生活方式的改变可改善非酒精性脂肪性肝病患者的胰岛素抵抗和肝脏组织学。
Life style modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease.
作者信息
Bhat Ganesh, Baba Chalamalasetty Sreenivasa, Pandey Amaresh, Kumari Neeraj, Choudhuri Gourdas
机构信息
Ganesh Bhat, Department of Gastroenterology, Kasturba Medical College, Manipal University, Manipal 576104, India.
出版信息
World J Hepatol. 2012 Jul 27;4(7):209-17. doi: 10.4254/wjh.v4.i7.209.
AIM
To study the effect of regular aerobic exercise on insulin resistance, serum aminotransferase and liver histology in nonalcoholic fatty liver disease (NAFLD) patients.
METHODS
Sixty (mean age 40.0 ± 8.5 years, 75% male) NAFLD patients were included in the study. After baseline anthropometric measurement i.e., body mass index (BMI), waist circumference (WC); all patients were advised regular aerobic exercise for 30 min/d, for at least 5 d/wk and trained to achieve around 70% of his maximal heart rate. In addition, moderately energy restricted diet was advised to patients with high BMI (> 25 kg/m(2)). Monthly follow up was done by measuring BMI, WC, aspartate aminotransferase, and alanine aminotransferase (ALT). Insulin resistance was calculated using homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) model, at baseline and after 6 mo. Insulin resistance was arbitrarily considered altered when it was ≥ 2. Liver biopsy was done in a section of patients at baseline and after 6 mo.
RESULTS
Seventy percent (42/60) patients were overweight or obese; 95% (57/60) had central obesity (WC > 90 cm in men, > 80 cm in women). In the 45 exercise compliant patients insulin resistance decreased from 6.4 ± 6.1 to 1.3 ± 1.0, BMI from 26.7 ± 3.3 kg/m(2) to 25.0 ± 3.3 kg/m(2), WC from 95.7 ± 8.9 cm to 90.8 ± 7.3 cm and ALT from 84.8 ± 43.5 U/L to 41.3 ± 18.2 U/L (P < 0.01). In 15 exercise noncompliant patient's insulin resistance, BMI, WC and ALT did not show significant change at 6 mo follow up. Six of 8 patients in compliant group on repeat liver biopsy showed significant change in steatosis and necroinflammation. Nonalcoholic steatohepatitis scores improved form 5.3 ± 1.5 to 3.35 ± 1.5. The decline in insulin resistance correlated with decline in ALT (P = 0.01, r(s) = 0.90) and liver histology (P = 0.03, r(s) = 0.73).
CONCLUSION
Life style modification improves insulin resistance resulting in improvement in ALT and liver histology in NAFLD patients.
目的
研究规律有氧运动对非酒精性脂肪性肝病（NAFLD）患者胰岛素抵抗、血清转氨酶及肝脏组织学的影响。
方法
60例NAFLD患者（平均年龄40.0±8.5岁，75%为男性）纳入本研究。在进行基线人体测量即体重指数（BMI）、腰围（WC）后；建议所有患者进行规律有氧运动，每天30分钟，每周至少5天，并训练使其达到最大心率的70%左右。此外，建议BMI较高（>25kg/m²）的患者适度限制能量饮食。通过测量BMI、WC、天冬氨酸转氨酶和丙氨酸转氨酶（ALT）进行每月随访。在基线和6个月后使用胰岛素抵抗稳态模型评估（HOMA）模型计算胰岛素抵抗（HOMA-IR）。当胰岛素抵抗≥2时，任意认为其发生改变。在一部分患者的基线和6个月后进行肝脏活检。
结果
70%（42/60）的患者超重或肥胖；95%（57/60）有中心性肥胖（男性WC>90cm，女性>80cm）。在45例依从运动的患者中，胰岛素抵抗从6.4±6.1降至1.3±1.0，BMI从26.7±3.3kg/m²降至25.0±3.3kg/m²，WC从95.7±8.9cm降至90.8±7.3cm，ALT从84.8±43.5U/L降至41.3±18.2U/L（P<0.01）。在15例不依从运动的患者中，胰岛素抵抗、BMI、WC和ALT在6个月随访时未显示出显著变化。依从组8例患者中有6例在重复肝脏活检时显示脂肪变性和坏死性炎症有显著变化。非酒精性脂肪性肝炎评分从5.3±1.5改善至3.35±1.5。胰岛素抵抗的下降与ALT的下降相关（P=0.01，rs=0.90）以及肝脏组织学变化相关（P=0.03，rs=0.73）。
结论
生活方式的改变可改善胰岛素抵抗，从而改善NAFLD患者的ALT及肝脏组织学。
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