steatosis and hepatic fibrosis in Asian countries was higher than non-Asian countries. The reduction of ALT and AST was 11.95U/L and 6.44 U/L after surgery.
Our study has revealed that bariatric surgery brought out significantly resolution of NAFLD in individuals with obesity. RYGB and SG have been proved to be of benefit to many hepatic parameters, and the improvement of liver steatosis and fibrosis, particularly in Asian countries. It is strongly suggested that bariatric surgery should be considered as a novel treatment for NAFLD.
已发现减肥手术可缓解肥胖患者的非酒精性脂肪性肝病（NAFLD），而目前的研究结果呈中性或相反。本系统评价和荟萃分析旨在评估减肥手术对肥胖患者NAFLD的影响。
检索PubMed、Embase、Cochrane Central和Web of Science数据库，以获取包含肥胖患者减肥手术前后肝脏活检比较结果的出版物。主要结局是活检证实的NAFLD缓解和NAFLD活动评分。次要结局是肝功能。本研究已在PROSPERO注册，注册号为CRD42021240346。
纳入37项研究。减肥手术后，56%的患者经活检证实脂肪变性得到改善，49%的患者气球样变得到改善，45%的患者炎症得到改善，25%的患者纤维化得到改善。减肥手术显著降低了平均NAFLD活动评分。胃旁路手术（RYGB）在脂肪变性方面改善最为明显，袖状胃切除术（SG）在纤维化方面改善最为显著。亚洲国家脂肪变性和肝纤维化改善患者的百分比高于非亚洲国家。术后谷丙转氨酶（ALT）和谷草转氨酶（AST）分别降低11.95U/L和6.44U/L。
我们的研究表明，减肥手术能使肥胖个体的NAFLD得到显著缓解。已证明RYGB和SG对许多肝脏参数有益，对肝脏脂肪变性和纤维化有改善作用，尤其是在亚洲国家。强烈建议将减肥手术视为NAFLD一种新的治疗方法。
