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二型糖尿病併有脂肪肝的患者,进行减重手术后,大部份能减缓脂肪肝问题。

Gastric Bypass Versus Sleeve Gastrectomy in Type 2 Diabetes: Effects on Hepatic Steatosis and Fibrosis



Abstract

Background

Weight loss improves fatty liver disease. No randomized trial has compared the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on liver fat content and fibrosis.

Objective

To compare the 1-year effects of SG and RYGB on hepatic steatosis and fibrosis.

Design

Single-center, randomized, controlled trial (Oseberg [ObesitySurgery in Tønsberg]). (ClinicalTrials.gov: NCT01778738)

Setting

Tertiary care obesity center in Norway.

Participants

100 patients (65% female; mean age, 47.5 years; mean body mass index, 42 kg/m2) with type 2 diabetes mellitus (T2DM).

Intervention

From January 2013 to February 2018, patients were randomly assigned (1:1 ratio) to SG or RYGB.

Measurements

The primary outcome was remission of T2DM (previously published). Predefined secondary outcomes in the present study were hepatic steatosis and fibrosis assessed by magnetic resonance imaging (liver fat fraction), enhanced liver fibrosis (ELF) test, noninvasive indices, and liver enzymes.

Results

Liver fat fraction declined similarly after SG (−19.7% [95% CI, −22.5% to −16.9%]) and RYGB (−21.5% [CI, −24.3% to −18.6%]) from surgery to 1-year follow-up, and almost all patients (SG, 94%; RYGB, 100%) had no or low-grade steatosis at 1 year. The ELF score category remained stable in 77% of patients, but 18% experienced worsening of fibrosis at 1 year, with no substantial between-group difference.

Limitations

Single-center study, short follow-up time, and lack of power for secondary outcomes.

Conclusion

With an almost complete clearance of liver fat 1 year after surgery, RYGB and SG were both highly effective in reducing hepatic steatosis. Bariatric surgery had less influence on degree of fibrosis in the short term, but assessment of long-term progression is warranted.


Research link
https://www.acpjournals.org/doi/10.7326/M21-1962