减肥手术与GLP-1受体激动剂降低新发NASH风险的比较效果：一项来自北美和欧洲的回顾性多国队列研究

IF 2.7 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism Pub Date : 2025-07-12 DOI:10.1002/edm2.70075

Abdallah Hussein, Ameer Awashra, Islam Rajab, Mohammad Bdair, Dawoud Hamdan, Ahmad Nouri, Elaf Khatib, Ghiras Khatib, Nyan Latt

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引用次数: 0

摘要

背景：非酒精性脂肪性肝炎（NASH）是一种严重的非酒精性脂肪性肝病（NAFLD），可发展为肝硬化和肝细胞癌（HCC）。肥胖是NASH的主要危险因素，代谢干预如减肥手术（BS）和胰高血糖素样肽-1受体激动剂（GLP-1 RAs）对肝脏相关结局的影响已被探索。本研究评估了BS和GLP-1 RAs在降低新发NASH及相关肝脏并发症发生率方面的比较有效性。方法：这是一项基于人群的大型回顾性队列研究，数据来自TriNetX平台。纳入了2014年1月1日至2019年12月31日期间接受BS与GLP-1RA治疗的体重指数(BMI)≥35且无NAFLD/NASH病史（无肝硬化）的成年患者。BS组与GLP-1RA组患者根据年龄、人口统计学、合并症、用药情况进行1:1倾向匹配。结果在180,022名符合条件的成年人中，143,404人接受了BS治疗，而36,618人接受了GLP-1 RA治疗。倾向评分匹配后，BS组33,594例患者(平均年龄49.1±13.2岁；72.73%为女性)与同等数量的GLP-1 RA组(平均年龄48.9±14.0岁；72.41%的女性)。与接受GLP-1 RA治疗的患者相比，接受BS治疗的患者发生HCC的风险显著降低(HR, 0.304；95% CI, 0.099-0.931)，显示出最强的保护作用，随后NASH显著降低(HR, 0.509；95% ci, 0.469-0.551)。肝硬化风险降低无统计学意义(HR, 0.865；95% ci, 0.696-1.075)。这些关联在1年、3年、5年和7年的随访期间仍然存在。结论：这些发现表明BS与NASH/NAFLD新发风险降低显著相关。

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Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe

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Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe

Background

Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.

Methods

This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.

Results

Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099–0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469–0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696–1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.