Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients:: A prospective study
Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients:: A prospective study
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DOI：
10.1007/s11695-007-9085-3
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发表时间：
2007-04-01
期刊：
影响因子：
2.9
通讯作者：
Coffin, Benoit
中科院分区：
文献类型：
--
作者：
Jouet, Pauline;Sabate, Jean-Marc;Coffin, Benoit
背景：病态肥胖是非酒精性脂肪性肝炎（NASH）的危险因素。阻塞性睡眠呼吸暂停（OSA）也可能是肝酶升高和NASH的独立危险因素。前瞻性研究了需要减肥手术的病态肥胖患者中肝损伤与OSA之间的关系。方法：2003年1月至2004年10月期间，纳入了所有需要减肥手术的病态肥胖患者（BMI ≥ 40 kg/m2或≥ 35 kg/m2，伴有严重合并症）。系统地进行多导生理记录、血清转氨酶（ALT、AST）、γ-谷氨酰转移酶（GGT）和肝活检。当呼吸暂停低通气指数（AHI）> 10/h时，存在OSA。结果：纳入62例患者（54例女性;年龄38.5 > 11.0（SD）岁; BMI 47.8 +/- 8.4 kg/m2）。肝酶（AST、ALT或GGT）升高者占46.6%。NASH占34.4%，OSA占84.7%。OSA患者年龄明显较大（P = 0.015），BMI较高（P = 0.003）。在多变量分析中，肝酶升高的危险因素是OSA和男性。NASH的存在是相似的患者或没有OSA（32.7%对44.4%的患者，P = 0.76）。结论：在这个队列的病态肥胖患者需要减肥手术，三分之一的患者有NASH，患病率类似于以前的研究。OSA被发现是肝酶升高的危险因素，但不是NASH的危险因素。
Background: Morbid obesity is a risk factor of nonalcoholic steatohepatitis (NASH). Obstructive sleep apnea (OSA) could also be an independent risk factor for elevated liver enzymes and NASH. The relationships between liver injuries and OSA in morbidly obese patients requiring bariatric surgery were studied prospectively.Methods: Every consecutive morbidly obese patient (BMI >= 40 kg/m(2) or >= 35 kg/m(2) with severe comorbidities) requiring bariatric surgery was included between January 2003 and October 2004. Polygraphic recording, serum aminotransferases (ALT, AST), gamma-glutamyltransferase (GGT) and liver biopsy were systematically performed. OSA was present when the apnea-hypopnea index (AHI) was > 10/h.Results: 62 patients (54 F; age 38.5 > 11.0 (SD) yrs; BMI 47.8 +/- 8.4 kg/m(2)) were included. Liver enzymes (AST, ALT or GGT) were increased in 46.6%. NASH was present in 34.4% and OSA in 84.7%. Patients with OSA were significantly older (P = 0.015) and had a higher BMI (P = 0.003). In multivariate analysis, risk factors for elevated liver enzymes were the presence of OSA and male sex. The presence of NASH was similar in patients with or without OSA (32.7% vs 44.4% of patients, P = 0.76).Conclusion: In this cohort of morbidly obese patients requiring bariatric surgery, one-third of patients had NASH, a prevalence similar to previous studies. OSA was found to be a risk factor for elevated liver enzymes but not for NASH.