de Jesus Rafael Nascimento, Callejas Guilherme Hoverter, David Mendonça Chaim Felipe, Antonio Gestic Martinho, Pimentel Utrini Murillo, Callejas-Neto Francisco, Adami Chaim Elinton, Cazzo Everton
Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil.
Obes Surg. 2022 Jul;32(7):2438-2444. doi: 10.1007/s11695-022-06103-y. Epub 2022 May 11.
Excess bodily iron content is commonly associated with obesity and metabolic associated medical conditions and is thought to lead to cardiovascular disease. The effect of Roux-en-Y gastric bypass (RYGB) on hepatic iron overload remains to be determined.
To assess the evolution of histologically proven hepatic iron overload after RYGB.
This is an exploratory historical cohort study in which 42 individuals who underwent RYGB, and then a second surgical procedure had paired liver biopsies collected. Hepatic iron overload and NAFLD features were assessed through histopathological examination. Biochemical iron metabolism parameters were also assessed.
The mean age at RYGB was 47 ± 10.2 years and 92.9% were female. The average time elapsed between RYGB and the second surgical procedure was 20.6 ± 15.4 months. The mean percentage of total weight loss between the two procedures was 26.7 ± 9.4%. Significant reductions in ferritin (220.8 ± 202.9 vs. 101.6 ± 116.7 ng/mL; p = 0.006), hemoglobin (13.7 ± 1.8 vs. 12.1 ± 2.6 g/dL; p = 0.01), and red blood cell count (4.7 ± 0.7 vs. 4.3 ± 0.5 10/mm; p = 0.003) were observed, as well as reductions in the frequencies of steatosis (83.3% vs. 23.8%; p < 0.0001) and steatohepatitis (52.4% vs. 11.9%; p < 0.0001). The frequency of hepatic iron overload significantly decreased from 16.7 to 2.4% (p = 0.03).
RYGB led to a significant decrease in hepatic iron overload, emerging as a possible therapeutical tool for this condition in individuals with obesity and dysmetabolic iron overload syndrome.
体内铁含量过高通常与肥胖及代谢相关疾病有关，被认为会导致心血管疾病。胃旁路手术（RYGB）对肝脏铁过载的影响仍有待确定。
评估胃旁路手术（RYGB）后经组织学证实的肝脏铁过载的演变情况。
这是一项探索性的历史性队列研究，42例接受胃旁路手术（RYGB），然后进行第二次手术的患者接受了配对肝脏活检。通过组织病理学检查评估肝脏铁过载和非酒精性脂肪性肝病（NAFLD）特征。还评估了生化铁代谢参数。
接受胃旁路手术（RYGB）时的平均年龄为47±10.2岁，92.9%为女性。胃旁路手术（RYGB）与第二次手术之间的平均时间间隔为20.6±15.4个月。两次手术之间总体重减轻的平均百分比为26.7±9.4%。观察到铁蛋白（220.8±202.9对101.6±116.7 ng/mL；p = 0.006）、血红蛋白（13.7±1.8对12.1±2.6 g/dL；p = 0.01）和红细胞计数（4.7±0.7对4.3±0.5×10⁶/mm³；p = 0.003）显著降低，同时脂肪变性（83.3%对23.8%；p < 0.0001）和脂肪性肝炎（52.4%对11.9%；p < 0.0001）的发生率也降低。肝脏铁过载的发生率从16.7%显著降至2.4%（p = 0.03）。
胃旁路手术（RYGB）导致肝脏铁过载显著降低，成为肥胖和代谢紊乱性铁过载综合征患者治疗这种疾病的一种可能治疗工具。
