Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Berta-Ottenstein Program, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Division of Hepatology, Gastroenterology and Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Nutrition. 2022 Nov-Dec;103-104:111806. doi: 10.1016/j.nut.2022.111806. Epub 2022 Jul 22.
Non-alcoholic fatty liver disease (NAFLD) represents an excessively rising entity of chronic liver disease and is a leading cause of mortality among patients with metabolic syndrome. The duodenal-jejunal bypass liner (DJBL) is a minimally invasive endoscopic treatment option for patients with obesity and type 2 diabetes (T2DM). Although beneficial effects of DJBL therapy on body weight reduction and glycemic control have been described, the effects of DJBL implantation on NAFLD is unknown. The aim of this study was to to evaluate the effects of DJBL implantation for 6 to 9 months on biochemical and clinical biomarkers of NAFLD in a large cohort of patients.
The effect of DJBL treatment on biochemical and clinical parameters of NAFLD were assessed in a study cohort of 71 patients with obesity and T2DM. DJBL was implanted for 9 to 12 months and patients were regularly monitored during the implantation period and for a follow-up period of 6 months after explantation.
DJBL therapy was associated with a significant decrease in fatty liver index during time of implantation (explantation versus implantation: 93.38 versus 98.22, P < 0.001). Moreover, DJBL implantation was associated with decreases of alanine aminotransferase (29.03 versus 42.29 U/L, P < 0.0001) and cytokeratin-18 fragments (CK18 MF30; 190.6 versus 276 U/L, P < 0.0001), that further remained stable during 6 months after explantation. NAFLD fibrosis and aspartate aminotransferase-to-platelet ratio index (APRI) scores decreased significantly during implantation (-0.83 versus 0.19, P < 0.001, 0.26 versus 0.36, P < 0.0001, respectively).
To our knowledge, this is the first study to demonstrate significant effects of DJBL treatment on biochemical and clinical markers of NAFLD activity. Significant effects of DJBL treatment on NAFLD fibrosis and APRI score further suggests protective effects of DJBL on liver-related morbidity and mortality in patients with obesity and T2DM.
非酒精性脂肪性肝病（NAFLD）是一种慢性肝病的过度上升实体，是代谢综合征患者死亡的主要原因。十二指肠空肠旁路衬垫（DJBL）是肥胖和 2 型糖尿病（T2DM）患者的一种微创内镜治疗选择。虽然已经描述了 DJBL 治疗对体重减轻和血糖控制的有益影响，但 DJBL 植入对 NAFLD 的影响尚不清楚。本研究的目的是评估 DJBL 植入 6 至 9 个月对肥胖和 T2DM 患者大量患者 NAFLD 的生化和临床生物标志物的影响。
在肥胖和 T2DM 的研究队列中评估 DJBL 治疗对 NAFLD 生化和临床参数的影响。DJBL 植入 9 至 12 个月，并在植入期间和植入后 6 个月的随访期间定期监测患者。
DJBL 治疗与植入期间肝脂肪指数的显著降低相关（植入时与植入时相比：93.38 与 98.22，P < 0.001）。此外，DJBL 植入与丙氨酸氨基转移酶（29.03 与 42.29 U/L，P < 0.0001）和细胞角蛋白 18 片段（CK18 MF30；190.6 与 276 U/L，P < 0.0001）的降低相关，植入后 6 个月时仍保持稳定。NAFLD 纤维化和天冬氨酸氨基转移酶-血小板比值指数（APRI）评分在植入期间显著降低（-0.83 与 0.19，P < 0.001，0.26 与 0.36，P < 0.0001）。
据我们所知，这是第一项证明 DJBL 治疗对 NAFLD 活性的生化和临床标志物具有显著影响的研究。DJBL 治疗对 NAFLD 纤维化和 APRI 评分的显著影响进一步表明 DJBL 在肥胖和 T2DM 患者中对与肝脏相关的发病率和死亡率具有保护作用。
