减重手术后代谢功能障碍相关脂肪性肝炎的缓解且纤维化无恶化可改善15年生存率：一项前瞻性队列研究
Resolution of Metabolic Dysfunction-associated Steatohepatitis With No Worsening of Fibrosis After Bariatric Surgery Improves 15-year Survival: A Prospective Cohort Study.
作者信息
Lassailly Guillaume, Caiazzo Robert, Goemans Armelle, Chetboun Mikael, Gnemmi Viviane, Labreuche Julien, Baud Gregory, Verkindt Helene, Marciniak Camille, Oukhouya-Daoud Naima, Ntandja-Wandji Line-Carolle, Ningarhari Massih, Leteurtre Emmanuelle, Raverdy Violeta, Dharancy Sébastien, Louvet Alexandre, Pattou François, Mathurin Philippe
机构信息
Service des Maladies de l'Appareil Digestif et de la Nutrition, Centre Hospitalier Universitaire de Lille, Lille, France; LIRIC (Lille Inflammation Research International Center) U995, Université de Lille, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Lille, France.
Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Universitaire de Lille, Lille, France; European Genomic Institute for Diabetes, UMR 1190 Translational Research for Diabetes, Inserm, CHU Lille, University of Lille, Lille, France.
出版信息
Clin Gastroenterol Hepatol. 2024 Dec 19. doi: 10.1016/j.cgh.2024.10.025.
BACKGROUND & AIMS: The aim of this study was to investigate the consequences of the histological progression of metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis on long-term survival after bariatric surgery.
METHODS
From 1994 to 2021, 3028 patients at the University Hospital of Lille were prospectively included. Baseline liver biopsies were systematically performed with proposed follow-up biopsies 1 year after surgery, mainly in patients with MASH. We evaluated the association of the baseline and 1-year histologic progression of MASH and fibrosis status and long-term survival using Cox regression models.
RESULTS
At baseline, 2641 patients (89%) had a biopsy, including 232 with MASH (8.7%) and 266 (10.8%) with significant fibrosis (grade F2-F4). The median follow-up was 10.1 years. At 1 year, 594 patients had qualitative paired biopsies. Survival was shorter at the 15-year follow-up in patients with baseline MASH, than in those without (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.38-3.53) and in F2 to F4 than in F0 to F1 (HR, 3.38; 95% CI, 2.24-5.10). At the 1-year landmark analysis, compared with patients without baseline MASH, mortality increased in those with persistent MASH and/or if fibrosis worsened (adjusted HR, 2.54; 95% CI, 1.06-6.10), but not if MASH resolved without the worsening of fibrosis (adjusted HR, 0.73; 95% CI, 0.28-1.87). Similarly, compared with patients without significant fibrosis at baseline, patients with persistent significant fibrosis had increased mortality (adjusted HR, 4.03; 95% CI, 1.86-8.72) but not if fibrosis improved from F2 to F4 to F0 to F1 (adjusted HR; 1.49; 95% CI, 0.52-4.24).
CONCLUSION
Histologic remission of MASH or significant fibrosis improves survival after bariatric surgery.
背景与目的
本研究旨在调查代谢功能障碍相关脂肪性肝炎（MASH）的组织学进展和纤维化对减肥手术后长期生存的影响。
方法
1994年至2021年，里尔大学医院前瞻性纳入了3028例患者。系统性地进行了基线肝活检，并在术后1年建议进行随访活检，主要针对患有MASH的患者。我们使用Cox回归模型评估了MASH的基线和1年组织学进展、纤维化状态与长期生存之间的关联。
结果
基线时，2641例患者（89%）进行了活检，其中232例患有MASH（8.7%），266例（10.8%）有显著纤维化（F2 - F4级）。中位随访时间为10.1年。1年后，594例患者进行了定性配对活检。在15年随访时，基线患有MASH的患者的生存期比未患MASH的患者短（风险比[HR]，2.21；95%置信区间[CI]，1.38 - 3.53），F2至F4级纤维化患者的生存期比F0至F1级患者短（HR，3.38；95% CI，2.24 - 5.10）。在1年的标志性分析中，与基线无MASH的患者相比，持续患有MASH和/或纤维化恶化的患者死亡率增加（调整后HR，2.54；95% CI，1.06 - 6.10），但MASH缓解且纤维化未恶化的患者死亡率未增加（调整后HR，0.73；95% CI，0.28 - 1.87）。同样，与基线无显著纤维化的患者相比，持续存在显著纤维化的患者死亡率增加（调整后HR，4.03；95% CI，1.86 - 8.72），但纤维化从F2至F4改善为F0至F1的患者死亡率未增加（调整后HR；1.49；95% CI，0.52 - 4.24）。
结论
MASH或显著纤维化的组织学缓解可改善减肥手术后的生存情况。
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