The short-term effects of laparoscopic sleeve gastrectomy for liver fibrosis in obesity-associated nonalcoholic fatty liver disease

doi:10.3877/cma.j.issn.2095-9605.2023.04.006

Abstract

Abstract:

Objective

To investigate the short-term effects of laparoscopic sleeve gastrectomy for liver fibrosis in obesity-associated nonalcoholic fatty liver disease.

Methods

To retrospectively analyze the clinical data of 119 obesity patients with NALFD who underwent LSG in the General Hospital of Ningxia Medical University from January 2021 to December 2022, followed up at 1, 3 and 6 months after the operation. The changes in human component analysis, liver function, lipid metabolism, blood glucose, and hepatic fibrosis were compared. The measurement data of normal distribution is expressed by (±s), the skew distribution is expressed by [M (QR)] and the counting data is expressed by absolute number. In the measurement data, repeated measurement ANOVA was used to compare the relevant indicators before surgery and 1, 3 and 6 months after surgery, and LSD was used for pairwise comparison.

Results

The body weight, body mass index, body fat mass, skeletal muscle mass, body fat ratio, waist-hip fat ratio, and visceral fat area of the patients at postoperative 1, 3, and 6 months decreased significantly compared with that before operation (P<0.05). The percentage of excess weight loss (%EWL) of the patients at postoperative 3 and 6 months improved significantly compared to postoperative 1 month (P<0.05). The aspartate transferase, aminotransferase, γ-glutamyltransferase, and cholinesterase of the patients at postoperative 3 and 6 months improved significantly compared with that before operation (P<0.05). The triglyceride, high-density lipoprotein cholesterol, fasting plasma glucose, and glycosylated hemoglobin of the patients at postoperative 1, 3, and 6 months improved significantly compared with that before operation (P<0.05). The liver stiffness measurement, controlled attenuation parameter and NALFD fiber score of the patients at postoperative 1, 3 and 6 months decreased significantly compared with that before operation (P<0.05).

Conclusions

LSG has an accurate short-term clinical efficacy for obesity-associated NAFLD, which not only reduce body mass, but also relieves the degree of liver fibrosis by improving liver function and the disorders of glucose and lipid metabolism.

Key words: Obesity, Laparoscopic sleeve gastrectomy, Nonalcoholic fatty liver disease, Hepatic fibrosis, Efficacy

Na Zhang, Zhihong Lu, Shengjun Zhang, Qizhong Chen, Yongtao Yu, Shensi Chen, Haiquan Qian, Ke Liu. The short-term effects of laparoscopic sleeve gastrectomy for liver fibrosis in obesity-associated nonalcoholic fatty liver disease[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(04): 261-266.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2023.04.006

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2023/V09/I04/261

Figures/Tables 3

References 29

[1]	Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-2018 [J]. Lancet, 2021, 398(10294): 53-63.
[2]	Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults [J]. Aliment Pharmacol Ther, 2011, 34(3): 274-285.
[3]	Machado M, Marques-vidal P, Cortez-pinto H. Hepatic histology in obese patients undergoing bariatric surgery [J]. J Hepatol, 2006, 45(4): 600-606.
[4]	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, 范建高, 等. 非酒精性脂肪性肝病防治指南(2018年更新版) [J]. 实用肝脏病杂志, 2018, 21(02): 30-39.
[5]	陈建能, 陈爱萍, 潘勤, 等. FibroScan~实施受控衰减参数检测肝脂肪变的影响因素及应用价值分析 [J]. 肝脏, 2016, 21(10): 805-809.
[6]	Pu Ke, Wang Yuping, Bai Suyang, et al. Diagnostic accuracy of controlled attenuation parameter （CAP） as a non－invasive test for steatosis in suspected non－alcoholic fatty liver disease: A systematic review and meta－analysis [J]. BMC Gastroenterol, 2019, 19(1): 51.
[7]	Andrade P, Rodrigues S, Rodrigues-pinto E, et al. Diagnostic Accuracy of Controlled Attenuation Parameter for Detecting Hepatic Steatosis in Patients with Chronic Liver Disease [J]. GE Port J Gastroenterol, 2017, 24(4): 161-168.
[8]	Segura-azuara N, Varela-chinchilla CD, Trinidad-calderon PA. MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis [J]. Front Med (Lausanne), 2021, 8: 774079.
[9]	von Schonfels W, Beckmann JH, Ahrens M, et al. Histologic improvement of NAFLD in patients with obesity after bariatric surgery based on standardized NAS (NAFLD activity score) [J]. Surg Obes Relat Dis, 2018, 14(10): 1607-1616.
[10]	高风娇, 刘海勇. 腹腔镜袖状胃切除术(LSG)治疗肥胖合并非酒精性脂肪肝病的效果分析 [J]. 世界最新医学信息文摘(连续型电子期刊), 2020, 20(43): 2.
[11]	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.
[12]	非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 实用肝脏病杂志, 2018, 21(02): 177-186.
[13]	冷雪君, 颜学兵. FibroTouch~对不同BMI水平非酒精性脂肪性肝病患者肝纤维化程度的评估比较 [J]. 临床肝胆病杂志, 2018, 34(09): 1891-1895.
[14]	魏建东, 苟小军, 陈远卓, 等. 非酒精性脂肪性肝病合并2型糖尿病患者脂肪受控衰减参数及肝脏硬度值的变化 [J]. 肝脏, 2022, 27(03): 355-357.
[15]	Maier S, Wieland A, Cree-green M, et al. Lean NAFLD: an underrecognized and challenging disorder in medicine [J]. Rev Endocr Metab Disord, 2021, 22(2): 351-366.
[16]	方伟进, 樊志强, 龚慧, 等. 酸性鞘磷脂酶对非酒精性脂肪肝病的作用及PPARα-PGC-1α通路的影响 [J]. 中国药理学通报, 2023, 39(01): 57-65.
[17]	Ramadan MS, Russo V, Nigro G, et al. Interplay between Heart Disease and Metabolic Steatosis: A Contemporary Perspective [J]. J Clin Med, 2021, 10(8): 6.
[18]	Cobbina E, Akhlaghi F. Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters [J]. Drug Metab Rev, 2017, 49(2): 197-211.
[19]	Ahima RS. The natural history of nonalcoholic fatty liver disease: insights from children and mice [J]. Gastroenterology, 2008, 135(6): 1860-1862.
[20]	肖志立, 郑文彬, 杨钧, 等. 腹腔镜袖状胃切除术治疗肥胖症相关非酒精性脂肪性肝病的临床疗效 [J]. 中华消化外科杂志, 2021, 20(9): 6.
[21]	徐淼, 王辉, 钱行君, 等. 女性肥胖型非酒精性脂肪性肝病患者肝脏炎症指标水平及关联性分析 [J]. 现代实用医学, 2021, 33(07): 862-864.
[22]	Vilar-gomez E, Martinez-perez Y, Calzadilla-bertot L, et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis [J]. Gastroenterology, 2015, 149(2): 367-378, quiz e14- quiz e15.
[23]	Mccarty T R, Echouffo-tcheugui J B, Lange A, et al. Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004-2012[J]. Surg Obes Relat Dis, 2018, 14(1): 74-80.
[24]	崔贝贝, 朱利勇, 李鹏洲, 等. 减重代谢手术对身体成分构成的影响[J]. 中华消化外科杂志, 2020, 19(11): 10.
[25]	Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States [J]. Am J Gastroenterol, 2003, 98(5): 960-967.
[26]	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]. Genet Mol Res, 2014, 13(3): 5880-5891.
[27]	何岩. 腹腔镜下袖状胃切除术治疗肥胖伴非酒精性脂肪肝病的疗效分析及其相关影响因素分析 [D]. 2021.
[28]	于新颖, 闫文貌, 王麟, 等. 腹腔镜袖状胃切除术治疗肥胖合并非酒精性脂肪肝的疗效 [J]. 中华普通外科杂志, 2021, 36(11).
[29]	郭洪礼, 梁红亮, 张涛, 等. 肝硬化患者左心室收缩功能与心功能分级肝脏硬度的关系分析 [J]. 河北医学, 2023, 29(02): 285-289.

变量	术前	术后1个月	术后3个月	术后6个月	F值	P值
体质量（kg）	110.9±22.2	96.8±18.8^a	85.6±16.5^ab	77.3±14.07^abc	311.62	<0.001
BMI（kg/m²）	39.5±6.8	34.2±5.9^a	30.2±5.2^ab	27.3±4.5^abc	416.21	<0.001
体脂肪（kg）	50.8±13.7	42.5±12.4^a	33.7±11.3^ab	25.7±9.8^abc	509.56	<0.001
骨骼肌（kg）	33.9±6.9	30.1±6.2^a	28.7±5.6^ab	28.1±5.6^ab	156.52	<0.001
体脂百分比	45.3±5.9	43.5±6.8^a	38.9±8.3^ab	32.6±8.7^abc	162.38	<0.001
腰臀脂肪比	0.99±.0.07	0.95±.0.07^a	0.91±0.06^ab	0.87±0.04^abc	401.57	<0.001
内脏脂肪面积（cm²）	183.5±51.1	148.2±49.6^a	110.8±41.5^ab	86.5±28.7^abc	420.19	<0.001
%EWL（%）	—	32.9±11.7	57.6±16.7^b	73.9±20.7^bc	518.19	<0.001

变量	术前	术后1个月	术后3个月	术后6个月	F值	P值
体质量（kg）	110.9±22.2	96.8±18.8^a	85.6±16.5^ab	77.3±14.07^abc	311.62	<0.001
BMI（kg/m²）	39.5±6.8	34.2±5.9^a	30.2±5.2^ab	27.3±4.5^abc	416.21	<0.001
体脂肪（kg）	50.8±13.7	42.5±12.4^a	33.7±11.3^ab	25.7±9.8^abc	509.56	<0.001
骨骼肌（kg）	33.9±6.9	30.1±6.2^a	28.7±5.6^ab	28.1±5.6^ab	156.52	<0.001
体脂百分比	45.3±5.9	43.5±6.8^a	38.9±8.3^ab	32.6±8.7^abc	162.38	<0.001
腰臀脂肪比	0.99±.0.07	0.95±.0.07^a	0.91±0.06^ab	0.87±0.04^abc	401.57	<0.001
内脏脂肪面积（cm²）	183.5±51.1	148.2±49.6^a	110.8±41.5^ab	86.5±28.7^abc	420.19	<0.001
%EWL（%）	—	32.9±11.7	57.6±16.7^b	73.9±20.7^bc	518.19	<0.001

变量	术前	术后1个月	术后3个月	术后6个月	F值	P值
TBIL（umol/L）	12.2±5.4	14.8±5.8^a	13.2±5.3^ab	12.7±5.1^bc	14.08	<0.001
BC（umol/L）	3.1±2.1	4.4±2.5^a	3.8±2.1^ab	3.7±2.1^ab	9.78	<0.001
BU（umol/L）	8.8±5.1	10.5±4.7^a	9.4±4.0^b	9.0±3.7^bc	6.32	0.001
AST（U/L）	32.7±22.8	28.9±14.4	21.7±9.0^ab	17.4±7.8^abc	23.65	<0.001
ALT（U/L）	52.4±37.7	38.3±25.2^a	28.7±15.8^ab	19.6±10.4^abc	28.88	<0.001
ALP（U/L）	74.3±21.1	73.5±20.3	72.4±22.2	71.8±19.3	0.67	0.569
GGT（U/L）	45.1±33.0	25.9±14.5^a	22.4±11.9^ab	19.5±10.9^abc	33.90	<0.001
CHE（mmol/L）	9096±1546	7371±1331^a	6308±1385^ab	5417±1105^abc	223.34	<0.001
TG（mmol/L）	2.1±1.1	1.6±0.6^a	1.2±0.4^ab	0.9±0.3^abc	68.92	<0.001
TC（mmol/L）	4.6±1.1	4.5±0.9	4.4±1.0	4.3±0.9	1.89	0.134
HDL-C（mmol/L）	0.98±0.19	0.91±0.16^a	1.14±0.28^ab	1.31±0.24^abc	103.41	<0.001
LDL-C（mmol/L）	2.9±0.2	2.8±0.9	2.9±1.0	3.0±0.9	0.92	0.432
FPG（mmol/L）	5.5±1.3	5.0±0.9^a	4.9±0.6^a	4.7±0.5^abc	14.06	<0.001
HbA1c（%）	6.4±1.2	5.8±0.9^a	5.4±0.8a^b	5.0±0.7^abc	82.8	<0.001

变量	术前	术后1个月	术后3个月	术后6个月	F值	P值
TBIL（umol/L）	12.2±5.4	14.8±5.8^a	13.2±5.3^ab	12.7±5.1^bc	14.08	<0.001
BC（umol/L）	3.1±2.1	4.4±2.5^a	3.8±2.1^ab	3.7±2.1^ab	9.78	<0.001
BU（umol/L）	8.8±5.1	10.5±4.7^a	9.4±4.0^b	9.0±3.7^bc	6.32	0.001
AST（U/L）	32.7±22.8	28.9±14.4	21.7±9.0^ab	17.4±7.8^abc	23.65	<0.001
ALT（U/L）	52.4±37.7	38.3±25.2^a	28.7±15.8^ab	19.6±10.4^abc	28.88	<0.001
ALP（U/L）	74.3±21.1	73.5±20.3	72.4±22.2	71.8±19.3	0.67	0.569
GGT（U/L）	45.1±33.0	25.9±14.5^a	22.4±11.9^ab	19.5±10.9^abc	33.90	<0.001
CHE（mmol/L）	9096±1546	7371±1331^a	6308±1385^ab	5417±1105^abc	223.34	<0.001
TG（mmol/L）	2.1±1.1	1.6±0.6^a	1.2±0.4^ab	0.9±0.3^abc	68.92	<0.001
TC（mmol/L）	4.6±1.1	4.5±0.9	4.4±1.0	4.3±0.9	1.89	0.134
HDL-C（mmol/L）	0.98±0.19	0.91±0.16^a	1.14±0.28^ab	1.31±0.24^abc	103.41	<0.001
LDL-C（mmol/L）	2.9±0.2	2.8±0.9	2.9±1.0	3.0±0.9	0.92	0.432
FPG（mmol/L）	5.5±1.3	5.0±0.9^a	4.9±0.6^a	4.7±0.5^abc	14.06	<0.001
HbA1c（%）	6.4±1.2	5.8±0.9^a	5.4±0.8a^b	5.0±0.7^abc	82.8	<0.001

变量	术前	术后1个月	术后3个月	术后6个月	F值	P值
LSM（KPa）	6.73±2.01	6.27±1.71^a	5.57±1.85^ab	5.03±1.31^abc	39.45	<0.001
CAP（dB/m）	329.7±70.3	299.8±75.9^a	253.9±91.2^ab	215.5±87.6^abc	48.07	<0.001
NFS	-1.22±0.85	-1.38±0.78^a	-1.94±1.17^ab	-2.33±1.45^abc	28.35	<0.001

Please choose a citation manager

Content to export