非酒精性脂肪肝对减重手术治疗肥胖相关疾病术后体重减轻和缓解的影响。

The Effect of Non-Alcoholic Fatty Liver Disease on Weight Loss and Resolution of Obesity-Related Disorders After Bariatric Surgery.

机构信息

Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.

出版信息

World J Surg. 2023 Dec;47(12):3281-3288. doi: 10.1007/s00268-023-07153-8. Epub 2023 Sep 25.

DOI:10.1007/s00268-023-07153-8

PMID:37747548

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10694115/

Abstract

BACKGROUND

Patients undergoing bariatric surgery have a high incidence of non-alcoholic fatty liver disease (NAFLD). However, the effect of NAFLD or non-alcoholic steatohepatitis (NASH) on the weight loss and resolution of obesity-related disorders is a matter of debate.

METHODS

In this study, we compare the long-term outcomes after bariatric with the presence of NAFLD in the liver biopsy at the time of surgery.

RESULTS

The follow-up was available for 226 out of 288 patients. The mean follow-up time was 24.9 (± 13.6) months. The baseline histology showed that 112 patients (38.9%) had no NASH, 70 (24.3%) were borderline, and 106 (36.8%) had NASH. At follow-up, the mean BMI dropped from (52 ± 10.2) to (36.6 ± 8) kg/m . Excess weight loss (EWL) was similar in all NAFLD groups. Type 2 diabetes mellitus dropped from 35.7 to 11.4%, hypertension from 65.6 to 36.7%, hyperlipidemia from 62.3 to 33%, and obstructive sleep apnea from 37.5 to 14.9%. Only hyperlipidemia was significantly associated with NASH compared to the groups with no NASH or borderline NASH (p value = 0.002 and p value = 0.04, respectively) during the first two years of follow-up.

CONCLUSION

The beneficial effects of bariatric surgery are evident across all patients with NAFLD. Patients with NASH have comparable outcomes regarding weight loss and resolution of obesity-related comorbidities.

摘要

背景

接受减重手术的患者非酒精性脂肪性肝病（NAFLD）发病率很高。然而，NAFLD 或非酒精性脂肪性肝炎（NASH）对减肥和解决肥胖相关疾病的影响仍存在争议。

方法

本研究比较了手术时肝活检存在 NAFLD 的患者与无 NAFLD 的患者在接受减重手术后的长期结果。

结果

288 例患者中有 226 例可获得随访。平均随访时间为 24.9（±13.6）个月。基线组织学显示，112 例（38.9%）患者无 NASH，70 例（24.3%）为边界性，106 例（36.8%）有 NASH。随访时，平均 BMI 从（52±10.2）kg/m²降至（36.6±8）kg/m²。所有 NAFLD 组的体重减轻程度相似。2 型糖尿病从 35.7%降至 11.4%，高血压从 65.6%降至 36.7%，高脂血症从 62.3%降至 33%，阻塞性睡眠呼吸暂停从 37.5%降至 14.9%。只有高脂血症与无 NASH 或边界性 NASH 组相比，在随访的前两年与 NASH 显著相关（p 值分别为 0.002 和 0.04）。