Clin Gastroenterol H:非酒精性脂肪肝肥胖患者接受减肥手术要当心!!!

2016-10-24 xing.T MedSci原创

由此可见,非酒精性脂肪肝炎与接受减肥手术患者的死亡风险增加有关,在非酒精性脂肪肝炎的受试者中进行减肥手术的生存获益可能性减少。

减肥手术与改善重度肥胖者的预后相关,近日,消化病领域权威杂志《Clinical Gastroenterology and Hepatology》发表了一篇很有意义的研究文章,旨在评估非酒精性脂肪肝患者接受减肥手术的预后情况。

研究者对1997年1月到2004年12月期间在瑞士单中心接受胃旁路减肥手术的492例患者进行了回顾性分析,并进行常规的围手术期肝活检、组织学分析以及分离RNA,并且收集了研究对象的总体生存率、临床和生化指标等数据。研究者通过肝脏活检来确定接受减肥手术者中非酒精性脂肪肝患者;而来自于NHANES III研究的对照者是基于超声回声以及增高的肝丙氨酸转氨酶水平来确定。


在研究之初,接受减肥手术的患者的平均身体质量指数为43.6 kg/m2;基于组织学检测结果,12%的患者患有非酒精性脂肪肝,16%的患者患有肝脏纤维化。手术后的中位随访时间为10.2年,其中4.2%的受试者死亡。在多变量Cox回归分析中,研究者发现非酒精性脂肪肝(风险比为2.9;P=0.2)和高血压(风险比为3.9;P=0.2)与减肥手术术后总死亡率相关。当行减肥手术患者与NHANES III参与者(对照者)进行匹配后,研究者发现在随访期内减肥手术可以减少肥胖患者的死亡风险(风险比为0.54;P=0.4)。然而,接受减肥手术的非酒精性脂肪肝患者并不能降低死亡风险(风险比为0.90;P=0.85)。

由此可见,非酒精性脂肪肝与接受减肥手术患者的死亡风险增加有关,在非酒精性脂肪肝的受试者中进行减肥手术的生存获益可能性减少。

原始出处:

Nicolas Goossens,et al. Nonalcoholic Steatohepatitis Is Associated With Increased Mortality in Obese Patients Undergoing Bariatric Surgery. clinical gastroenterology and hepatology 2016. November 2016.Volume 14, Issue 11, Pages 1619–1628. 

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    2017-09-15 许安
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