生活方式干预对非酒精性脂肪肝疗效的Meta分析

Effects of lifestyle intervention on nonalcoholic fatty liver disease： a Meta-analysis

目的 评价生活方式干预治疗非酒精性脂肪肝（NAFLD）的疗效.方法 对PubMed （1966年7月至2011年3月）、Google Scholar（1985年7月至2011年3月）、中国知网数据库（1980年7月至2011年3月）、万方优秀硕士博士学位论文全文数据库（1999年7月至2011年3月）及维普期刊网（1989年7月至2011年3月）进行计算机检索,并手工检索相关资料和各论文参考文献目录,筛选出生活方式干预治疗NAFLD的文献18篇,进行文献质量评分和数据提取转换.所有数据纳入RevMan 5.0进行异质性检验、Meta分析及发表偏倚检验.结果 共纳入7个随机对照试验和10个半随机对照试验,共1 467例患者.纳入研究的方法学质量均偏低.结果显示生活方式干预对NAFLD患者治疗综合效果有明显影响[相对危险度（RR）=0.64,95％置信区间：0.47 ～0.87,P＜0.01],且能明显降低患者的体重指数（均数差=2.06,95％置信区间：1.12 ～2.99）、三酰甘油（均数差=0.66,95％置信区间：0.40 ～0.91）、丙氨酸转氨酶（均数差=27.34,95％置信区间：14.45 ～40.22）、空腹血糖（均数差=0.47,95％置信区间：0.07 ～0.88）、胰岛素抵抗指数（均数差=1.00,95％置信区间：0.73 ～ 1.26）（均P＜0.05）,对患者的总胆固醇（均数差=0.52,95％置信区间：-0.08 ～ 1.12,P=0.09）、天冬氨酸转氨酶（均数差=14.34,95％置信区间：-0.33 ～29.0,P=0.06）、高密度脂蛋白胆固醇、肝脂肪变性指数和肝纤维化指数无明显影响.仅有3项研究描述了生活方式干预对患者低密度脂蛋白和空腹胰岛素水平的影响,研究数量有限,不足以合并分析.结论 生活方式干预治疗可以降低NAFLD患者的肥胖程度,部分改善其三酰甘油代谢及其肝功能,因此可以作为NAFLD患者的首选治疗措施.

Objective To collect and study information and data extracted from research papers quantitatively which are concerning using lifestyle intervention in the treatment of non-alcoholic fatty liver disease.Methods Papers were searched in PubMed,Google Scholar,CNKI Database,Wanfang Outstanding Master＇s/ Ph.D.Dissertation Database and VIP Journals Online Full-text databases and 18 records of using lifestyle intervention treatment of non-alcoholic fatty liver disease were located.At the same time,article quality scores were judged,data were extracted and converted.All the data were input into RevMan 5.0 for heterogeneity test,Meta analysis,and publication bias tests.Results The lifestyle intervention has a significant impact on treatment of non-alcoholic fatty liver disease patients,and BMI [（MD） =2.06,95％ CI：1.12-2.99],TG [MD =0.66,95 ％ CI：0.40-0.91],A LT[M D =27.34,95 ％ CI：14.45-40.22],F-GLU [MD =0.47,95 ％ CI：0.07-0.88],HOMA-IR[MD =1.00,95％ CI：0.73-1.26],F-Insulin were significantly reduced in non-alcoholic fatty liver disease patients （all P ＜0.05）,but that lifestyle interventions can not reduced TC[MD =0.52,95％ CI：-0.08 -1.12,P ＞ 0.05],AST [MD =14.34,95 ％ CI：-0.33-29.0,P ＞ 0.05],hepatic steatosis and hepatic fibrosis index significantly was also found.Only three studies describe the effect of lifestyle intervention on LDL and fasting insulin levels.The number of studies is so limited that not enough to combine analysis.Conclusions The lifestyle intervention can reduce non-alcoholic fatty liver disease patients＇ obesity,improve triglyceride metabolism,improve liver function and the optimization of glucose metabolism,but lifestyle intervention can not reduce the levels of hepatic steatosis,hepatic fibrosis and serum apolipoprotein,thus more other treatment studies are badly needed.