切换至 "中华医学电子期刊资源库"
高级检索
中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 153 -158. doi: 10.3877/cma.j.issn.2095-9605.2020.03.003

所属专题： 文献；

论著

腹腔镜袖状胃切除术对重度肥胖患者非酒精性脂肪肝病及糖脂代谢的短期影响
陈伟1, 罗衡桂1,†(), 赵象文2, 毛岳峰1, 唐彬1, 李绍杰1, 张晓玲1, 陈香林1, 王力1   
  1. 1. 411100　湘潭，湖南省湘潭市中心医院减重代谢外科中心
    2. 528415　中山，广东省中山市小榄人民医院减重代谢外科
  • 收稿日期:2020-05-17 出版日期:2020-08-30
  • 通信作者: 罗衡桂
  • 基金资助:
    湘潭市医学科研基金项目(2018xtyx-7)

The short-term effects of laparoscopic sleeve gastrectomy on nonalcoholic fatty liver disease and glycolipid metabolism in severely obese patients

Wei Chen1, Henggui Luo1,†(), Xiangwen Zhao2, Yuefeng Mao1, Bing Tang1, Shaojie Li1, Xiaoling Zhang1, Xianglin Chen1, Li Wang1   

  1. 1. Bariatric and Metabolic Surgery Center, Xiangtan Central Hospital, Xiangtang 411100
    2. Department of Weight Loss and Metabolism, Xiaolan People’s Hospital, Zhongshan 528415, China
  • Received:2020-05-17 Published:2020-08-30
  • Corresponding author: Henggui Luo
  • About author:
    Correspongding author: Luo Henggui, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈伟, 罗衡桂, 赵象文, 毛岳峰, 唐彬, 李绍杰, 张晓玲, 陈香林, 王力. 腹腔镜袖状胃切除术对重度肥胖患者非酒精性脂肪肝病及糖脂代谢的短期影响[J]. 中华肥胖与代谢病电子杂志, 2020, 06(03): 153-158.

Wei Chen, Henggui Luo, Xiangwen Zhao, Yuefeng Mao, Bing Tang, Shaojie Li, Xiaoling Zhang, Xianglin Chen, Li Wang. The short-term effects of laparoscopic sleeve gastrectomy on nonalcoholic fatty liver disease and glycolipid metabolism in severely obese patients[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(03): 153-158.

目的

探讨腹腔镜袖状胃切除术（LSG）对重度肥胖合并非酒精脂肪肝病（NAFLD）患者的疗效及糖脂代谢的影响。

方法

回顾性分析2016年12月至2019年3月在湘潭市中心医院减重代谢外科中心及中山市小榄人民医院减重代谢外科中心行LSG手术的78例合并NAFLD肥胖患者的临床资料，术后随访1年以上，比较患者体重、糖脂代谢、肝功能[谷草转氨酶（ALT）；谷丙转氨酶（AST）]、肝平均CT值及肝脏体积的变化情况。

结果

术后1年患者体重、体质量指数（BMI）、腰围、臀围均较术前明显下降（P<0.01）；空腹血糖、空腹胰岛素、糖化血红蛋白、胰岛素抵抗指数较术前有显著性改善（P<0.01） ；胆固醇、甘油三脂、低密度脂蛋白相比术前均有显著改善（P<0.01）；肝功能（ALT、AST）均较术前明显改善（P<0.01)；术后1年肝平均CT值（39.84±4.25）较术前（22.34±6.64）较明显升高，肝脏体积从术前（1983.61±821.7）cm3下降至术后（1549.32±752.01）cm3，差异有显著统计学意义（P<0.01），腰围及BMI与胰岛素抵抗、肝脏体积呈正相关，与肝脏CT值呈负相关。

结论

LSG手术不仅能有效减轻肥胖患者体重，改善糖脂代谢，能明显改善NAFLD的作用。对于重度肥胖合并NAFLD的患者，LSG手术是一种有效的治疗方法。

关键词: 肥胖, 非酒精性脂肪肝病, 腹腔镜袖状胃切除术, 糖脂代谢
Objective

To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on the glucose and lipid metabolism in patients with severe obesity and non-alcoholic fatty liver disease (NAFLD).

Methods

To retrospectively analyze the clinical data of 78 severely obese patients with non-alcoholic fatty liver disease, followed up for more than 1 year after operation. The change of body weight, glucose and lipid metabolism, liver function (aspartate aminotransferase, ALT; alanine aminotransferase, AST), average liver CT value and liver volume were compared.

Results

The body weight, body mass index (BMI), waist circumference, and hip circumference of the patient decreased significantly compared with that before operation (P<0.01); fasting blood glucose, fasting insulin, glycosylated hemoglobin, and insulin resistance index were significantly improved (P<0.01); Cholesterol, triglyceride and low density lipoprotein were significantly improved (P<0.01); Liver function (ALT, AST) were significantly improved compared with that before operation (P<0.01). The average liver CT value (39.84±4.25) one year after operation was significantly higher than that before operation (22.34±6.64). The liver volume decreased from (1983.61±821.7) cm3 before operation to (1549.32±752.01) cm3 after operation, and the difference was statistically significant (P<0.01). Waist circumference and BMI were positively correlated with insulin resistance and liver volume, and negatively with liver CT value.

Conclusions

LSG can not only effectively reduce the weight of obese patients, improve glucose and lipid metabolism, but also has a significant effect on the treatment of NAFLD. For patients with severe obesity and NAFLD, LSG surgery is an effective treatment.

Key words: Obesity, Nonalcoholic fatty liver disease, Laparoscopic sleeve gastrectomy, Glucolipid metabolism
表1 78例患者手术前后体重指标变化情况
指标 体重（kg） BMI（kg/m2） 臀围（cm） 腰围（cm）
术前 118.55±35.59 40.86±8.22 114.61±11.91 128.92±10.67
术后1年 82.24±22.49 28.39±4.07 95.20±11.91 86.86±9.54
t值 7.61 12.00 10.18 25.95
P值 <0.01 <0.01 <0.01 <0.01
表2 78例患者手术前后患者糖脂代谢变化情况
指标 术前 术后1年 t值 P值
FBG （mmol/L） 8.90±7.05 5.20±0.76 4.60 <0.01
FINS（mU/L） 38.66±15.40 27.31±5.73 6.10 <0.01
HbA1 c（%） 7.30± 1.20 5.20± 1.05 15.4 <0.01
HOMA-IR 28.34±9.98 4.52±5.40 18.53 <0.01
TC（mmol /L） 6.58±0.28 4.21±0.75 26.15 <0.01
TG（mmol /L） 2.44±0.76 1.51±0.60 1.67 <0.01
HDL-C（mmol /L） 0.84±0.31 1.45±0.86 9.12 <0.01
LDL-C（mmol /L） 3.56±1.66 2.3±0.67 6.21 <0.01
表3 8例患者手术前后转氨酶、CT值、肝体积变化
? 术前 术后1年 t值 P值
谷草转氨酶ALT（IU/L） 59.82±14.56 32.45±5.29 15.60 <0.01
谷丙转氨酶AST（IU/L） 42.98±8.16 26.98±5.84 14.08 <0.01
肝平均CT值（Hu） 20.34±7.64 39.84±4.25 19.70 <0.01
肝体积（cm3） 1983.61±821.7 1549.32±752.01 3.44 <0.01
表4 ALT、肝平均CT值、肝体积、胰岛素抵抗指数与BMI、腰围之间相关分析显示
? BMI 腰围
R值 P值 R值 P值
ALT 0.1901 0.760 0.271 0.659
肝平均CT值 -0.986 0.002a -0.934 0.020*
肝体积（cm3） 0.988 0.002a 0.893 0.041*
胰岛抵抗指数 0.990 0.001a 0.978 0.004a
[1]
Wild SH, Roglic G, Green A, et al. Global Prevalence of Diabetes: Estimates for the Year 2000 and Projections for 2030: Response to Rathman and Giani[J]. Diabetes Care, 2004, 27(10): 2569-2570.
[2]
Subichin M, Clanton J, Makuszewski M, et al. Liver disease in the morbidly obese: a review of 1000 consecutive patients undergoing weight loss surgery[J]. Surgery for Obesity and Related Diseases, 2015, 11(1): 137-141.
[3]
Rinella ME. Nonalcoholic fatty liver disease: a systematic review[J]. JAMA The Journal of the American Medical Association, 2015, 314(14): 1521-1521.
[4]
Jian W, Man J, Yongning X. Role of endoplasmic reticulum stress in pathogenesis of nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2014, 30(11): 1768-1776.
[5]
Marceau P, Bimn S, Hould FS，et al. Liver pathology and the metabolic syndmme X in severe obesity[J]． J Clin Endocrinol Metab，1999，84(5): 1513-1517.
[6]
Klebanoff MJ, Corey KE, Chhatwal J, et al. Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost-effectiveness analysis[J]. Hepatology, 2017, 65(4): 1156-1164.
[7]
中华医学会肝病学分会脂肪肝和酒精性肝病学组，中国医师协会脂肪性肝病专家委员会．非酒精性脂肪性肝病防治指南(2018更新版)[J]．中华肝脏病杂志，2018，26(3)：195-203．
[8]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会．中国肥胖和2型糖尿病外科治疗指南(2014)[J]．中国实用外科杂志，2014，34(11)：1005-1010．
[9]
中华医学会肝脏病学会脂肪肝和酒精性肝病学组．非酒精性脂肪肝病诊断标准[J] ．中华肝脏病杂志，2003，11(2)：71．
[10]
中华医学会外科学分会甲状腺及代谢外科学组，中国医师协会外科医师分会肥胖和糖尿病外科医师委员会．中国肥胖及2型糖尿病外科治疗指南(2019版)[J]．中国实用外科杂志，2019，39(4)：301-306．
[11]
Rinella ME. Nonalcoholic fatty liver disease: a systematic review[J]. JAMA, 2015, 313(22): 2263-2273.
[12]
Diehl AM, Day C. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis[J]. The New England journal of medicine, 2017377(21).
[13]
中华医学会肝脏病学分会脂肪肝和酒精性肝病学组．非酒精性脂肪性肝病诊疗指南[J]．中华肝脏病杂志，2006(03)：161-163．
[14]
Bays HE, Fox KM, Grandy S. Anthropometric Measurements and Diabetes Mellitus: Clues to the "Pathogenic" and "Protective" Potential of Adipose Tissue[J]. Metabolic Syndrome & Related Disorders, 2010, 8(4): 307-315.
[15]
Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study[J]. Circulation, 2007, 116(1): 39-48.
[16]
Bays, Harold. Central obesity as a clinical marker of adiposopathy; increased visceral adiposity as a surrogate marker for global fat dysfunction[J]. Current Opinion in Endocrinology Diabetes & Obesity, 2014, 21(5): 345-351.
[17]
Irlbeck T, Massaro JM, Bamberg F, et al. Association between single-slice measurements of visceral and abdominal subcutaneous adipose tissue with volumetric measurements: the Framingham Heart Study[J]. International Journal of Obesity, 2010, 34(4): 781-787.
[18]
Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective Study of the Long-Term Effects of Bariatric Surgery on Liver Injury in Patients Without Advanced Disease[J]. Gastroenterology, 2009, 137(2): 532-540.
[19]
施晨晔，常薪霞，颜红梅，等．代谢手术对肥胖伴或不伴2型糖尿病的疗效分析[J/CD]．中华肥胖与代谢病电子杂志，2015，1(2)：76-79．
[20]
Mottin C C, Moretto M, Padoin AV, et al. Histological behavior of hepatic steatosis in morbidly obese patients after weight loss induced by bariatric surgery[J]. Obesity Surgery, 2005, 15(6): 788-793.

URL    
[21]
Clark Jeanne M,Brancati Frederick L,Diehl Anna Mae. The prevalence and etiology of elevated aminotransferase levels in the United States.[J]. Pubmed,2003,98(5):960-967.
[22]
Bi WR, Yang CQ, Shi Q, et al. Large-scale analysis of factors influencing nonalcoholic fatty liver disease and its relationship with liver enzymes[J]. Pubmed,2014,13(3): 5880-589
[23]
Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome[J]. Ann Surg, 2005, 242(4): 610-620.
[24]
Day CP, James OF. Steatohepatitis: a tale of two "hits"?[J]. Pubmed, 1998, 114(4): 842-845.
[25]
褚薛慧，邱晨，单晓东，等．腹腔镜Roux-en-Y胃旁路术在治疗肥胖症合并非酒精性脂肪肝中的应用价值[J/CD]．中华肥胖与代谢病电子杂志，2016，2(2)：85-89．
[26]
Poniachik J, Mancilla C, Contreras J, et al. Obesity: risk factor for steatohepatitis and hepatic fibrosis[J]. Revista Médica De Chile, 2002, 130(7): 731-736.
[27]
Bugianesi E, Gastaldelli A, Vanni E, et al. Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: sites and mechanisms[J]. Diabetologia, 2005, 48(4): 634-642.

URL    
[28]
王倩，管小琴．非酒精性脂肪肝病与胰岛素抵抗[J]．中国临床康复，2006，10(36)：149-151．
[29]
Bibbb S, Ianiro G, Dore MP, et a1. Gut microbiota as a driver of inflammation in nonalcoholic fatty liver disease[J]. Mediators Inflatom, 2018, 2018: 1-7．
[30]
李震，冯毕龙，李丽君，等．袖状胃切除术在减重代谢外科中的发展及应用价值[J/CD]．中华肥胖与代谢病电子杂志，2017，3(4)：226-230．
[31]
Magouliotis DE, Tasiopoulou VS, Sioka E, et al. Impact of Bariatric Surgery on Metabolic and Gut Microbiota Profile: a Systematic Review and Meta-analysis[J]. Obesity Surgery, 2017, 27(5): 1345-1357.
[1] 陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[2] 孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[3] 李猛, 姜腊, 董磊, 吴情, 贾犇黎. 腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 554-557.
[4] 吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[5] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[6] 刘超凡, 王文越, 杨珵璨, 朱冬梓, 王兵. 胃袖状切除术上调循环Nrg4浓度抑制肝脏脂肪酸合成改善肥胖小鼠肝脏脂肪变性[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 133-136.
[7] 赵帅, 王伟, 李瑞奇, 周家杰, 王道荣. 3D腹腔镜下袖状胃切除术治疗肥胖合并2型糖尿病的临床疗效及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 146-149.
[8] 刘盾, 潘晟. 不同入路腹腔镜袖状胃切除术用于肥胖症合并2型糖尿病的效果[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 150-154.
[9] 唐小久, 胡曼, 许必君, 肖亚. 肥胖合并胃食管反流病患者严重程度与其焦虑抑郁及营养状态的相关性研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 360-364.
[10] 王星, 陈园, 热孜万古丽·乌斯曼, 郭艳英. T2DM、Obesity、NASH、PCOS共同致病因素相关的分子机制[J]. 中华临床医师杂志(电子版), 2024, 18(05): 481-490.
[11] 颜宥彤, 赵锐, 万谦益, 张贵祥, 沈弘毅, 程中, 陈亿. GLP-1受体激动剂——司美格鲁肽的应用及安全性[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 88-93.
[12] 杨宁琍, 梁辉. 中国肥胖代谢外科个案管理教育培训现状及展望[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 94-99.
[13] 周彪, 李政奇, 孟化. 肥胖与内镜下减重治疗研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 100-107.
[14] 王婉杰, 宋文超, 王键, 倪良晨, 洪健, 朱孝成, 姚立彬. 肥胖与中枢神经系统调控的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 108-112.
[15] 陆远欣, 龚莉琳, 曾梦华. 肥胖与非酒精性脂肪肝研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 113-119.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号