Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy A Secondary Analysis of a Randomized Clinical Trial
Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy A Secondary Analysis of a Randomized Clinical Trial
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DOI：
10.1097/sla.0000000000002397
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发表时间：
2017-11-01
影响因子：
9
通讯作者：
Krawczyk, Marek
中科院分区：
文献类型：
--
作者：
Kalinowski, Piotr;Paluszkiewicz, Rafal;Krawczyk, Marek
目的：该研究的目的是在一项随机临床试验（NCT01806506）中比较袖式胃切除术（SG）与Roux-en-Y胃旁路术（RYGB）对非酒精性脂肪性肝病（NAFLD）肥胖患者肝功能的影响。背景：NAFLD或脂肪性肝炎（NASH）患者在减肥手术后体重迅速减轻和吸收不良可能损害肝功能。方法：66例随机分配到SG或RYGB的病态肥胖患者纳入次要结局分析。术中肝活检采用NAFLD活动评分（NAS）进行分类，术前、术后1个月、6个月和12个月分别进行肝功能检查。结果：54.5%的RYGB患者和51.5%的SG患者存在NASH （P < 0.05）。12个月时，SG组体重减轻68.7 +/- 19.7%，RYGB组体重减轻62.8 +/- 18.5% （P < 0.05）。RYGB治疗后1个月国际标准化比值（INR）升高（0.98 +/- 0.05 vs 1.14 +/- 0.11, P < 0.05）， SG治疗后1个月国际标准化比值（INR）升高（0.99 +/- 0.06 vs 1.04 +/- 0.06, P < 0.05）， RYGB治疗组及NASH患者INR升高明显高于SG治疗组。RYGB白蛋白在1个月后下降（41.2 +/- 2.7 vs 39.0 +/- 3.2 g/L; P < 0.05）。12个月时，INR和白蛋白恢复到基线水平。在NASH组12个月时，SG诱导天冬氨酸转氨酶（32.4 +/- 17.4 vs 21.5 +/- 6.9U/L）、丙氨酸转氨酶（39.9 +/- 28.6U/L vs 23.8 +/- 14.1U/L）、γ -谷氨酰转肽酶（34.3 +/- 16.6 vs 24.5 +/- 16.8U/L）和乳酸脱氢酶（510.8 +/- 33 vs 292.4 +/- 29）显著改善。预测1个月后INR变化的变量包括手术类型、NAS >= 5、胆红素、体重指数、糖化血红蛋白和血脂异常。结论：接受RYGB治疗的NASH患者比接受SG治疗的患者更容易发生早期一过性肝功能恶化。
Objectives: The aim of the study was to compare the influence of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on liver function in bariatric patients with non-alcoholic fatty liver disease (NAFLD) in a randomized clinical trial (NCT01806506).Background: Rapid weight loss and malabsorption after bariatric surgery in patients with NAFLD or steatohepatitis (NASH) may impair liver function.Methods: Sixty-six morbidly obese patients randomized to SG or RYGB were included in a secondary outcome analysis. Intraoperative liver biopsies were categorized with NAFLD Activity Score (NAS) and liver function tests were done before surgery and after 1, 6 and 12 months.Results: NASH was present in 54.5% RYGB and 51.5% SG patients (P > 0.05). At 12 months excess weight loss was 68.7 +/- 19.7% after SG and 62.8 +/- 18.5% after RYGB (P > 0.05). At 1 month international normalized ratio (INR) increased after RYGB (0.98 +/- 0.05 vs 1.14 +/- 0.11; P < 0.05) and SG (0.99 +/- 0.06 vs 1.04 +/- 0.06; P < 0.05), RYGB induced significantly greater increase in INR in the whole group and NASH patients than SG. After RYGB albumin decreased at 1 month (41.2 +/- 2.7 vs 39.0 +/- 3.2 g/L; P < 0.05). At 12 months, INR and albumin returned to baseline. At 12 months in NASH group, SG induced significant improvement in aspartate aminotransferase (32.4 +/- 17.4 vs 21.5 +/- 6.9U/L), alanine aminotransferase (39.9 +/- 28.6U/L vs 23.8 +/- 14.1U/L), gamma-glutamyl transpeptidase (34.3 +/- 16.6 vs 24.5 +/- 16.8U/L), and lactate dehydrogenase (510.8 +/- 33 vs 292.4 +/- 29). Variables predictive of INR change after 1 month included operation type, NAS >= 5, bilirubin, body mass index, hemoglobin A1C, and dyslipidemia.Conclusions: Patients with NASH undergoing RYGB are more susceptible to early transient deterioration of liver function than after SG.