胃减容手术对重度肥胖患者脂肪肝及代谢紊乱的效应初探

Effect of laparoscopic vertical banding gastroplasty on hepatic steatosis and metabolic abnormalities in morbidly obese patients

目的 通过对重度肥胖伴脂肪肝患者垂直束带式腹腔镜胃减容术 (LVBG)前及术后 1年的随访研究 ,探讨胃减容手术对重度肥胖患者脂肪肝及代谢紊乱的效应初探。方法 比较 11例重度肥胖患者LVBG术后 1年体重、BMI、腰围、空腹血糖 (FPG)、空腹胰岛素 (FINS)、胰岛素抵抗指数 (HOMA IR)、空腹血脂、肝脏酶谱及肝平均CT值的变化。结果 术后患者体重、BMI、腰围均明显下降 ( P <0 0 1) ;空腹胰岛素、HOMA IR及TG降低 (P <0 0 5 ) ;术后肝平均CT值升高 (P <0 0 1)。空腹胰岛素及HOMA IR的降低与腰围的减少相关 (P <0 0 1) ,与肝CT值的增加相关 (P <0 0 5 )。结论 单纯性重度肥胖患者LVBG术后体重显著下降 ,肝脂肪变减轻 ,血脂紊乱及胰岛素抵抗均明显改善。

Objective To investigate the effect of laparoscopic vertical banding gastroplasty (LVBG) on hepatic steatosis and metabolic abnormalities in morbidly obese patients one year after surgery.Methods A total of 11 morbidly obese patients with CT diagnosis of liver steatosis were studied to compare the following data before and one year after LVBG,including weight,body mass index(BMI),waist circumference,fasting plasma glucose(FPG),fasting insulin(FINS),insulin resistance index (HOMA IR), total cholesterol(TC),triglyceride(TG) and liver enzymes.Results With the loss of weight,BMI,waist circumference,FINS,HOMA IR and TG were declined,while liver CT values increased significantly after LVBG.The change of waist circumference was correlated with the change of FINS and that of HOMA IR significantly (P<0 01).Also,the change of liver CT values was negtively related to the change of both FINS and HOMA IR(P<0 05).Conclusion Morbidly obese patients can achieve weight loss obviously after LVBG,with significant improvement in hepatic steatosis,and the improvement is accompanied by the decrease in insulin resistance.