Syed-Abdul Majid M, Moore Mary P, Wheeler Andrew, Ganga Rama R, Diaz-Arias Alberto, Rector R Scott, Ibdah Jamal A, Parks Elizabeth J
Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA.
Research Services-Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA.
AME Surg J. 2021 Jun 30;1. doi: 10.21037/asj-20-5.
Metabolic surgeries are regularly performed as a treatment for morbid obesity and have been shown to improve nonalcoholic fatty liver disease (NAFLD). The present case study aimed to evaluate the changes in hepatic fatty acid oxidation (FAO) before and 12-months after metabolic surgery in a patient who exhibited characteristics of NAFLD. A 34 year-old female with a body mass of 68.0 kg/m underwent metabolic surgery (sleeve gastrectomy) and a blood sample and liver biopsy were obtained at the time of surgery. All procedures occurred without incident. Liver tissue was scored histologically to determine the extent of NAFLD using the NAFLD Activity Score (NAS) and fibrosis staging (NAS =5; Fibrosis =1). A follow-up liver biopsy and a blood sample were obtained at 12 months when she had roux-en-Y gastric bypass (RYBG). Hepatic FAO in whole liver lysate and isolated mitochondria was measured ex vivo at baseline and at 12-month. At 12-month post-metabolic surgery, the patient had lost 19% of her body weight (BMI 68.0 to 55.2 kg/m), and she exhibited lower concentrations of fasting plasma glucose (-16%), triglycerides (TG) (-17%), HbA1c (-4%), aspartate transaminase (AST) (-39%), and alanine aminotransferase (ALT) (-42%). Liver fat was reduced by 18% as measured via FibroScan. FAO in whole liver samples and in isolated hepatic mitochondria increased 1.6- and 4.2-fold, respectively. Histologically, NAS and fibrosis scores were markedly improved at 12-month (NAS =0; Fibrosis =0). This case highlights the significant improvements in liver histology that can occur following metabolic surgery in conjunction with an increased capacity for hepatic FAO. Thus, metabolic surgery-induced weight loss may be an effective therapy to treat NAFLD, in part due to improvements in hepatic mitochondrial function. ClinicalTrials.gov Identifier: NCT03151798.
代谢手术经常被用于治疗病态肥胖症，并且已被证明可以改善非酒精性脂肪性肝病（NAFLD）。本病例研究旨在评估一名具有NAFLD特征的患者在代谢手术前和术后12个月肝脏脂肪酸氧化（FAO）的变化。一名体重指数为68.0 kg/m²的34岁女性接受了代谢手术（袖状胃切除术），手术时采集了血样和肝活检样本。所有操作均顺利进行。使用非酒精性脂肪性肝病活动评分（NAS）和纤维化分期对肝组织进行组织学评分以确定NAFLD的程度（NAS = 5；纤维化 = 1）。12个月后她接受了 Roux-en-Y 胃旁路术（RYBG）时，再次进行了肝活检和血样采集。在基线和12个月时，对全肝裂解物和分离的线粒体中的肝脏FAO进行离体测量。代谢手术后12个月，患者体重减轻了19%（体重指数从68.0降至55.2 kg/m²），空腹血糖（-16%）、甘油三酯（TG）（-17%）、糖化血红蛋白（HbA1c）（-4%）、天冬氨酸转氨酶（AST）（-39%）和丙氨酸转氨酶（ALT）（-42%）的浓度均降低。通过FibroScan测量，肝脏脂肪减少了18%。全肝样本和分离的肝线粒体中的FAO分别增加了1.6倍和4.2倍。组织学上，12个月时NAS和纤维化评分显著改善（NAS = 0；纤维化 = 0）。该病例突出了代谢手术后肝脏组织学的显著改善，同时肝脏FAO能力增强。因此，代谢手术引起的体重减轻可能是治疗NAFLD的有效疗法，部分原因是肝脏线粒体功能的改善。ClinicalTrials.gov标识符：NCT03151798。
