首頁資訊非酒精性脂肪性肝炎患者進行減肥手術(shù)可顯著降低重大不良肝臟和心血管結(jié)局—小柯機器人—科學(xué)網(wǎng)

非酒精性脂肪性肝炎患者進行減肥手術(shù)可顯著降低重大不良肝臟和心血管結(jié)局—小柯機器人—科學(xué)網(wǎng)

來源：泰然健康網(wǎng) 時間：2024年12月08日 18:20

非酒精性脂肪性肝炎患者進行減肥手術(shù)可顯著降低重大不良肝臟和心血管結(jié)局

作者：小柯機器人發(fā)布時間：2021/11/18 13:44:51

美國俄亥俄州克利夫蘭診所Steven E. Nissen團隊研究了在經(jīng)活檢證實的非酒精性脂肪性肝炎患者中，減肥手術(shù)與重大不良肝臟和心血管結(jié)局的相關(guān)性。這一研究成果發(fā)表在2021年11月11日出版的《美國醫(yī)學(xué)會雜志》上。

在非酒精性脂肪性肝炎（NASH）患者中，尚無治療顯示可降低嚴重不良結(jié)局的風(fēng)險。該研究旨在探討肥胖和活檢證實無肝硬化的纖維性NASH患者的減肥手術(shù)與重大不良肝臟結(jié)局和重大不良心血管事件（MACE）之間的長期關(guān)系。

2004至2016年，美國衛(wèi)生系統(tǒng)進行了25828次肝活檢，確定1158名成年肥胖患者符合入選標(biāo)準，包括確診的NASH組織學(xué)診斷和肝纖維化（組織學(xué)1-3期）。采用重疊加權(quán)法，將在減肥手術(shù)時同時進行肝活檢患者的基線臨床特征、組織學(xué)疾病活動和纖維化分期與非手術(shù)對照組進行平衡。后續(xù)隨訪于2021年3月結(jié)束。

減肥手術(shù)包括Roux-en-Y胃分流術(shù)、袖狀胃切除術(shù)，其他患者接受非手術(shù)護理。主要結(jié)局是重大不良肝臟結(jié)局（進展為臨床或組織學(xué)肝硬化、發(fā)生肝細胞癌、肝移植或肝相關(guān)死亡率）和MACE（冠狀動脈事件、腦血管事件、心力衰竭或心血管死亡的綜合）的發(fā)生率。

1158名患者中740名（63.9%）為女性，中位年齡為49.8歲，中位體重指數(shù)為44.1。其中650名患者接受了減肥手術(shù)，508名患者接受了非手術(shù)對照護理，中位隨訪時間為7年。重疊加權(quán)后，基線協(xié)變量的分布（包括肝損傷的組織學(xué)嚴重程度）非常平衡。

在未加權(quán)數(shù)據(jù)集的研究期結(jié)束時，減肥手術(shù)組的5名患者和非手術(shù)對照組的40名患者出現(xiàn)了嚴重的肝臟不良反應(yīng)，減肥手術(shù)組的39名患者和非手術(shù)組的60名患者出現(xiàn)了MACE。

在采用重疊加權(quán)法分析的患者中，減肥手術(shù)組10年重大不良肝臟結(jié)局的累積發(fā)生率為2.3%，顯著低于非手術(shù)護理組的9.6%。減肥手術(shù)組和非手術(shù)護理組的10年MACE累積發(fā)生率分別為8.5%和15.7%，組間差異顯著。在減肥手術(shù)后的第一年內(nèi)，4名患者（0.6%）死于手術(shù)并發(fā)癥，包括2例胃腸道滲漏和2例呼吸衰竭。

研究結(jié)果表明，在NASH和肥胖患者中，與非手術(shù)治療相比，減肥手術(shù)可顯著降低發(fā)生嚴重不良肝臟結(jié)局和MACE的風(fēng)險。

附：英文原文

Title: Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis

Author: Ali Aminian, Abbas Al-Kurd, Rickesha Wilson, James Bena, Hana Fayazzadeh, Tavankit Singh, Vance L. Albaugh, Faiz U. Shariff, Noe A. Rodriguez, Jian Jin, Stacy A. Brethauer, Srinivasan Dasarathy, Naim Alkhouri, Philip R. Schauer, Arthur J. McCullough, Steven E. Nissen

Issue&Volume: 2021-11-11

Abstract:

Importance No therapy has been shown to reduce the risk of serious adverse outcomes in patients with nonalcoholic steatohepatitis (NASH).

Objective To investigate the long-term relationship between bariatric surgery and incident major adverse liver outcomes and major adverse cardiovascular events (MACE) in patients with obesity and biopsy-proven fibrotic NASH without cirrhosis.

Design, Setting, and Participants In the SPLENDOR (Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk) study, of 25828 liver biopsies performed at a US health system between 2004 and 2016, 1158 adult patients with obesity were identified who fulfilled enrollment criteria, including confirmed histological diagnosis of NASH and presence of liver fibrosis (histological stages 1-3). Baseline clinical characteristics, histological disease activity, and fibrosis stage of patients who underwent simultaneous liver biopsy at the time of bariatric surgery were balanced with a nonsurgical control group using overlap weighting methods. Follow-up ended in March 2021.

Exposures Bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy) vs nonsurgical care.

Main Outcomes and Measures The primary outcomes were the incidence of major adverse liver outcomes (progression to clinical or histological cirrhosis, development of hepatocellular carcinoma, liver transplantation, or liver-related mortality) and MACE (a composite of coronary artery events, cerebrovascular events, heart failure, or cardiovascular death), estimated using the Firth penalized method in a multivariable-adjusted Cox regression analysis framework.

Results A total of 1158 patients (740 [63.9%] women; median age, 49.8 years [IQR, 40.9-57.9 years], median body mass index, 44.1 [IQR, 39.4-51.4]), including 650 patients who underwent bariatric surgery and 508 patients in the nonsurgical control group, with a median follow-up of 7 years (IQR, 4-10 years) were analyzed. Distribution of baseline covariates, including histological severity of liver injury, was well-balanced after overlap weighting. At the end of the study period in the unweighted data set, 5 patients in the bariatric surgery group and 40 patients in the nonsurgical control group experienced major adverse liver outcomes, and 39 patients in the bariatric surgery group and 60 patients in the nonsurgical group experienced MACE. Among the patients analyzed with overlap weighting methods, the cumulative incidence of major adverse liver outcomes at 10 years was 2.3% (95% CI, 0%-4.6%) in the bariatric surgery group and 9.6% (95% CI, 6.1%-12.9%) in the nonsurgical group (adjusted absolute risk difference, 12.4% [95% CI, 5.7%-19.7%]; adjusted hazard ratio, 0.12 [95% CI, 0.02-0.63]; P=.01). The cumulative incidence of MACE at 10 years was 8.5% (95% CI, 5.5%-11.4%) in the bariatric surgery group and 15.7% (95% CI, 11.3%-19.8%) in the nonsurgical group (adjusted absolute risk difference, 13.9% [95% CI, 5.9%-21.9%]; adjusted hazard ratio, 0.30 [95% CI, 0.12-0.72]; P=.007). Within the first year after bariatric surgery, 4 patients (0.6%) died from surgical complications, including gastrointestinal leak (n=2) and respiratory failure (n=2).

Conclusions and Relevance Among patients with NASH and obesity, bariatric surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident major adverse liver outcomes and MACE.

DOI: 10.1001/jama.2021.19569

Source: https://jamanetwork.com/journals/jama/fullarticle/2786270

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