Billmann Franck, El Shishtawi Sherehan, Bruckner Tom, ElSheikh Mostafa, Müller-Stich Beat Peter, Billeter Adrian
Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
Institut für Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg, Germany.
Hepatobiliary Surg Nutr. 2022 Dec;11(6):795-807. doi: 10.21037/hbsn-21-71.
We aimed to evaluate the medium-term efficacy of sleeve gastrectomy (SG) Roux-en-Y gastric bypass (RYGB) on remission of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).
We identified severely obese patients [body mass index (BMI) >35 kg/m] with NAFLD (as defined by the Longitudinal Assessment of Bariatric Surgery Study) and T2DM (as defined by the American Association of Clinical Endocrinologists and the American College of Endocrinology) who underwent SG or RYGB in a single university surgical centre. The cohorts were match-paired and data were analysed after at least 3 years of follow up. The key outcomes measured were: (I) the improvement of liver function tests and NAFLD markers; (II) glycemic control and insulin resistance.
Ninety-six patients were investigated; 44 (45.8%) were women. The mean pre-operative BMI was 45.2 kg/m in the SG and 42.0 kg/m in the RYGB group. SG and RYGB both significantly reduced serum liver enzyme concentrations. NAFLD markers resolved 2 years after SG in all patients. In contrast, only 78% and 80% of patients achieved remission of NAFLD 2 and 3 years after RYBG respectively. Both procedures resulted in comparable rates of remission of T2DM.
Bariatric surgery with SG may be preferable to RYGB for obese patients with NAFLD and T2DM based on the rates of remission of markers of these co-morbidities. However, our results need to be confirmed in prospective trials. Understanding the metabolic effects of specific bariatric surgical procedures may facilitate the development of a personalised approach to weight-loss surgery.
我们旨在评估袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）对2型糖尿病（T2DM）患者非酒精性脂肪性肝病（NAFLD）缓解的中期疗效。
我们在一个大学手术中心确定了患有NAFLD（由减肥手术纵向评估研究定义）和T2DM（由美国临床内分泌学家协会和美国内分泌学会定义）的严重肥胖患者[体重指数（BMI）>35kg/m²]，这些患者接受了SG或RYGB手术。对队列进行匹配配对，并在至少3年的随访后进行数据分析。测量的关键结果是：（I）肝功能检查和NAFLD标志物的改善；（II）血糖控制和胰岛素抵抗。
共调查了96例患者；44例（45.8%）为女性。SG组术前平均BMI为45.2kg/m²，RYGB组为42.0kg/m²。SG和RYGB均显著降低了血清肝酶浓度。所有患者在SG术后2年NAFLD标志物均消失。相比之下，RYBG术后2年和3年分别只有78%和80%的患者NAFLD得到缓解。两种手术导致T2DM缓解率相当。
基于这些合并症标志物的缓解率，对于患有NAFLD和T2DM的肥胖患者，SG减肥手术可能比RYGB更可取。然而，我们的结果需要在前瞻性试验中得到证实。了解特定减肥手术的代谢效应可能有助于制定个性化的减肥手术方法。
