代谢性手术治疗重度肥胖伴非酒精性脂肪性肝病患者的疗效观察

Effect of metabolic surgery in treatment of severe obesity with nonalcoholic fatty liver disease

目的:探讨腹腔镜下袖状胃切除术(LSG)对肥胖伴非酒精性脂肪性肝病(NAFLD)及代谢紊乱的治疗作用。方法:回顾性分析2012年12月至2017年6月在同济大学附属第十人民医院收治的行LSG手术的108例重度肥胖伴NAFLD患者的临床资料。其中,女性66例,男性42例,平均年龄(32.5±10.5)岁,术前体质量指数(BMI)39.2±5.2。观察术前和术后1、3、6及12个月的人体各项基础指标、糖代谢指标及胰岛素分泌水平、脂代谢指标、肝脏酶谱及脂肪肝变化。手术前、后临床指标的比较采用配对样本t检验。结果:与术前相比,术后1~12个月患者的人体测量学指标、总胆固醇(TC)、三酰甘油(TG)、空腹胰岛素(FINS)、稳态模型评估胰岛素抵抗指数(HOMA-IR)及糖化血红蛋白(Hb A1c)均显著降低(均P<0.05)。术后3个月,患者高密度脂蛋白胆固醇(HDL-C)水平显著增加,而空腹血糖(FPG)水平显著下降。术后12个月,患者低密度脂蛋白胆固醇(LDL-C)水平较术前下降明显(均P<0.05)。术前肥胖并肝功能异常者63例,丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及γ-谷氨酰转移酶(GGT)水平术后3个月完全恢复正常。完成1年随访的患者中20例NAFLD患者完全康复,部分患者得到显著改善。结论:LSG在有效减重的同时,能显著改善NAFLD、肝功能异常及糖、脂代谢紊乱。

Objective To investigate the effect of laparoscopic sleeve gastrectomy （LSG） on severe obesity with nonalcoholic fatty liver disease （NAFLD） and metabolic derangement. Methods Retrospective analysis was performed on 108 severely obese patients with NAFLD undergoing LSG in Shanghai Tenth People＇s Hospital, Tongji University Medical School from December 2012 to June 2017. Of them 66 were females and 42 were males, with an average age of （32.5±10.5） years old and an average body mass index of 39.2±5.2. The anthropometric indexes, glucose metabolic indices and insulin secretion level, lipid profile, liver enzymes [alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, and γ-glutamyltransferase （GGT）] and fatty liver were examined preoperatively and 1, 3, 6 and 12 months postoperatively. Data before and after surgery were compared using paired-sample t test. Results At 1-12 months after operation, the anthropometric indexes, total cholesterol （TC）, triglyceride （TG）, fasting insulin （FINS）, homeostasis model assessment-insulin resistance index （HOMA-IR） and hemoglobin A1c （HbA1c） levels were significantly decreased compared with those before surgery（P〈0.05）. At 3 months after surgery, high density lipoprotein-cholesterol （HDL-C） level increased significantly and fasting plasma glucose （FPG） decreased significantly. At 12 months after surgery, low density lipoprotein-cholesterol （LDL-C） level was significantly lower than that before surgery（P〈0.05）. In addition, for those with abnormal liver function（n=63）, the ALT, AST, and GGT levels had complete recovery 3 months after LSG. One year after LSG, 20 of those who completed 1 year follow up obtained complete remission of fatty liver, and most patients obtained significant improvement. Conclusions LSG not only can decrease weight effectively, but also can improve NAFLD, liver function, and glycolipid metabolism significantly.