Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome
Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome
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DOI：
10.1097/01.sla.0000179652.07502.3f
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发表时间：
2005-10-01
影响因子：
9
通讯作者：
Schauer, PR
中科院分区：
文献类型：
--
作者：
Mattar, SG;Velcu, LM;Schauer, PR
目标：为了评估手术减肥对严重肥胖患者脂肪肝的影响，摘要背景资料：非酒精性脂肪肝（NAFLD），一种扩展到肝纤维化和肝硬化的疾病，正在以惊人的速度上升。这种增加与严重肥胖的增加同时发生，并且可能部分由代谢综合征（MS）介导。手术减肥手术，可能是通过逆转MS，已被证明会导致肝脏组织学的改善，方法：从1999年3月至2004年8月接受腹腔镜手术减肥手术的患者，谁同意有一个术中肝活检，然后至少有一个术后肝活检，包括在内。所有患者均接受腹腔镜手术，大多数为腹腔镜Roux-en-Y胃旁路术。第二次活检时平均体重减轻59% +/- 22%，活检间隔时间为15 - 9个月。代谢综合征的患病率从70%降至14%（P < 0.001），肝脏脂肪变性（从88%降至8%）、炎症（从23%降至2%）和纤维化（从31%降至13%;均P < 0.001）显著改善。炎症和纤维化分别在37%和20%的患者中得到解决，对应于82%（P < 0.001）的分级改善和39%（P < 0.001）的肝病分期。患者这些有益的变化可能与代谢综合征患病率的显著降低有关。
Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients.Summary Background Data: Nonalcoholic fatty liver disease (NAFLD), a spectrum that extends to liver fibrosis and cirrhosis, is rising at an alarming rate. This increase is occurring in conjunction with the rise of severe obesity and is probably mediated in part by metabolic syndrome (MS). Surgical weight loss operations, probably by reversing MS, have been shown to result in improvement in liver histology,Methods: Patients who underwent laparoscopic surgical weight loss operations from March 1999 through August 2004, and who agreed to have an intraoperative liver biopsy followed by at least one postoperative liver biopsy, were included.Results: There were 70 patients who were eligible. All patients underwent laparoscopic operations, the majority being laparoscopic Roux-en-Y gastric bypass. The mean excess body weight loss at time of second biopsy was 59% +/- 22% and the time interval between biopsies was 15 9 months. There was a reduction in prevalence of metabolic syndrome, from 70% to 14% (P < 0.001), and a marked improvement in liver steatosis (from 88% to 8%), inflammation (from 23% to 2%), and fibrosis (from 31% to 13%; all P < 0.001). Inflammation and fibrosis resolved in 37% and 20% of patients, respectively, corresponding to improvement of 82% (P < 0.001) in grade and 39% (P < 0.001) in stage of liver disease.Conclusion: Surgical weight loss results in significant improvement of liver morphology in severely obese. patients. These beneficial changes may be associated with a significant reduction in the prevalence of the metabolic syndrome.