有氧运动对非酒精性脂肪性肝病疗效的Meta分析

Effect of aerobic exercise in non-alcoholic fatty liver disease patients: a Meta-analysis

目的探讨有氧运动是否能预防或改善非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD),评估患者在接受有氧运动后,能否对肝脏脂肪、肝功能、血脂、体质量等产生影响。方法根据纳入标准确定检索词,对相关数据库搜索后,选择有氧运动与NAFLD对比或控制性的随机性研究。提取文章数据、纳入研究方法学和质量评估工作由2名作者分别进行。以Cochrane系统评价手册为指导方针进行纳入研究的资料提取及质量评价,使用Rev Man 5.2软件进行Meta分析。结果该研究共纳入文献6篇,包含206例患者,得出结果:有氧运动对NAFLD的肝内脂肪(intrahepatic lipid,IHL)有明显的缓解作用(MD=-3.29,95%CI:-5.53^-1.05,P=0.004)。有氧运动对NAFLD患者的丙氨酸氨基转移酶(alanine aminotransferase,ALT)差异无统计学意义(SMD=0.12,95%CI:-0.23~0.48,P=0.49);有氧运动对天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)没有缓解作用(SMD=0.27,95%CI:-0.11~0.65,P=0.16);有氧运动对患者血脂包括甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白(high density lipoprotein,HDL)及低密度脂蛋白(low density lipoprotein,LDL)的改善差异无明显统计学意义(TG:SMD=-0.04,95%CI:-0.40~0.32,P=0.93;TC:SMD=-0.33,95%CI:-0.68~0.02,P=0.06;HDL:SMD=0.02,95%CI:-0.31~0.35,P=0.90;LDL:SMD=-0.07,95%CI:-0.42~0.28,P=0.68)。有氧运动对NAFLD患者的体质量指数(body mass index,BMI)也无明显降低(MD=0.33,95%CI:-2.50~3.17,P=0.82)。结论有氧运动可以明显改善NAFLD患者的IHL,但对肝功能、血脂、BMI等方面并无明显改善,这与研究的设计有很大关系。我们仍需进一步探讨如何调整有氧运动的内容结构,及如何利用其改变生活方式以改善NAFLD患者的病情。

Objective To investigate whether aerobic exercise can prevent or improve the condition of non-alcoholic fatty liver disease（ NAFLD）,and evaluate the efficacy of indicators including liver fat,liver function,blood fat and body mass after accepting the intervention. Methods According to the inclusion criteria,random and controlled trials of aerobic exercise combined with NAFLD were chosen. Data extraction of articles and methodology of included research and quality evaluation were carried out by two authors. Regard Cochrane reviewer handbook as guidelines for the assessment of extracting data,Rev Man 5. 2 software was used for Meta analysis. Results This study included 6 researches including 206 patients. Aerobic exercise could improve IHL of NAFLD patients（ MD =- 3. 29,95 % CI：- 5. 53 -- 1. 05,P = 0. 004）. However,the exercise alone vs control（ without diet intervention or other interventions in both groups）,there was no significant efficacy on liver function,blood fat and body mass index（ BMI）,respectively（ ALT：SMD = 0. 12,95% CI：- 0. 23 - 0. 48,P = 0. 49; AST： SMD = 0. 27,95 % CI：- 0. 11 - 0. 65,P = 0. 16; TG：SMD =- 0. 04,95% CI：- 0. 40 - 0. 32,P = 0. 93; TC： SMD =- 0. 33,95% CI：- 0. 68 - 0. 02,P = 0. 06;HDL： SMD = 0. 02,95% CI：- 0. 31 - 0. 35,P = 0. 90; LDL： SMD =- 0. 07,95% CI：- 0. 42 - 0. 28,P = 0. 68;BMI： MD = 0. 33,95% CI：- 2. 50 - 3. 17,P = 0. 82）. Conclusion Aerobic exercise can improve the condition of NAFLD on IHL instead of liver functions,blood fat and BMI. The structure of aerobic exercise and how to use the interventions of lifestyle are worthy of further exploration.