Bornia Matavelli Christian, Echeverria Luisa Souza, Pereira Luca Maunsell, Chrispim Isadora, Mounzer Daniel Leandro Saran, Chaim Felipe David Mendonça, Chaim Elinton Adami, Utrini Murillo Pimentel, Gestic Martinho Antonio, Callejas-Neto Francisco, Cazzo Everton
State University of Campinas, Campinas, Brazil.
Pontifícia Universidade Católica de Campinas, Campinas, Brazil.
Obes Surg. 2025 Mar;35(3):926-933. doi: 10.1007/s11695-025-07688-w. Epub 2025 Jan 27.
Metabolic dysfunction-associated steatotic liver disease (MASLD) includes simple steatosis and metabolic dysfuncion-associated steatohepatitis (MASH), with fibrosis in MASH serving as a critical prognostic marker. This study investigates the effects of Roux-en-Y gastric bypass (RYGB) on fibrotic MASH, assessed using the fibrotic NASH index (FNI) and the non-invasive NASH detection score (NI-NASH-DS), as well as provides further data on the diagnostic accuracy of both scores.
A retrospective cohort study was conducted involving 104 individuals (91.3% female, mean age 39.4 ± 8.6 years) who underwent RYGB. Histopathological evaluations during surgery identified fibrotic MASH, and FNI and NI-NASH-DS values were calculated at baseline and 1 year post-surgery.
At the time of surgery, participants had a mean BMI of 35.3 ± 2.8 kg/m, which decreased to 27.1 ± 4.0 kg/m 1 year after surgery. The mean % total weight loss (%TWL) was 23.8 ± 10.1%, and the mean % excess weight loss (%EWL) was 82.4 ± 37.3%. Fibrotic MASH was present in 17.3% of participants pre-operatively. The mean FNI score significantly decreased after surgery (p < 0.0001). Female gender (p < 0.001) and histological evidence of lobular inflammation (p < 0.001) were independently associated with the improvement of FNI. The FNI demonstrated high diagnostic accuracy (sensitivity: 61.1%, specificity: 96.4%, overall accuracy: 90.2%). NI-NASH-DS had a 60% accuracy in detecting MASH, alongside an 85.9% specificity.
RYGB seemingly promotes improvement of fibrotic MASH as evaluated by FNI, highlighting its potential as a therapeutic intervention to mitigate MASLD progression. Both FNI and NI-NASH-DS are helpful and inexpensive tools for assessing MASH.
代谢功能障碍相关脂肪性肝病（MASLD）包括单纯性脂肪变性和代谢功能障碍相关脂肪性肝炎（MASH），MASH中的纤维化是一个关键的预后指标。本研究调查了Roux-en-Y胃旁路术（RYGB）对纤维化MASH的影响，使用纤维化非酒精性脂肪性肝炎指数（FNI）和非侵入性非酒精性脂肪性肝炎检测评分（NI-NASH-DS）进行评估，并提供了这两种评分诊断准确性的进一步数据。
进行了一项回顾性队列研究，纳入104例接受RYGB手术的个体（91.3%为女性，平均年龄39.4±8.6岁）。手术期间的组织病理学评估确定了纤维化MASH，并在基线和术后1年计算FNI和NI-NASH-DS值。
手术时，参与者的平均体重指数（BMI）为35.3±2.8kg/m²，术后1年降至27.1±4.0kg/m²。平均总体重减轻百分比（%TWL）为23.8±10.1%，平均多余体重减轻百分比（%EWL）为82.4±37.3%。术前17.3%的参与者存在纤维化MASH。术后FNI评分显著降低（p<0.0001）。女性（p<0.001）和小叶炎症的组织学证据（p<0.001）与FNI的改善独立相关。FNI显示出较高的诊断准确性（敏感性：61.1%，特异性：96.4%，总体准确性：90.2%）。NI-NASH-DS在检测MASH方面的准确性为60%，特异性为85.9%。
RYGB似乎能促进FNI评估的纤维化MASH的改善，凸显了其作为减轻MASLD进展的治疗干预措施的潜力。FNI和NI-NASH-DS都是评估MASH的有用且廉价的工具。
