代谢相关脂肪性肝病患者有氧运动干预实施的前瞻性研究

Implementation of aerobic exercise intervention in patients with metabolic associated fatty liver disease:A prospective study

目的采用中等强度的有氧运动对代谢相关脂肪性肝病(MAFLD)患者进行干预,评价其干预效果并对干预方案进行初步探讨,为有效防治MAFLD提供理论依据和新思路。方法选取2019年5月-2019年8月在四川省人民医院健康管理中心进行体检,以及通过"四川省人民医院健康管理中心"微信公众平台招募的共计158例MAFLD患者为研究对象。采用随机数字表法将患者分为对照组52例,每月随访组54例和每周随访组52例。对照组仅在入组时给予健康教育,每月随访组和每周随访组均接受中等强度的有氧运动干预,两组均使用运动手环监测运动情况和微信平台进行随访,两组随访频率分别是每月1次和每周1次。采用无创肝纤维化诊断系统FibroTouch检测干预前后MAFLD患者的脂肪肝程度。比较3个月后各组干预前后的BMI、腰围、肝脏脂肪衰减指数、肝脏硬度、血压、AST、ALT、GGT、空腹血糖、尿素、TC、TG、LDL-C及HDL-C的变化。服从正态分布的计量资料多组间比较采用单因素方差分析,2组间干预前后比较采用配对t检验;不服从正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Nemenyi检验,2组间干预前后比较采用Wilcoxon符号秩和检验。结果最终完成试验共147例,其中对照组49例(失访3例),每月随访组49例(失访5例)和每周随访组49例(失访3例)。以每周5次,每次30 min以上达到靶心率的运动量为标准,每月随访组的运动达标率为66.7%,每周随访组的达标率是93.2%。干预前3组患者各项指标间比较,差异均无统计学意义(P值均> 0.05)。每月随访组中干预后腰围明显小于干预前[(93.39±9.24) cm vs (94.24±8.89) cm,t=2.590,P <0.05]。每周随访组中干预后BMI[(26.46±3.36) kg/m^2vs (27.63±3.46) kg/m^2,t=8.534,P <0.001]、腰围[(87.04±8.84) cm vs (91.47±8.08) cm,t=6.854,P <0.001]、肝脏脂肪衰减值[(260.08±31.07) d B/m vs (287.88±23.28) dB/m,t=8.521,P <0.001]、DBP[(76.78±11.23) mm Hg vs (79.27±12.36) mm Hg,t=2.106,P=0.040]、ALT[32(20~43) U/L vs 43(28~59) U/L,Z=-3.973,P <0.001]、GGT[25 (19~40) U/L vs 34 (24~47) U/L,Z=-3.847,P <0.001]、TG[1.48 (1.20~2.02) mmol/L vs2.04(1.63~2.80) mmol/L,Z=-3.873,P <0.001]、UA [(381.53±71.89)μmol/L vs (414.37±81.27)μmol/L,t=3.953,P <0.001]和FPG[(5.05±0.58) mmol/L vs (5.21±0.71) mmol/L,t=2.185,P=0.034]均较干预前显著降低,差异均有统计学意义。结论中等强度有氧运动可以明显降低MAFLD患者的血清TG、ALT、GGT水平,显著减轻脂肪肝程度,每周1次随访频率管理效果较每月1次效果好,同时基于运动手环、微信软件远程管理的方式简便易行,MAFLD患者的接受度高。

Objective To investigate the intervention effect of moderate-intensity aerobic exercise on patients with metabolic associated fatty liver disease( MAFLD) and preliminary intervention regimens,and to provide a theoretical basis and new ideas for the effective prevention and treatment of MAFLD. Methods A total of 158 MAFLD patients who underwent physical examination in Health Management Center of Sichuan Provincial People’s Hospital from May to August 2019 or who were recruited through the WeChat official account of"Health Management Center of Sichuan Provincial People’s Hospital"were enrolled as subjects,and the patients were divided into control group with 52 patients,monthly follow-up group with 54 patients,and weekly follow-up group with 52 groups using a random number table. The patients in the control group were given health education alone on admission,and those in the monthly follow-up group and the weekly follow-up group were received the intervention of moderate-intensity aerobic exercise;in the monthly follow-up group and the weekly follow-up group,a sports bracelet was used to monitor the exercise and follow-up was performed through the WeChat platform at a frequency of once a month and once a week,respectively. The noninvasive liver fibrosis diagnosis system FibroTouch was used to evaluate the degree of fatty liver disease before and after intervention. The three groups were compared in terms of the changes in body mass index( BMI),waist circumference,hepatic fat attenuation index,liver stiffness,blood pressure,aspartate aminotransferase,alanine aminotransferase( ALT),gamma-glutamyl transpeptidase( GGT),fasting plasma glucose( FPG),uric acid( UA),total cholesterol( TG),triglyceride( TG),low-density lipoprotein cholesterol,and high-density lipoprotein cholesterol after 3 months of intervention. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the paired t-test was used for comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Nemenyi test or Wilcoxon signed rank-sum test was used for comparison between two groups. Results A total of 147 patients completed the trial,with 49 patients in the control group( 3 were lost to follow-up),49 in the monthly follow-up group( 5 were lost to follow-up),and 49 in the weekly follow-up group( 3 were lost to follow-up). With the amount of exercise,which reached the target heart rate,5 times a week for more than 30 minutes each time as the criteria,the rate of reaching the standard was 66. 7% in the monthly follow-up group and 93. 2% in the weekly follow-up group. There were no significant differences in each index between the three groups before intervention( all P > 0. 05). The monthly follow-up group had a significant reduction in waist circumference after intervention( 93. 39 ± 9. 24 cm vs 94. 24 ± 8. 89 cm,t = 2. 590,P < 0. 05). After intervention,the weekly follow-up group had significant reductions in BMI( 26. 46 ± 3. 36 kg/m^2 vs 27. 63 ± 3. 46 kg/m^2,t =8. 534,P <0. 001),waist circumference( 87. 04 ±8. 84 cm vs 91. 47 ±8. 08 cm,t =6. 854,P <0. 001),hepatic fat attenuation index( 260. 08 ± 31. 07 d B/m vs 287. 88 ± 23. 28 d B/m,t = 8. 521,P < 0. 001),diastolic blood pressure( 76. 78 ±11. 23 mm Hg vs 79. 27 ± 12. 36 mm Hg,t = 2. 106,P = 0. 040),ALT [32( 20-43) U/L vs 43( 28-59) U/L,Z =-3. 973,P <0. 001],GGT [25( 19-40) U/L vs 34( 24-47) U/L,Z =-3. 847,P < 0. 001],TG [1. 48( 1. 20-2. 02) mmol/L vs 2. 04( 1. 63-2. 80) mmol/L,Z =-3. 873,P < 0. 001],UA( 381. 53 ± 71. 89 μmol/L vs 414. 37 ± 81. 27 μmol/L,t = 3. 953,P < 0. 001),and FPG( 5. 05 ± 0. 58 mmol/L vs 5. 21 ± 0. 71 mmol/L,t = 2. 185,P = 0. 034). Conclusion Moderate-intensity aerobic exercise can significantly reduce the serum levels of TG,ALT,and GGT and alleviate the degree of fatty liver disease in MAFLD patients,and weekly follow-up has a better management effect than monthly follow-up. The method of remote management based on sports bracelet and We Chat software is simple and easy,with a high level of acceptance among MAFLD patients.