[1]褚薛慧 邱晨 单晓东 邓玲 孙喜太.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].中华肥胖与代谢病电子杂志,2016,2(02):85-89.[doi:10.3877//cma.j.issn.2095-9605.2016.02.006]
 Chu Xuehui,Qiu Chen,Shan Xiaodong,et al.Application value of laparoscopic Roux-en-Y gastric bypass in treating obesity with nonalcoholic fattyliver[J].Chinese Journal of Obesity and Metabolic Disease (Electronic Edition),2016,2(02):85-89.[doi:10.3877//cma.j.issn.2095-9605.2016.02.006]
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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()
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《中华肥胖与代谢病电子杂志》[ISSN:2095-9605/CN:11-9362]

卷:
第2卷
期数:
2016年02期
页码:
85-89
栏目:
临床研究
出版日期:
2016-06-29

文章信息/Info

Title:
Application value of laparoscopic Roux-en-Y gastric bypass in treating obesity with nonalcoholic fattyliver
作者:
褚薛慧 邱晨 单晓东 邓玲 孙喜太
210008 南京,南京大学医学院附属鼓楼医院普通外科
Author(s):
Chu Xuehui Qiu Chen Shan Xiaodong Deng Ling Sun Xitai
Department of General Surgery, GulouHispital Affiliated to Medical College of Nanjing University, Nanjing 210008, ChinaCorresponding author: Sun Xitai, Email: sunxitai@vip.qq.com
关键词:
腹腔镜Roux-en-Y胃旁路术 肥胖症 非酒精性脂肪肝
Keywords:
Laparoscopic Roux-en-Y gastric bypass Obesity Nonalcoholic fatty liver disease
DOI:
10.3877//cma.j.issn.2095-9605.2016.02.006
摘要:
目的 探讨腹腔镜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。 方法 回顾性分析2011年11月至2014年11月在南京大学医学院附属鼓楼医院接受腹腔镜Roux-en-Y胃旁路术治疗的69例肥胖症合并非酒精性脂肪肝患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男25例,女44例;平均年龄(40±13)岁;平均体质指数(body mass index, BMI)(37.9±6.5)kg/m2。比较术前和术后不同时点患者的体重、丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase, AST)、谷氨酰转移酶(glutamyltransferase, GGT)、白蛋白、总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、空腹血糖(fasting plasma glucose, FPG)、空腹胰岛素(fasting insulin, FIns)、空腹C肽(fasting plasma C-peptide, FCp)等指标和手术前后肝胆超声检查结果。手术前后肝胆超声检查结果的比较采用Spearman秩相关分析,其他临床指标的比较采用t检验。结果 69例患者均成功完成腹腔镜Roux-en-Y胃旁路术治疗。截至术后1个月,患者的BMI为(34±5)kg/m2,明显低于术前的(38±7)kg/m( 2 t=3.863, P<0.05);TG为(1.8±0.7)mmol/L,明显低于术前的(2.9±1.2)mmol/L( t=6.577, P<0.05); ALT为(47±26)U/L,明 显 低 于 术 前 的(71±48)U/L( t=3.652,P<0.05); FPG为(5.1±1.1)mmol/L,明显低于术前的(8.0±2.8)mmol/L( t=8.008,P<0.05); FIns为(16±12)mIU/L,明显低于术前的(32±20)mIU/L( t=5.698,P<0.05)。术后6个月,脂肪肝完全康复者29例、轻度脂肪肝者23例、中度脂肪肝者17例、重度脂肪肝者0例,脂肪肝的严重程度等级明显低于术前的正常者0例、轻度脂肪肝者39例、中度脂肪肝者23例和重度脂肪肝者7例( χ2=25.777,P<0.05)。 结论 腹腔镜Roux-en-Y胃旁路术在治疗肥胖症的同时,能显著改善合并的脂肪肝,原因可能与改善脂质代谢和胰岛素抵抗有关。
Abstract:
Objective To investigate the application value of laparoscopic Roux-en-Y gastric bypass(LRYGB) in treating obesity with nonalcoholic fatty liver disease. Methods Clinical data of 69 obesepatients with nonalcoholic fatty liver disease undergoing LRYGB in Gulou Hospital Affiliated to MedicalCollege of Nanjing University from November 2011 to November 2014 were analyzed retrospectively. Theinformed consents were obtained from all of the patients and the local ethical committee approval hadbeen received. Among the 69 patients, 25 were males and 44 were females with an average age of (40±13)years old and an average body mass index of (37.9±6.5) kg/m2. Levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST), glutamyltransferase (GGT), albumin, total cholesterol (TC), triglyceride(TG), fasting plasma glucose (FPG), fasting insulin (FIns), fasting plasma C-peptide (FCp) and results ofliver ultrasound were tested before and at different time points after operation. Results of liver ultrasound were compared using Spearman rank correlation analysis, and other clinical indexes were compared usingt test. Results Sixty-nine patients received LRYGB successfully. At 1 month after operation, BMI was(34±5) kg/m2, which was significantly lower than (38±7) kg/m2 before operation( t=3.863,P<0.05); TGwas (1.8±0.7) mmol/L, which was significantly lower than (2.9±1.2) mmol/L( t=6.577,P<0.05)beforeoperation; ALT was (47±26) U/L, which was significantly lower than (71±48) U/L before operation( t=3.652,P<0.05); FPG was (5.1±1.1) mmol/L, which was significantly lower than (8.0±2.8) mmol/L( t=8.008,P<0.05); and FIns was (16±12) mIU/L, which was also significantly lower than (32±20) mIU/L( t=5.698,P<0.05). At 6 months after operation, 29 patients got complete remission of fatty liver; 23 patients werediagnosed with mild fatty liver, 17 patients with moderate fatty liver, and no patient with severe fatty liver.These severity ranks of fatty liver were significantly milder than that before operation (0 normal, 39 mild,23 moderate and 7 severe( χ2=25.777,P<0.05)). Conclusion LRYGB can not only treat obesity, but alsoimprove fatty liver significantly, which may be related to lipid metabolism and insulin resistance.

参考文献/References:

[1] Jin MJ, Chen BB, Mao YY, et al. Prevalence of overweight andobesity and their associations with socioeconomic status in a ruralHan Chinese adult population[J]. PLoS One, 2013, 8(11):e79946.
[2] Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysisof randomised controlled trials[J]. BMJ, 2013(347):f5934.
[3] Tham JC, Howes N, le Roux CW, et al. The role of bariatric surgeryin the treatment of diabetes[J]. Ther Adv Chronic Dis, 2014, 5(3):149-157.
[4] Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetesmellitus in patients with BMI < 30 kg/m2: a systematic review andmeta-analysis[J]. PLoS One, 2015, 10(7):e0132335.
[5] Cho YM. A gut feeling to cure diabetes: potential mechanisms ofdiabetes remission after bariatric surgery[J]. Diabetes Metab J, 2014,38(6):406-415.
[6] Hafeez S, Ahmed MH. Bariatric surgery as potential treatment fornonalcoholic fatty liver disease: a future treatment by choice or bychance?[J]. J Obes, 2013(2013):839275.
[7] 中华医学会肝病学分会脂肪肝和酒精性肝病学组 . 中国非酒精性脂肪性肝病诊疗指南 ( 2010 年修订版) [J]. 中国医学前沿杂志 ( 电子版) , 2012, 4(7):4-10.
[8] 中华医学会外科学分会内分泌外科学组 , 中华医学会外科学分会腹腔镜与内镜外科学组 , 中华医学会外科学分会胃肠外科学组 ,等 . 中国肥胖病外科治疗指南( 2007) [J]. 中国实用外科杂志 ,2007, 27(10):759-762.
[9] Popov VB, Lim JK. Treatment of nonalcoholic fatty liver disease: therole of medical, surgical, and endoscopic weight loss[J]. J Clin TranslHepatol, 2015, 3(3):230-238.
[10] Jung UJ, Choi MS. Obesity and its metabolic complications: the roleof adipokines and the relationship between obesity, inflammation,insulin resistance, dyslipidemia and nonalcoholic fatty liverdisease[J]. Int J Mol Sci, 2014, 15(4):6184-6223.
[11] Asai A, Chou PM, Bu HF, et al. Dissociation of hepatic insulinresistance from susceptibility of nonalcoholic fatty liver diseaseinduced by a high-fat and high-carbohydrate diet in mice[J]. Am JPhysiol Gastrointest Liver Physiol, 2014, 306(6):G496-G504.

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备注/Memo

备注/Memo:
基金项目:南京市科技资金发展项目(YKK14066)
通讯作者:孙喜太,Email:sunxitai@vip.qq.com
更新日期/Last Update: 2016-05-30