Department of Endocrinology and Metabolism, Obesity Unit, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
Liver Unit, Department of Gastroenterology, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
Obes Surg. 2022 Aug;32(8):2682-2695. doi: 10.1007/s11695-022-06153-2. Epub 2022 Jun 14.
In patients with clinically severe obesity, metabolic associated fatty liver disease (MAFLD) and steatohepatitis are highly prevalent. There is a lack of prospective studies evaluating the impact of bariatric surgery (BS) on MAFLD using both noninvasive and histological criteria. The present study aims to assess the impact of BS on MAFLD using histological and biochemical criteria.
This is a prospective study of 52 patients subjected to BS. Noninvasive fibrosis risk scores (NIFRS) along with anthropometric, clinical, and biochemical parameters were recorded pre- and 12 months post-BS. Liver biopsy was obtained in all individuals at baseline (wedge biopsy) and was repeated at 12 months (percutaneous Tru-cut) in those diagnosed with steatohepatitis. The primary outcome was the change in the degree of steatohepatitis and fibrosis. The secondary outcome was the change in scores for hepatocellular ballooning, lobular inflammation, steatosis, and fibrosis.
One year after BS, steatohepatitis resolved in core biopsies with no worsening of fibrosis in 95.7% of individuals (n = 21, 95% CI: 87.3-100), and 13 (56.5%) exhibited complete resolution. Of 15 patients with fibrosis at baseline, 13 (86.7%) showed improvement and 12 exhibited fibrosis resolution. The values of transaminases improved, but only gamma glutamyl transferase (GGT) showed statistical significance. Among the NIFRS, NAFLD fibrosis score (NFS) and Hepamet fibrosis score (HFS) showed significant improvement.
In the setting it was studied, BS improved or resolved steatohepatitis and fibrosis in patients with obesity. NIFRS, especially NFS and HFS, and levels of GGT could be used as markers of recovery of liver function after BS.
在患有临床严重肥胖症的患者中，代谢相关脂肪性肝病（MAFLD）和脂肪性肝炎非常普遍。缺乏使用非侵入性和组织学标准评估减肥手术（BS）对 MAFLD 影响的前瞻性研究。本研究旨在使用组织学和生化标准评估 BS 对 MAFLD 的影响。
这是一项对 52 例接受 BS 的患者进行的前瞻性研究。记录了非侵入性纤维化风险评分（NIFRS）以及人体测量、临床和生化参数，分别在 BS 前和 12 个月后进行。所有患者均在基线时（楔形活检）获得肝活检，并在诊断为脂肪性肝炎的患者中在 12 个月时重复（经皮 Tru-cut）。主要结局是评估肝脂肪变性和纤维化程度的变化。次要结局是评估肝细胞气球样变、肝小叶炎症、脂肪变性和纤维化评分的变化。
BS 后 1 年，核心活检中脂肪性肝炎消退，纤维化无恶化在 95.7%的患者中（n=21，95%CI：87.3-100），13 例（56.5%）完全消退。在基线时有纤维化的 15 例患者中，13 例（86.7%）改善，12 例显示纤维化消退。转氨酶值有所改善，但只有γ-谷氨酰转移酶（GGT）具有统计学意义。在 NIFRS 中，非酒精性脂肪性肝病纤维化评分（NFS）和 Hepamet 纤维化评分（HFS）显著改善。
在本研究中，BS 改善或消除了肥胖患者的脂肪性肝炎和纤维化。NIFRS，尤其是 NFS 和 HFS，以及 GGT 水平可作为 BS 后肝功能恢复的标志物。
