减重治疗逆转超重及肥胖症患者脂肪肝的作用

The effects of weight reduction in reversing fatty liver changes in overweight and obese patients

目的 探讨超重及肥胖症患者合并脂肪肝的发病情况及其危险因素 ,减重治疗对肥胖症患者脂肪肝的逆转作用。方法 2 2 0例超重及肥胖症患者进行血生化、肝脏B超检查 ,其中 45例肥胖症患者接受为期 1年减重治疗 ,治疗前后测定体重 ,进行 75g葡萄糖耐量试验 ,同时测定血真胰岛素水平 ,血生化及肝脏B超检查 ,评价减重治疗后脂肪肝转归的影响因素。结果 75 9%的超重及肥胖症患者患有不同程度的脂肪肝 ,患者的体重指数、年龄、服糖后 2h血糖水平、服糖后 1h真胰岛素水平、腰围、低密度脂蛋白胆固醇水平是脂肪肝的危险因素。经过减重治疗 ,65 7%肥胖症患者的脂肪肝得到了改善 ,患者的血清转氨酶水平也有显著下降。结论 脂肪肝是肥胖症患者常见的并发症之一 。

Objective To study the effects of weight loss on nonalcoholic steatohepatitis(NASH) in obese patients Methods It is a prospective study Blood biochemical parameters were examined in 220 overweight or obese patients without alcoholic consumption and without detectable HBsAg Ultrasonographic examination was performed by a fixed doctor 45 obese patients followed a program of weight loss, including diet restriction, exercise or drug for a trial period of one year Weight, blood biochemical tests and ultrasonic examination of liver were compared before and after the trial in all the patients Results 75 9% of the patients were diagnosed as NASH Logistic regression analysis revealed that the risk factors of NASH were body mass index(BMI, β=0 926, P =0 021), age(β=0 973, P =0 021), 2 hour postprandial glucose(β=0 987, P =0 012), 1 hour postprandial net insulin in serum(β=1 027, P =0 032), waist circumference(β=1 091, P =0 038)and low density lipoprotein cholesterol (β=0 980, P =0 041) After the treatment, 65 7% of the patients with NASH improved The level of ALT in these patients decreased significantly ( P =0 040) The improvement of NASH correlated positively with the reduction of BMI(β=3 032, P =0 010), triglycerides(TG, β=1 041, P =0 025)and waist circumference (β=1 115, P =0 029) The decrease of ALT level correlated with the decrease of BMI(β=1 165, P =0 002), TG ( β=0 986, P =0 005), waist circumference(β=0 736, P =0 041), and the increase of high density lipoprotein cholesterol (β=-0 772, P =0 016) Conclusion NASH is one of the most important complications of obesity Weight loss is the mainstay of treatment for obese patients