Prevalence of nonalcoholic steatohepatitis in Japanese patients with morbid obesity undergoing bariatric surgery
Prevalence of nonalcoholic steatohepatitis in Japanese patients with morbid obesity undergoing bariatric surgery
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DOI：
10.1007/s00535-015-1114-8
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发表时间：
2016-03-01
影响因子：
6.3
通讯作者：
Kasama, Kazunori
中科院分区：
文献类型：
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作者：
Seki, Yosuke;Kakizaki, Satoru;Kasama, Kazunori
背景：选择接受减肥手术的病态肥胖患者非酒精性脂肪性肝炎（NASH）的患病率较高;然而，发病率各不相同，并取决于种族。NASH在日本肥胖患者中的患病率尚不清楚。我们评估了NASH的患病率在一个前瞻性队列的日本患者病态obesity.Methods从2009年10月至2011年7月，连续患者需要减肥手术进行了肝活检手术过程中。减肥手术的适应症遵循亚太代谢和减肥手术society.Results102例（55男47女，年龄42.7 +/- 10.7岁）的指南进行了分析。平均体重指数为42.1 ± 8.2 kg/m2。在102例患者中，84例患者（82.4%）患有非酒精性脂肪性肝病，79例患者（77.5%）患有NASH。根据Brunt分类的NASH分级和分期如下：0级脂肪变性，1例患者; 1级脂肪变性，35例患者; 2级脂肪变性，32例患者; 3级脂肪变性，11例患者; 1期纤维化，25例患者; 2期纤维化，38例患者; 3期纤维化，16例患者，4期纤维化，无患者。与非NASH组相比，NASH组的体重、腰臀比、内脏脂肪面积、天冬氨酸转氨酶、丙氨酸转氨酶、c-谷氨酰转肽酶、空腹血糖、空腹血浆胰岛素、C肽、血红蛋白A1 c和稳态模型评估胰岛素抵抗水平显著升高。NASH组血小板计数显著降低。腰臀比和丙氨酸氨基转移酶，空腹血糖，和稳态模型评估胰岛素抵抗水平被认为是独立的预测NASH在多变量analysis.Conclusion NASH的患病率为77.5%，在这个前瞻性的日本队列。日本病态肥胖患者NASH的患病率极高，应进行早期干预。
Background Patients with morbid obesity selected for bariatric surgery have a high prevalence of nonalcoholic steatohepatitis (NASH); however, the incidence is varied and depends on race. The prevalence of NASH in obese Japanese patients is unknown. We evaluated the prevalence of NASH in a prospective cohort of Japanese patients with morbid obesity.Methods From October 2009 to July 2011, consecutive patients requiring bariatric surgery underwent a liver biopsy during the operation. The indications for bariatric surgery followed the guidelines of the Asia-Pacific Metabolic and Bariatric Surgery Society.Results One hundred two patients (55 males and 47 females, age 42.7 +/- 10.7 years) were analyzed. The mean body mass index was 42.1 +/- 8.2 kg/m(2). Among the 102 patients, 84 patients (82.4 %) had nonalcoholic fatty liver disease and 79 patients (77.5 %) had NASH. The grading and staging of NASH by Brunt's classification were as follows: grade 0 steatosis, one patient; grade 1 steatosis, 35 patients; grade 2 steatosis, 32 patients; grade 3 steatosis, 11 patients; stage 1 fibrosis, 25 patients; stage 2 fibrosis, 38 patients; stage 3 fibrosis, 16 patients, stage 4 fibrosis, no patients. The body weight, waist-hip ratio, visceral fat area, and aspartate aminotransferase, alanine aminotransferase, c-glutamyl transpeptidase, fasting plasma glucose, fasting plasma insulin, C peptide, hemoglobin A1c, and homeostasis model assessment insulin resistance levels were significantly elevated in the NASH group in comparison with the non-NASH group. The platelet count was significantly decreased in the NASH group. The waist-hip ratio and the alanine aminotransferase, fasting plasma glucose, and homeostasis model assessment insulin resistance levels were found to be independent predictors of NASH in a multivariate analysis.Conclusion The prevalence of NASH was 77.5 % in this prospective Japanese cohort. The prevalence of NASH in Japanese morbidly obese patients was extremely high, and early intervention should be undertaken.