生活方式管理对NASH患者胰岛素抵抗的影响

Effect of life-style management on the expression of insulin resistance in patients with non-alcoholic adipose hepatitis

目的探讨生活方式管理后非酒精性脂肪性肝炎(NASH)患者胰岛素抵抗(IR)以及病情的变化。方法84例NASH患者随机分为干预组和对照组,每组各42例。所有患者均给予服用熊去氧胆酸,疗程24周,对干预组同时实施生活方式管理。比较治疗前后两组间体重指数(BMI)、腰围(WI)、血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、γ-谷氨酰转氨酶(GGT)等水平及稳态模型胰岛素抵抗指数(HOMA-IR)。结果干预前,两组间BMI、WI、TG、TC、HDL-C、ALT、AST、GGT、HOMA-IR等指标的差异无统计学意义(P>0.05);干预24周后,干预组总有效率(78.57%)显著高于对照组(57.14%)(P<0.05),干预组干预后上述指标显著下降(P<0.01),也显著低于对照组(P<0.05);对照组干预后ALT、AST、GGT显著下降(P<0.05),但BMI、WI、TG、TC、HDL-C及HOMA-IR的差异无统计学意义(P>0.05)。结论生活方式管理能改善IR,促进NASH患者肝功能的恢复。

Objective To observe the status of insulin resistance （IR） in patients with non-alcoholic adipose hepatitis （NASH） after life-style management. Methods There 84 patients with NASH were divided into treatment and control groups,each consisted of 42 patients. All patients were took with ursodeoxycholic acid. At the same time the patients in the treatment group were accepted life-style management. Before and after treated 24 weeks,the changes of the levels of BMI, WI,HOMA-IR and serum TG,TC,HDL-C,ALT,AST,GGT were compared. Results After treated,the effective rate treatment group was 78.57% higher than that of the control group （57.14%, P〈0.05）.The levels of BMI, WI, HOMA-IR and serum TG,TC,HDL-C,ALT,AST,GGT of the patients in the treatment group after treated were markedly reduced as compared with those before treated（P〈0.01 ） and the control group too（P〈0.05）. The levels of serum ALT,AST,GGT of the patients in the control group after treated were markedly reduced as compared with those before treated （P〈0.05）. Conclusion Life-style management can improve IR and then promote the recovery of liver function in patients with NASH.