Luyckx F H, Desaive C, Thiry A, Dewé W, Scheen A J, Gielen J E, Lefèbvre P J
Department of Clinical Chemistry, CHU Sart Tilman, University of Liège, Belgium.
Int J Obes Relat Metab Disord. 1998 Mar;22(3):222-6. doi: 10.1038/sj.ijo.0800571.
To examine the factors associated with liver steatosis in severely obese subjects and to test the potential reversibility of fatty liver after weight loss.
Retrospective clinical study.
528 obese patients before bariatric surgery and 69 obese subjects of the initial cohort evaluated before and 27+/-15 months after gastroplasty.
Fatty deposition (scored as mild, moderate or severe) and inflammatory changes were evaluated in liver biopsies; clinical (body mass index (BMI), age, gender, duration of obesity) and biological (glucose, triglycerides, liver enzymes) parameters were related to histological findings.
74% of the 528 biopsies showed fatty change, estimated as mild in 41% of cases, moderate in 32% and severe in 27%. The prevalence of steatosis was significantly higher in men than in women (91% vs 70%, P = 0.001) and in patients with impaired glucose tolerance or type 2 diabetes compared with nondiabetics (89% vs 69% P = 0.001). The severity of the steatosis was associated with BMI (P = 0.002) but not with the duration of obesity or the age of the patient. When compared with patients without fatty change, those with liver steatosis had significantly higher fasting plasma glucose (5.5 mmol/l vs 5.1 mmol/l, P = 0.007) and triglycerides (1.8 mmol/l vs 1.3 mmol/l, P = 0.002). Mean serum liver enzyme activities (alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl-transpeptidase (gammaGT) were significantly (P < 0.001) increased in patients with fatty change but remained within laboratory reference values. In the 69 patients who have been evaluated after a marked weight reduction (-32+/-19kg), 45% of the biopsies were considered as normal (vs 13% before, P < 0.001) while pure fatty change was still observed in 38% of the patients (vs 83% before, P = 0.001). However, the severity of the steatosis was significantly (P < 0.001) reduced (mild: 62% vs 21%; moderate: 23% vs 37%; severe: 15% vs 42%). In addition, a significant increase of hepatitis was observed in 26% of the biopsies (vs 14% before, P < 0.05).
Liver steatosis in obese subjects is associated with men, diabetic status, BMI, higher fasting glucose and hypertriglyceridaemia. Postgastroplasty weight loss reduces liver steatosis, but seems to increase the incidence of inflammatory lobular hepatitis.
研究重度肥胖患者肝脂肪变性的相关因素，并测试体重减轻后脂肪肝的潜在可逆性。
回顾性临床研究。
528例接受减肥手术前的肥胖患者，以及初始队列中的69例肥胖受试者，在胃成形术前和术后27±15个月进行评估。
在肝活检中评估脂肪沉积（分为轻度、中度或重度）和炎症变化；临床指标（体重指数（BMI）、年龄、性别、肥胖持续时间）和生物学指标（血糖、甘油三酯、肝酶）与组织学结果相关。
528例活检中有74%显示脂肪变化，41%的病例估计为轻度，32%为中度，27%为重度。男性脂肪变性的患病率显著高于女性（91%对70%，P = 0.001），糖耐量受损或2型糖尿病患者与非糖尿病患者相比也更高（89%对69%，P = 0.001）。脂肪变性的严重程度与BMI相关（P = 0.002），但与肥胖持续时间或患者年龄无关。与无脂肪变化的患者相比，有肝脂肪变性的患者空腹血糖（5.5 mmol/L对5.1 mmol/L，P = 0.007）和甘油三酯（1.8 mmol/L对1.3 mmol/L，P = 0.002）显著更高。脂肪变化患者的平均血清肝酶活性（碱性磷酸酶、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和γ-谷氨酰转肽酶（γGT））显著升高（P < 0.001），但仍在实验室参考值范围内。在69例体重显著减轻（-32±19kg）后接受评估的患者中，45%的活检被认为正常（术前为13%，P < 0.001），而仍有38%的患者观察到单纯脂肪变化（术前为83%），P = 0.001）。然而，脂肪变性的严重程度显著降低（P < 0.001）（轻度：62%对21%；中度：23%对37%；重度：15%对42%）。此外，26%的活检中观察到肝炎显著增加（术前为该14%，P < 0.05）。
肥胖患者的肝脂肪变性与男性、糖尿病状态、BMI、空腹血糖升高和高甘油三酯血症有关。胃成形术后体重减轻可减少肝脂肪变性，但似乎会增加小叶性肝炎的发生率。
