Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Endocrinology, Diabetology, Metabolism and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany; German Center of Diabetes Research (DZD), Neuherberg, Germany.
Surg Obes Relat Dis. 2023 Dec;19(12):1421-1434. doi: 10.1016/j.soard.2023.07.005. Epub 2023 Jul 24.
Nonalcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) are strongly associated with obesity, metabolic syndrome, and insulin resistance (IR).
The aim of this study was to investigate the effects of metabolic surgery on pancreatic beta cell function and IR in patients with obesity and NAFLD.
University Hospital, Germany.
Liver biopsies were taken intraoperatively from 112 patients undergoing sleeve gastrectomy (n = 68) or Roux-en-Y gastric bypass (n = 44) and analyzed histologically for the presence of simple steatosis (NAFL) or NASH. Clinical and biochemical parameters were collected over up to 2 years. Beta cell function and IR were assessed using the homeostasis model assessment of beta-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) index.
NASH was present in 53.6% (n = 60) of the patients and NAFL in 25.9% (n = 29). Liver enzymes, adiponectin/leptin ratio, triglycerides, and HbA1C were improved at 6 months, 1, and 2 years after surgery. HOMA2-IR was significantly lower in patients without NAFLD while HOMA2-IR did not differ between patients with NAFL and/or NASH. HOMA2-%B was highest in the NAFLD group and lowest in patients with NASH. While there was no change in HOMA2-%B and HOMA2-IR in the No-NAFLD group, HOMA2-%B decreased and IR improved in the NAFL and NASH groups.
Insufficient compensatory beta-cell function may contribute to the progression from NAFL alongside with IR to NASH. Our findings suggest that bariatric surgery decreases IR while at the same time reducing compensatory insulin oversecretion. These results are associated with beneficial changes in adipose tissue function after bariatric surgery.
非酒精性脂肪性肝病（NAFLD）和脂肪性肝炎（NASH）与肥胖、代谢综合征和胰岛素抵抗（IR）密切相关。
本研究旨在探讨代谢手术对肥胖合并 NAFLD 患者胰岛β细胞功能和 IR 的影响。
德国大学医院。
对 112 例行袖状胃切除术（n=68）或 Roux-en-Y 胃旁路术（n=44）的患者术中进行肝活检，组织学分析存在单纯性脂肪变性（NAFL）或 NASH。在长达 2 年的时间内收集临床和生化参数。使用稳态模型评估胰岛β细胞功能（HOMA2-%B）和胰岛素抵抗（HOMA2-IR）指数评估胰岛β细胞功能和 IR。
53.6%（n=60）的患者存在 NASH，25.9%（n=29）的患者存在 NAFL。术后 6 个月、1 年和 2 年，肝酶、脂联素/瘦素比值、甘油三酯和 HbA1C 均得到改善。无 NAFLD 的患者 HOMA2-IR 明显较低，而 NAFL 和/或 NASH 的患者 HOMA2-IR 无差异。NAFLD 组的 HOMA2-%B 最高，NASH 组最低。无 NAFLD 组的 HOMA2-%B 和 HOMA2-IR 无变化，而 NAFL 和 NASH 组的 HOMA2-%B 降低，IR 改善。
胰岛素分泌不足可能导致 NAFL 合并 IR 进展为 NASH。我们的研究结果表明，减重手术可降低 IR，同时减少代偿性胰岛素分泌过多。这些结果与减重手术后脂肪组织功能的有益变化相关。
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