减肥手术与GLP-1受体激动剂在降低非酒精性脂肪性肝炎新发风险方面的比较效果：一项来自北美和欧洲的回顾性多国队列研究。
Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe.
作者信息
Hussein Abdallah, Awashra Ameer, Rajab Islam, Bdair Mohammad, Hamdan Dawoud, Nouri Ahmad, Khatib Elaf, Khatib Ghiras, Latt Nyan
机构信息
Internal Medicine Department, Virtua Health Inc., Voorhees, New Jersey, USA.
Department of Medicine, An Najah National University, Nablus, Palestine.
出版信息
Endocrinol Diabetes Metab. 2025 Jul;8(4):e70075. doi: 10.1002/edm2.70075.
BACKGROUND
Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.
METHODS
This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.
RESULTS
Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099-0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469-0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696-1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.
CONCLUSIONS
These findings suggest that BS was significantly associated with lower risk of new onset of NASH/NAFLD.
背景
非酒精性脂肪性肝炎（NASH）是一种严重的非酒精性脂肪性肝病（NAFLD），可进展为肝硬化和肝细胞癌（HCC）。肥胖是NASH的主要危险因素，人们已经探索了代谢干预措施，如减肥手术（BS）和胰高血糖素样肽-1受体激动剂（GLP-1 RAs）对肝脏相关结局的影响。本研究评估了BS和GLP-1 RAs在降低新发NASH及相关肝脏并发症发生率方面的相对有效性。
方法
这是一项基于人群的大型回顾性队列研究，使用来自TriNetX平台的数据。纳入2014年1月1日至2019年12月31日期间接受BS或GLP-1RA治疗、体重指数（BMI）≥35且无NAFLD/NASH（无肝硬化）病史的成年患者。通过1:1倾向匹配，将BS组患者与GLP-1RA组患者按年龄、人口统计学、合并症和用药情况进行匹配。
结果
在180,022名符合条件的成年人中，143,404人接受了BS治疗，36,618人接受了GLP-1RA治疗。倾向得分匹配后，BS组的33,594名患者（平均年龄49.1±13.2岁；72.73%为女性）与GLP-1RA组同等数量的个体（平均年龄48.9±14.岁；72.41%为女性）进行了匹配。与接受GLP-1RA治疗的患者相比，接受BS治疗的患者发生HCC的风险显著更低（HR，0.304；95%CI，0.099-0.931），显示出最强的保护作用，其次是NASH显著降低（HR，0.509；95%CI，0.469-0.551）。肝硬化风险的降低无统计学意义（HR，0.865；95%CI，0.696-1.075）。这些关联在1年、3年、5年和7年的随访期内均持续存在。
结论
这些发现表明，BS与新发NASH/NAFLD的较低风险显著相关。
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