Krönert Natalie, Moulla Yusef, Lange Undine Gabriele, Blüher Matthias, Linder Nicolas, Fuhrmann Alexander, Busse Harald, Linder Anna, Karlas Thomas, Wiegand Johannes, Morgenroth Roland, Seidemann Lena, Dietrich Arne
Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany.
Department of Endocrinology, Nephrology, Rheumatology, Leipzig University Hospital, Leipzig, Germany.
Langenbecks Arch Surg. 2025 Jan 13;410(1):36. doi: 10.1007/s00423-024-03600-9.
Obesity and type 2 diabetes (T2DM) are major risk factors for hepatic steatosis. Diet or bariatric surgery can reduce liver volume, fat content, and inflammation. However, little is known about their effects on liver function, as evaluated here using the LiMAx test.
In the MetaSurg study (RCT on the effects of different Roux-en-Y gastric bypass (RYGB) limb lengths on diabetes remission in patients with BMI ≥ 27 to ≤ 60 kg/m and T2DM; trial registration: DRKS00007810, German Clinical Trials Register Freiburg), 24 consecutive patients underwent liver function (LiMAx) and imaging assessments (MRI, transient elastography; TE) before and after diet and surgery. Two weeks before surgery, the patients received a hypocaloric protein-rich diet.
Nine of 18 patients had a pathologic LiMAx value (≤ 315 µg/kg/h) at baseline. After two weeks of diet, LiMAx values improved (p = 0.01, paired t test, n = 15). LiMAx values further recovered six months after RYGB (p = 0.01, paired t test, n = 15), which was accompanied by decreased liver volumes (p = 0.005, paired t test, n = 10), proton density fat fraction (p = 0.003, paired t test, n = 12), and TE measurements (p = 0.032, paired t test, n = 14). The need for medical diabetes treatment decreased from 100 to 35%.
Liver function improved after a two-week hypocaloric protein-rich diet and metabolic surgery in patients with obesity and T2DM. These data suggest that a two-week diet for this group of patients prior to abdominal surgery could improve a presumably impaired liver function.
肥胖和2型糖尿病（T2DM）是肝脂肪变性的主要危险因素。饮食或减肥手术可减少肝脏体积、脂肪含量和炎症。然而，对于它们对肝功能的影响知之甚少，本文使用LiMAx试验对此进行评估。
在MetaSurg研究（一项关于不同Roux-en-Y胃旁路术（RYGB）肠袢长度对BMI≥27至≤60kg/m且患有T2DM患者糖尿病缓解影响的随机对照试验；试验注册号：DRKS00007810，德国临床试验注册中心弗赖堡）中，24例连续患者在饮食和手术前后接受了肝功能（LiMAx）和影像学评估（MRI、瞬时弹性成像；TE）。手术前两周，患者接受低热量高蛋白饮食。
18例患者中有9例在基线时LiMAx值病理性降低（≤315μg/kg/h）。饮食两周后，LiMAx值有所改善（p = 0.01，配对t检验，n = 15）。RYGB术后6个月LiMAx值进一步恢复（p = 0.01，配对t检验，n = 15），同时肝脏体积减小（p = 0.005，配对t检验，n = 10），质子密度脂肪分数降低（p = 0.003，配对t检验，n = 12），TE测量值降低（p = 0.032，配对t检验，n = 14）。糖尿病药物治疗的需求从100%降至35%。
肥胖和T2DM患者在接受两周低热量高蛋白饮食和代谢手术后肝功能得到改善。这些数据表明，该组患者在腹部手术前进行两周饮食可改善可能受损的肝功能。
