非酒精性脂肪性肝病患者的循证治疗

Evidence- based Treatment for A Case with Non- alcoholic Steatohepatitis

目的借助循证医学方法为1例非酒精性脂肪性肝炎(NASH)患者确定治疗方案。方法 2012-04-23本院消化内科收治1例37岁男性中度NASH患者,在评估患者情况后针对其情况提出临床问题,通过计算机检索Cochrane图书馆、PubMed、Embase、中国知网(CNKI)(1990—2012年),收集相关高质量证据进行评价,并结合医生经验及患者愿望制定治疗方案。结果共纳入相关文献24篇,其中系统评价/Meta分析12篇,随机对照试验(RCT)10篇,队列研究2篇。结合患者的情况对检索结果进行综合分析,制定合理的治疗方案:低糖低脂饮食;中等量有氧运动200 min/周;将体质量减至79 kg以下;口服吡格列酮30 mg/d。随访6个月后,患者食欲不振、肝区胀痛等症状明显缓解,肝脏超声显示轻度脂肪肝。结论改变生活方式、控制体质量、改善胰岛素抵抗、加用护肝药物,能有效提高NASH的治疗效果,并提高患者生活质量,但其远期疗效尚需进一步观察。

Objective To make an individualized treatment plan for a case of non - alcoholic steatohepatitis （NASH） by using methods of evidence - based medicine. Methods A 37 - year - old man was diagnosed as moderate NASH on April 23rd, 2012. After clinical problems were put forward, evidence from 1990 to 2012 was collected from the Cochrane library, PubMed, Embase and Chinese Journal Full -text Database （CNKI） . Treatment protocols were made according to the search re- suits, combined with patient preferences and physicians＇ clinical experience. Results A total of 12 metaanalysis or systematic reviews, 10 RCTs and 2 cohort studies were included. The results were analyzed and a therapy plan was formulated as follows： low - fat and low - carbohydrate diet, moderate - intensity activities 200 min/week, body weight loss to the goal of 79 kg, taking pioglitazone 30 mg/d. After a six - month follow up, the patient＇s anorexia and hepatalgia were improved, and ultrasound showed mild fatty liver. Conclusion Integration of lifestyle intervention, weight control, drugs improving insulin resistance and drugs of liver protection can improve the outcome and life quality in non - alcoholic fatty liver patient, but long - term effect needs further observation.