热量限制饮食对非酒精性脂肪性肝病患者胰岛素抵抗、血脂和氧化应激指标的影响

Improvement of insulin resistance,lipid profile and oxidative stress index by calorie restriction diet in patients with nonalcoholic fatty liver diseases

目的非酒精性脂肪性肝病(NAFLD)是慢性肝病中最常见的一种,与代谢异常和氧化应激相关。本研究旨在评估热量限制饮食对NAFLD患者胰岛素抵抗、血脂谱和氧化应激指标的影响。方法2018年1月~2019年1月我院诊治的NAFLD患者124例,将符合纳入标准的NAFLD患者随机分为A组和B组,每组62例。A组患者在保证蛋白质、基本维生素和微量元素供给的前提下,每日热量摄入控制在1200~1500 kcal,B组自行设计饮食控制,观察12周。结果治疗前,两组空腹血糖(FPG)、胰岛素、胰岛素抵抗指标(HOMA-IR)、胰岛B细胞功能(HOMA-B)和胰岛素敏感性检测指标(QUICKI)无显著性差异(P>0.05),经过12周饮食控制治疗后,A组HOMA-IR为(3.5±2.0),显著低于B组[(4.7±2.2),P<0.05],QUICKI为(0.3±0.1),显著高于B组[(0.2±0.2),P<0.05],而两组FPG、胰岛素水平和HOMA-B均无显著性统计学差异(P>0.05);治疗前,两组血低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯(TG)和总胆固醇(TC)水平无显著性差异(P>0.05),在12周观察期末,A组血LDL为(120.7±23.7)mg/dL,显著低于B组[(149.0±33.4)mg/dL,P<0.05],TC为(197.6±40.7)mg/dL,显著低于B组[(230.5±42.8)mg/dL,P<0.05],TG为(176.2±75.0)mg/dL,显著低于B组[(186.4±63.7)mg/dL,P<0.05],而血HDL水平为(43.5±7.4)mg/dL,显著高于B组([(40.9±8.2)mg/dL,P<0.05];治疗前,A组和B组血清MDA水平分别为(60.6±35.2)μmol/L和(60.7±36.2)μmol/L,无显著性差异(P>0.05),而在12周观察期末,A组为(55.5±35.8)μmol/L,显著低于B组[(60.3±34.3)μmol/L,P<0.05]。结论采取热量限制饮食可有效改善NAFLD患者胰岛素抵抗、血脂谱和氧化应激指标,值得在临床上进行广泛的验证。

Objective Non-alcoholic fatty liver diseases(NAFLD)is the most common type of chronic liver disease all over the world,which is related to metabolic abnormalities and oxidative stress.The purpose of this study was to assess the effects of calorie restriction diet on insulin resistance,lipid profile and oxidative stress index in patients with NAFLD.Methods 124 patients with NAFLD were recruited in our hospital From January 2018 through January 2019,and were randomly divided into group A and group B,with 62 in each.The daily calorie intake in group A was controlled at 1200~1500 kcal.d-1 on the premise of ensuring protein,basic vitamin and trace element intake,the patients in group B designed their own diets forthemselves.The study lasted for 12 weeks.Results At presentation,there was no significant differences in fasting blood glucose(FPG),insulin,insulin resistance index(HOMA-IR),islet B cell function(HOMA-B)and insulin sensitivity detection index(QUICKI)between the two groups(P>0.05),while at the end of 12 weeks of observation,the HOMA-IR in group A was(3.5±2.0),significantly lower than[(4.7±2.2),P<0.05)in group B,and the QUICKI was(0.3±0.1),significantly higher than[(0.2±0.2),P<0.05]in group B,and there were no significant differences(P>0.05)as respect to FPG,insulin and HOMA-B in the two groups;before treatment,there was no significant difference in blood lipid profile,such as blood low density lipoprotein(LDL),high density lipoprotein(HDL),triglyceride(TG)and total cholesterol(TC)between the two groups(P>0.05),and at the end of 12 week observation,the blood LDL level in group A was(120.7±23.7)mg/dl,significantly lower than[(149.0±33.4)mg/dl,P<0.05]in group B,blood TC level was(197.6±40.7)mg/dl,significantly lower than[(230.5±42.8)mg/dl,P<0.05],and blood TG level was(176.2±75.0)mg/dl,significantly lower than[(186.4±63.7)mg/dl,P<0.05],while blood HDL level was(43.5±7.4)mg/dl,significantly higher than[(40.9±8.2)mg/dl,P<0.05)in group B;there was no significant difference in serum malondialdehyde(MDA)between the two groups[(60.6±35.2)μmol/l vs.(60.7±36.2)μmol/l,P>0.05],while at the end of 12 week observation,serum MDA level in group A was[(55.5±35.8)μmol/l,significantly lower than[(60.3±34.3)μmol/l,P<0.05]in group B.Conclusion The application of calorie restriction diets might effectively improve insulin resistance,blood lipid profile and oxidative stress in patients with NAFLD,which is worth further study in multi-central clinical practice.