Cenário das hepatites virais no estado de Sergipe e o impacto da cirurgia bariátrica na doença hepática gordurosa não alcoólica

• Autor(a) principal: Nascimento, Tereza Virgínia Silva Bezerra do
• Data de Publicação: 2022
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: https://ri.ufs.br/jspui/handle/riufs/18554
• topic: Análise espacial; Cirurgia bariátrica; Doença hepática gordurosa não alcoólica; Estudos de séries temporais; Hepatite viral humana; Hepatopatias; Mortalidade; Spatial analysis; Bariatric surgery; Non-alcoholic fatty liver disease; Time series studies; Human viral hepatitis; Liver diseases; Mortality; CIENCIAS DA SAUDE

Introduction: Liver diseases, which compromise the liver both structurally and functionally, are a group of diseases of multifactorial etiology; some of the main ones are hepatitis and alcoholic and non-alcoholic fatty liver disease. By compromising vital functions, such as albumin production and coagulation factors, metabolization of substances, among others, this group of diseases presents high morbidity and mortality worldwide. Objectives: 1) To evaluate the scenario of viral hepatitis in the state of Sergipe, focusing on a spatial analysis and temporal trends of mortality in the state, in the period from 1980 to 2019; 2) To understand the impact of bariatric surgery on nonalcoholic fatty liver disease. Methods: In the present study, two different methodologies were applied. Through this thesis, two papers with different methodologies were written. In objective 1, an ecological-exploratory and analytical study of time series with spatial analysis techniques was conducted, which included all deaths from viral hepatitis recorded in Sergipe between 1980 and 2019. In objective 2, an integrative review on the impact of bariatric surgery on non-alcoholic fatty liver disease was performed. Results: Regarding the study of viral hepatitis, 368 deaths with a higher prevalence among men (65.21%) and more than one third related to virus C (37.72%) were recorded. The mortality trends due to HBV were increasing among men (APC: 1.56; IC95%: 0.41; 2.72) with an adjusted rate of 0.347/100,000 inhabitants in 2019; stable to HCV in both sexes (adjusted rate of 0.388 in males and 0.205 in females in 2019); and decreasing to the other viruses. Although there was no spatial autocorrelation of mortality from viral hepatitis, the highest rates are distributed among the municipalities of the metropolitan region and those near the São Francisco river. Among men, HAV, HBV and HCV presented high-risk clusters. Among women, only deaths from "other viral hepatitis" presented high-risk clusters. In the integrative review, related to objective 2 of this thesis, 31 studies were identified in the last 5 years; 10 were excluded because there was no postoperative evaluation and 8 were excluded because they did not meet the methodological criteria. At the end, 13 studies from the current literature were included, which, despite the heterogeneity of the studies in relation to the sample and methodology for the evaluation of NAFLD and postoperative time, all of them reported a positive effect of bariatric surgery on the regression of the liver lesion, in an evaluation period between 6 months and 1 year after surgery. Conclusions: Viral hepatitis is still an important cause of death in the state of Sergipe, with a stable trend in the HCV mortality rate among men and women. In the integrative review on the impact of bariatric surgery on NAFLD regression, we concluded that, although evidence level 2b, there is a beneficial effect of the surgery on liver injury regression, however, more randomized clinical studies and longer follow-up are needed, so that it is possible to document with greater evidence a beneficial effect of this surgery on NAFLD.