PDF(Pubmed)
Abstract：
OBJECTIVE: Bariatric intervention has been reported to be an effective way to improve metabolic dysfunction-associated steatotic liver disease (MASLD) in obese individuals. The current systemic review aimed to assess the changes in MRI-determined hepatic proton density fat fraction (MRI-PDFF) and nonalcoholic fatty liver disease activity score (NAS) after bariatric surgery or intragastric balloon/gastric banding in MASLD patients with obesity.
METHODS: We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH).
RESULTS: Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3-6 months compared to baseline, 40% at 12-24 months, and 50% at 36-60 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3-6 months, 37% at 12-24 months, and 29% at 36-60 months; lobular inflammation by 36% at 12-24 months and 51% at 36-60 months; ballooning degeneration by 38% at 12-24 months; significant fibrosis (≥F2) by 18% at 12-24 months and by 17% at 36-60 months after intervention.
CONCLUSIONS: Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.
METHODS: We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH).
RESULTS: Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3-6 months compared to baseline, 40% at 12-24 months, and 50% at 36-60 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3-6 months, 37% at 12-24 months, and 29% at 36-60 months; lobular inflammation by 36% at 12-24 months and 51% at 36-60 months; ballooning degeneration by 38% at 12-24 months; significant fibrosis (≥F2) by 18% at 12-24 months and by 17% at 36-60 months after intervention.
CONCLUSIONS: Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.
摘要：
目的：据报道，减肥干预是改善肥胖个体代谢功能障碍相关脂肪变性肝病（MASLD）的有效方法。目前的系统评价旨在评估MASLD肥胖患者减重手术或胃内球囊/胃束带术后MRI确定的肝质子密度脂肪分数（MRI-PDFF）和非酒精性脂肪肝疾病活动评分（NAS）的变化。
方法：我们搜索了各种数据库，包括PubMed、OVIDMedline,EMBASE,科克伦图书馆主要结果是MRI-PDFF肝内脂肪的变化和代谢功能障碍相关脂肪性肝炎（MASH）的组织学特征。
结果：选择30项研究，共3,134例患者进行meta分析。减肥干预显着降低了BMI(平均比率，0.79），并在减肥干预后6个月在MRI-PDFF上显示出肝内脂肪减少72％（平均比率，0.28)。八项研究显示，与基线相比，NAS在3-6个月时降低了60%，40%在12-24个月，和50%在36-60个月。19项研究显示，脂肪变性患者的比例在3-6个月时下降了44%，37%在12-24个月，在36-60个月时为29%;小叶炎症在12-24个月时为36%,在36-60个月时为51%;球囊变性在12-24个月时为38%;显著纤维化(≥F2)在12-24个月时为18%,在36-60个月时为17%。
结论：减肥干预可显著改善肥胖患者的MRI-PDFF和MASH组织学特征。对于对生活方式改变或药物治疗无反应的MASLD患者，减肥干预可能是有效的替代治疗选择。
方法：我们搜索了各种数据库，包括PubMed、OVIDMedline,EMBASE,科克伦图书馆主要结果是MRI-PDFF肝内脂肪的变化和代谢功能障碍相关脂肪性肝炎（MASH）的组织学特征。
结果：选择30项研究，共3,134例患者进行meta分析。减肥干预显着降低了BMI(平均比率，0.79），并在减肥干预后6个月在MRI-PDFF上显示出肝内脂肪减少72％（平均比率，0.28)。八项研究显示，与基线相比，NAS在3-6个月时降低了60%，40%在12-24个月，和50%在36-60个月。19项研究显示，脂肪变性患者的比例在3-6个月时下降了44%，37%在12-24个月，在36-60个月时为29%;小叶炎症在12-24个月时为36%,在36-60个月时为51%;球囊变性在12-24个月时为38%;显著纤维化(≥F2)在12-24个月时为18%,在36-60个月时为17%。
结论：减肥干预可显著改善肥胖患者的MRI-PDFF和MASH组织学特征。对于对生活方式改变或药物治疗无反应的MASLD患者，减肥干预可能是有效的替代治疗选择。
