腹腔镜袖状胃切除术治疗肥胖合并非酒精性脂肪肝患者肝纤维化的短期疗效分析  

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

作　　者：张娜[1] 鲁志宏 张盛军 陈启众[1] 俞永涛 陈申思 钱海权 刘轲 Zhang Na;Lu Zhihong;Zhang Shengjun;Chen Qizhong;Yu Yongtao;Chen Shensi;Qian Haiquan;Liu Ke(Department of Clinical Nutrition,General Hospital of Ningxia Medical University,750001 Yinchuan,China;Department of Gastrointestinal Surgery,General Hospital of Ningxia Medical University,750001 Yinchuan,China;Department of health care office,Zhongwei City People's Hospital,755000 Zhongwei,China)

机构地区：[1]宁夏医科大学总医院临床营养科,银川750001 [2]宁夏中卫市人民医院医保办,中卫755000 [3]宁夏医科大学总医院胃肠外科,银川750001

出　　处：《中华肥胖与代谢病电子杂志》2023年第4期261-266,共6页Chinese Journal Of Obesity and Metabolic Diseases：Electronic Edition

基　　金：宁夏自然科学基金(2021AAC03370);宁夏科技惠民计划(2020CMG03004);宁夏重点研发计划项目(2022BEG03076)。

摘　　要：目的分析肥胖合并非酒精性脂肪肝(NAFLD)患者通过腹腔镜袖状胃切除术(LSG)治疗肝纤维化的短期疗效。方法回顾性分析2021年1月至2022年12月在宁夏医科大学总医院胃肠外科行LSG的119例肥胖合并NAFLD患者的临床资料,在术后1、3、6月进行随访,比较患者手术前后人体成分分析、肝功能、血脂、血糖、肝纤维化指标的变化情况。正态分布的计量资料以(±s)表示,偏态分布以[M(QR)]表示,计数资料以绝对数表示。计量资料中术前和术后1、3、6月相关指标比较采用重复测量方差分析,其中两两比较采用LSD。结果术后1、3、6月人体成分分析相关指标中体质量、BMI、骨骼肌、体脂肪、体脂百分比、内脏脂肪面积、腰臀脂肪比均较术前明显下降(P<0.05),术后3、6月多余体质量减少百分比(%EWL)较术后1个月明显升高(P<0.05);术后3、6月天门冬氨酸转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰基转移酶(GGT)、胆碱酯酶(CHE)水平均较术前明显改善(P<0.05);术后1、3、6月甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平均较术前明显改善(P<0.05);术后1、3、6月肝脏硬度值(LSM)、受控衰减参数(CAP)、NAFLD纤维化评分(NFS)均较术前明显下降(P<0.05)。结论LSG在短期内治疗肥胖合并NAFLD的疗效效果显著,不仅有助于减轻患者的相关体重指标,还能通过改善肝功能异常及糖脂代谢紊乱,从而缓解肝脏纤维化程度。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 th

关 键 词：肥胖症 腹腔镜袖状胃切除术 非酒精性脂肪肝病 肝纤维化 疗效 

分 类 号：R656.6[医药卫生—外科学] R589.2[医药卫生—临床医学] R575