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| 腹腔镜袖状胃切除术经肠-肝轴对肥胖患者NAFLD的影响 |
| Effect of laparoscopic sleeve gastrectomy on NAFLD in obese patients via gut-liver axis |
| 投稿时间：2022-04-22 |
| DOI：10.3969/j.issn.1000-0399.2022.08.005 |
| 中文关键词: 肥胖 肠道菌群 炎症因子 非酒精性脂肪肝 袖状胃切除术 |
| 英文关键词: Obesity Gut microbiota Cytokine Non-alcoholic fatty liver disease Laparoscopic sleeve gastrectomy |
| 基金项目:2019安徽省省级质量工程项目(项目编号:2019jyxm1014),安徽医科大学第二附属医院临床医学学科建设项目(项目编号:2021lcxk033) |
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| 中文摘要: |
| 目的 探讨肥胖患者腹腔镜下袖状胃切除术(LSG)前后肠道菌群的变化,及对非酒精性脂肪肝(NALFD)的影响。方法 收集2020年7月至2021年1月在安徽医科大学第二附属医院胃肠减重代谢外科就诊并接受LSG治疗的30例肥胖合并NAFLD患者的临床资料,观察并记录LSG术前和术后3个月的体质量参数、血清检验结果和粪便菌群测序等指标。计算LSG治疗前后患者肝脏脂肪(FLI)指数和FIB-4评分,评估手术后患者肝脂肪变性和纤维化的改善情况。结果 LSG术后患者身体质量参数、FLI及FIB-4评分较术前降低,差异有统计学意义(P＜0.05)。Wilcoxon秩和检验显示术后肠道菌群的丰度和多样性较术前增加,其中梭杆菌的比例增加,厚壁菌比例减少,差异有统计学意义(P<0.05)。白介素-1β(IL-1β)、肿瘤坏死因子-a (TNF-a)水平较术前降低,白介素-4(IL-4)水平较术前升高,差异均有统计学意义(P＜0.05)。细胞因子与菌群的Spearman相关性分析显示,梭杆菌与TNF-a,IL-1β呈负相关(r=-0.203、-0.329,P<0.05),厚壁菌与TNF-a,IL-1β呈正相关(r=0.315、0.459,P<0.05)。术前Pearson相关性分析显示TNF-a、IL-1β分别与FLI、FIB-4评分呈正相关(r=0.391、0.435、0.402、0.373,P<0.05),IL-4与FLI、FIB-4评分呈负相关(r=-0.523、-0.410,P<0.05)。术后相关性分析提示同样结果。结论 LSG可改善肠道菌群的丰度及分布,降低FLI和FIB-4评分进而缓解了肥胖患者肝脂肪变性和纤维化,IL-1β、IL-4和TNF-a可能在肠-肝轴中起到调节作用。 |
| 英文摘要: |
| Objective To explore the correlation between the changes in gut microbiota before and after laparoscopic sleeve gastrectomy (LSG) performed on non-alcoholic fatty liver disease(NALFD in obese patients. Methods The clinical data of 30 obese patients with NAFLD who received LSG treatment in the Department of Gastrointestinal Weight-loss Metabolic Surgery, the Second Hospital of Anhui Medical University from July 2020 to January 2021 were collected, including body mass parameters, serum test results and fecal flora sequencing before and three months after LSG. Fatty liver index (FLI) and fibrosis index (FIB-4) scores were calculated before and after LSG treatment to evaluate the improvement of liver steatosis and fibrosis in patients before and after surgery.Results FLI and FIB-4 scores of LSG patients after surgery were significantly lower than those before surgery (P<0.05). Wilcoxon rank sum test showed that the abundance and diversity of intestinal flora increased significantly after operation, including the proportion of Fusobacteriia increased, and the proportion of Negativicutes decreased,and the difference was statistically significant (P<0.05). The level of interleukin-1β(IL-1β), tumor necrosis factor-A (TNF-A) decreased significantly after operation, and the level of interleukin-4 (IL-4) increased compared with that before operation (P<0.05). Spearman correlation analysis showed that Fusobacterlia was negatively correlated with TNF-a and IL-1β (r=-0.203, P<0.05; r=-0.329, P<0.05), andNegativicutes were positively correlated with TNF-a and IL-1β (r=0.315, P<0.05; r=0.459, P<0.05). Preoperative Person correlation analysis showed that TNF-A IL-1β was positively correlated with FLI FIB-4 score (r=0.391,P<0.05, r=0.435,P<0.05; r=0.402,P<0.05, r=0.373,P<0.05), and IL-4 was negatively correlated with FLI FIB-4 score(r=-0.523,P<0.05; r=-0.410,P<0.05). Postoperative correlation analysis found the same result. Conclusions LSG improves the abundance and distribution of intestinal flora, and alleviates hepatic steatosis and fibrosis in obese patients, while IL-1β, IL-4 and TNF-a may play a regulatory role in the entero-liver axis. |
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