Incidence and risk factors of nonalcoholic fatty liver disease after total pancreatectomy: A first multicenter prospective study in Japan
Incidence and risk factors of nonalcoholic fatty liver disease after total pancreatectomy: A first multicenter prospective study in Japan
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DOI：
10.1002/jhbp.1093
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发表时间：
2021-12-15
影响因子：
3
通讯作者：
Takeyama, Yoshifumi
中科院分区：
文献类型：
--
作者：
Kato, Hiroyuki;Kamei, Keiko;Takeyama, Yoshifumi
背景/目的本研究旨在前瞻性评估全胰腺切除术（TP）后非酒精性脂肪性肝病（NAFLD）的患病率和危险因素。方法2015年8月至2017年12月期间，我们前瞻性地收集了来自68家日本中心的148名接受TP的连续患者的数据，这些患者的计算机断层扫描（CT）衰减值被评估了12个月。我们将TP后NAFLD定义为肝实质CT值小于40 Hounsfield单位（HU）。从所有患者中检索有关围手术期变量的数据，并使用单变量和多变量分析进行评估，以确定NAFLD的围手术期风险因素。结果148例患者术后均补充胰外分泌酶，97%的患者术后给予高滴度胰脂肪酶（中位剂量1800 mg）治疗。事实上，29例患者（19.6%）在TP后一年内发生NAFLD。多变量分析显示，女性（P = 0.002）、较高的体重指数（BMI）（P = 0.001）和术后腹泻（P = 0.038）是TP后NAFLD的独立危险因素。然而，术后12个月，11例患者（37.9%）的TP后NAFLD改善。结论在有女性、高BMI、术后腹泻等危险因素的患者中，应注意TP后NAFLD的发生。
Background/Purpose In the present study we aimed to prospectively assess the current prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD) after total pancreatectomy (TP). Methods Between August 2015 and December 2017, we prospectively collected data from 68 Japanese centers on 148 consecutive patients who underwent TP whose computed tomography (CT) attenuation values were evaluated for 12 months. We defined post-TP NAFLD as a liver parenchyma CT value of less than 40 Hounsfield units (HU). Data on perioperative variables were retrieved from all patients and evaluated using univariate and multivariate analyses to identify the perioperative risk factors of NAFLD. Results In this prospective cohort study, supplementation of pancreatic exocrine enzymes was provided to all 148 patients, and 97% of them were treated with high-titer pancrelipase (median dosage: 1800 mg) postoperatively. Indeed, 29 patients (19.6%) developed NAFLD within a year after TP. Multivariate analysis revealed that female sex (P = .002), higher body mass index (BMI) (P = .001), and postoperative diarrhea (P = .038) were independent risk factors for post-TP NAFLD. However, post-TP NAFLD ameliorated in 11 patients (37.9%) at 12 months after surgery. Conclusions Among patients with risk factors such as female sex, higher BMI, and postoperative diarrhea, attention should be paid to the occurrence of NAFLD after TP.