替尔泊肽与减肥代谢手术治疗成人代谢相关脂肪性肝病和肥胖症的比较疗效：一项多机构倾向评分匹配研究
Comparative effectiveness of tirzepatide versus bariatric metabolic surgery in adults with metabolic-associated steatotic liver disease and obesity: a multi-institutional propensity score-matched study.
作者信息
Wu Jheng-Yan, Lin Yu-Min, Hsu Wan-Hsuan, Liu Ting-Hui, Tsai Ya-Wen, Huang Po-Yu, Chuang Min-Hsiang, Yu Tsung, Lai Chih-Cheng
机构信息
Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
Hepatol Int. 2025 Jul 16. doi: 10.1007/s12072-025-10857-9.
OBJECTIVE
This study compared the clinical outcomes of tirzepatide versus bariatric metabolic surgery (BMS) in adults with metabolic-associated steatotic liver disease (MASLD) and obesity.
METHODS
A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients with MASLD and obesity were stratified into tirzepatide and BMS groups. Propensity score matching (PSM) was used to balance baseline characteristics. The primary outcome was a composite measure including all-cause mortality, major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and major adverse liver outcomes (MALO).
RESULTS
After PSM, 6199 patients were classified into each group (tirzepatide and BMS). The tirzepatide group showed a lower risk of the composite outcome, with an incidence rate of 1.9 per 100 person-years compared to 3.5 per 100 person-years in the BMS group (HR 0.47; 95% CI 0.36-0.61). Additionally, the incidence of all-cause mortality was lower in the tirzepatide group (0.4 vs. 0.9 per 100 person-years, HR 0.36, 95% CI 0.21-0.63). Similarly, MAKEs occurred less frequently in the tirzepatide group (0.7 vs. 1.8 per 100 person-years, HR 0.32, 95% CI 0.21-0.49), as did MALOs (0.8 vs. 2.0 per 100 person-years, HR 0.32, 95% CI 0.22-0.48).
CONCLUSIONS
Tirzepatide offers better clinical outcomes compared to BMS in adults with MASLD and obesity, significantly reducing all-cause mortality as well as kidney- and liver-related complications. These findings highlight tirzepatide as a promising alternative to BMS, offering a less invasive approach with potential benefits in managing MASLD and obesity. This study found that tirzepatide, a medication used to treat obesity and metabolic conditions, led to better health outcomes than bariatric surgery in adults with metabolic-associated steatotic liver disease (MASLD) and obesity. Patients treated with tirzepatide had lower risks of death and serious heart, kidney, and liver complications, suggesting it may be a safer, less invasive alternative to surgery.
目的
本研究比较了替尔泊肽与减重代谢手术（BMS）对患有代谢相关脂肪性肝病（MASLD）和肥胖症的成年人的临床疗效。
方法
使用TriNetX全球合作网络进行回顾性队列分析。将患有MASLD和肥胖症的患者分为替尔泊肽组和BMS组。采用倾向得分匹配（PSM）来平衡基线特征。主要结局是一项综合指标，包括全因死亡率、主要不良心血管事件（MACE）、主要不良肾脏事件（MAKE）和主要不良肝脏结局（MALO）。
结果
经过PSM后，每组（替尔泊肽组和BMS组）各有6199例患者。替尔泊肽组的综合结局风险较低，发生率为每100人年1.9例，而BMS组为每100人年3.5例（风险比[HR]0.47；95%置信区间[CI]0.36 - 0.61）。此外，替尔泊肽组的全因死亡率较低（每100人年0.4例对0.9例，HR 0.36，95% CI 0.21 - 0.63）。同样，MAKEs在替尔泊肽组中发生频率较低（每100人年0.7例对1.8例，HR 0.32，95% CI 0.21 - 0.49），MALOs也是如此（每100人年0.8例对2.0例，HR 0.32，95% CI 0.22 - 0.48）。
结论
对于患有MASLD和肥胖症的成年人，替尔泊肽与BMS相比具有更好的临床疗效，显著降低了全因死亡率以及与肾脏和肝脏相关的并发症。这些发现突出了替尔泊肽作为BMS的一种有前景的替代方案，提供了一种侵入性较小的方法，在管理MASLD和肥胖症方面具有潜在益处。本研究发现，用于治疗肥胖症和代谢性疾病的药物替尔泊肽，在患有代谢相关脂肪性肝病（MASLD）和肥胖症的成年人中，比减重手术带来更好的健康结局。接受替尔泊肽治疗的患者死亡以及严重心脏、肾脏和肝脏并发症的风险较低，这表明它可能是一种比手术更安全、侵入性更小的替代方案。
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