营养干预结合有氧运动对非酒精性脂肪肝患者血清脂联素的影响

Effect of nutritional intervention combined with aerobic exercises on serum adiponectin of nonalcoholic fatty liver patients

目的探讨营养干预结合有氧运动对非酒精性脂肪肝（NAFL）患者血清脂联素水平和胰岛素抵抗的影响。方法以2008年4月至2009年8月聊城市人民医院查体中心和肝病门诊确诊的32例NAFL患者为NAFL组，同期健康查体人员31例为对照组。对NAFL组进行营养干预并实施有氧运动方案，检测两组干预前后体重指数（BMI）、血清脂联素、空腹血糖（FBG）、空腹胰岛素（FINS）及血脂水平变化，计算胰岛素抵抗指数（HOMA—IR），比较组间差异、干预前后差异以及血清脂联素与各指标的相关性。结果干预前NAFL组的BMI[（29．84±3．16）kg／m。比（22．22±1．81）kg／m2，P=0．000]、总脾崮醇（TC）[（5．09±0．86）mmol／L比（4．38±0．85）mmol／L，P=0．002]、甘油三酯（TG）[（1．99±0．86）mmol／L比（1．10±0．38）mmol／L，P=0．000]、FBG[（6．02±0．63）mmoL／L比（5．02±0．71）mmol／L，P=0．000l、FINSl（13．73±3．24）mU／L比（9．55±1．99）mU／L，P=0．000]、HOMA—IR[（3．74±1．21）mmol／L比（2．08±0．27）mmo]／L，P=0．000]水平均显著高于正常对照组，脂联素水平明显低于对照组[（4．89±1．81）ug／L比（12．97±3．15）ug／L，P=0．000]。NAFL组干颅后BMI[（26．65±2．39）kg／m2比（29．84±3．16）kg／m2，P=0．000]、FBG[（5．61±0．47）mmol／L比（6．02±0．63）mmol／L，P=0．004]和FINS[（11．12±2．01）mU／L比（13．73±3．24）mU／L，P=0．000]水平显著低于干预前，脂联素水平显著高于干预前[（6．54±2．12）ug／L比（4．89±1．81）．g／L，P=0．001]。脂联素与BMI、FBG、FINS、HOMA—IR和TG呈显著负相关（P值分别为0．004、0．000、0．000、0．000、0．010），与高密度脂蛋白呈显著正相关（P=0．026），与TC无相火性（P=0．101）。结论营养干预结合有氧运动可提高NAFL患者的血清脂联素水平，调宵血糖血脂水平，改善胰岛素抵抗。

Objective To study the effect of nutritional intervention combined with aerobic exercises on serum adiponectin and insulin resistance in nonalcoholic fatty liver （NAFL） patients. Methods 32 patients confirmed as NAFL between April 2008 and August 2009 were enrolled into NAFL group and 31 health people into control group. NAFL group received nutritional intervention and followed aerobic exercise program. The changes of body mass index （BMI）, serum adiponectin, fasting blood glucose （FBG） , fasting insulin （FINS） and serum lip- ids were recorded before and after interventions. Insulin resistance index （HOMA-IR） was calculated. Inter-group difference, changes after intervention, and correlation between serum adiponectin and the other indexes were ana- lyzed. Results Compared with the control group, BMI [ （29. 84±3.16） kg/ml vs. （22.22±1.81 ） kg/m2, P =0. 000 ], total cholesterol （TC） [ （5.09± 0. 86） mmol/L vs. （4. 38 ±0. 85 ） retool/L, P = 0. 002 ], triglyceride （TG） [ （1.99±0.86） mmol/Lvs. （1.10±0.38） mmol/L,P=0. 000], FBG[ （6.02±0.63） mmol/Lvs. （5.02±0.71） mmol/L, P=0. O00], FINS [ （13.73 ±3.24） mU/Lvs. （9. 55±1.99） mU/L, P=0.000], HOMA-IR [ （3.74 ± 1.21 ） mmol/L vs. （2.08± 0. 27） retool/L, P = 0. 000 ] in the NAFL group were signifi- cantly higher, while serum adiponeetin in the NAFL group was significantly lower （4. 89± 1.81 ） ug/L vs. （ 12. 97 ±3.15） ug/L, P =0. 000]. After nutritional intervention and aerobic exercises, BMI [ （26.65 ±2. 39） kg/m2 vs. （29. 84±3.16） kg/m2 P =0. 000], FBG [ （5.61 ±0. 47） mmol/L vs. （6.02 ±0. 63） mmol/L, P = 0. 004 ], and FINS [ （ 11.12±2.01 ） mU/L vs. （ 13.73± 3.24） mU/L, P = 0. 000 ] in the NAFL group were decreased significantly, while serum adiponectin [ （6.54 ±2.12） ug/L vs. （4.89 ±1.81 ） ug/L, P =0. 001 ] was significantly higher than the level before intervention. Serum adiponectin was negatively correlated with BMI, FBG, FINS, HOMA-IR, and TG （ P = 0. 004, 0. 000, 0. 000, 0. 000, and 0. 010）, and positively correlated with high density lipoprotein cholesterol （P = 0. 026） , but not correlated with TC （P = 0. 101 ）. Conclusion The combination of nutritional intervention and aerobic exercises can improve the level of serum adiponeetin, adjust the level of serum glueose and serum lipids, and alleviate insulin resistance in NAFL patients.