Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis
Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis
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DOI：
10.1016/j.surg.2003.10.003
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发表时间：
2004-01-01
期刊：
影响因子：
3.8
通讯作者：
Marceau, P
中科院分区：
文献类型：
--
作者：
Kral, JG;Thung, SN;Marceau, P
背景减肥和胃肠道手术治疗肥胖都可能导致肝脏疾病，这使得它们在治疗肥胖相关肝脏疾病中的作用存在争议。689例重度肥胖女性（n = 55 1）和男性（n = 138），BMI = 4 7 9 kg m（-2）（平均值+/- SD），无已知肝脏疾病，接受了胆胰分流术（BPD）和肝活检。14名患者（2%）有隐源性肝硬化，其中11人进行了多次重复活检。体重减轻38 ± 18 kg后，689例患者中的104例在BPD后41 ± 25个月再次手术期间接受了常规第二次活检。所有的活检标本由一位不知情的肝脏病理学家进行钙化、纤维化和炎症分级。所有689名患者体重减轻，代谢综合征改善。在104例接受再次手术的患者中，28例重度纤维化（3-5级）减少，而42例出现轻度纤维化（1-2级）。纤维化增加与血清白蛋白正常值偏低、腹泻不受控制、饮酒量少和绝经状态有关。纤维化和炎症随着时间的推移而减少（P
Background. Both weight loss and gastrointestinal surgery for obesity can cause liver disease, making their role in the treatment of obesity-related liver disease controversial.Methods. Six hundred eighty-nine severely obese women (n = 55 1) and men (n = 138), BMI = 4 7 9 kg m(-2) (mean +/- SD), without known liver disease, underwent biliopancreatic diversion (BPD) with liver biopsy. Fourteen patients (2%) had cryptogenic cirrhosis, 11 of whom underwent multiple repeat biopsies. After 38 18 kg weight loss, 104 of the 689 patients underwent routine second biopsies during reoperations 41 +/- 25 months after BPD. All biopsy specimens were graded for stealosis, fibrosis, and inflammation by a blinded hepatopathologist.Results. All 689 patients lost weight accompanied by improvements in the metabolic syndrome. Among the 104 patients who underwent reoperation, severe fibrosis (grade 3-5) decreased in 28 whereas mild fibrosis (grade 1-2) appeared in 42. Increased fibrosis was related to low-normal serum albumin, uncontrolled diarrhea, low intake of alcohol, and menopausal status. Fibrosis and inflammation decreased over time (P