Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Clin Mol Hepatol. 2024 Jul;30(3):561-576. doi: 10.3350/cmh.2023.0384. Epub 2024 Jun 3.
BACKGROUND/AIMS: Bariatric intervention has been reported to be an effective way to improve metabolic dysfunction-associated steatotic liver disease (MASLD) in obese individuals. The current systemic review aimed to assess the changes in MRI-determined hepatic proton density fat fraction (MRI-PDFF) and nonalcoholic fatty liver disease activity score (NAS) after bariatric surgery or intragastric balloon/gastric banding in MASLD patients with obesity.
We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH).
Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3-6 months compared to baseline, 40% at 12-24 months, and 50% at 36-60 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3-6 months, 37% at 12-24 months, and 29% at 36-60 months; lobular inflammation by 36% at 12-24 months and 51% at 36-60 months; ballooning degeneration by 38% at 12-24 months; significant fibrosis (≥F2) by 18% at 12-24 months and by 17% at 36-60 months after intervention.
Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.
背景/目的：减重干预被报道为改善肥胖个体代谢相关脂肪性肝病（MASLD）的有效方法。本系统评价旨在评估 MASLD 肥胖患者接受减重手术后或胃内球囊/胃带后 MRI 测定的肝质子密度脂肪分数（MRI-PDFF）和非酒精性脂肪性肝病活动评分（NAS）的变化。
我们检索了包括 PubMed、OVID Medline、EMBASE 和 Cochrane Library 在内的多个数据库。主要结局是 MRI-PDFF 上肝内脂肪的变化和代谢相关脂肪性肝炎（MASH）的组织学特征。
共纳入 30 项研究，共 3134 例患者进行荟萃分析。减重干预显著降低 BMI（均数比，0.79），并在减重干预后 6 个月显示 MRI-PDFF 上肝内脂肪减少 72%（均数比，0.28）。8 项研究显示，与基线相比，NAS 在 3-6 个月时降低 60%，12-24 个月时降低 40%，36-60 个月时降低 50%。19 项研究显示，脂肪变性患者的比例在 3-6 个月时降低 44%，12-24 个月时降低 37%，36-60 个月时降低 29%；12-24 个月时肝小叶炎症降低 36%，36-60 个月时降低 51%；气球样变性在 12-24 个月时降低 38%；12-24 个月时显著纤维化（≥F2）降低 18%，36-60 个月时降低 17%。
减重干预显著改善了肥胖患者的 MRI-PDFF 和 MASH 的组织学特征。对于对生活方式改变或药物治疗无反应的 MASLD 患者，减重干预可能是有效的替代治疗选择。
