Cognitive-Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score-Adjusted Observational Study
Cognitive-Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score-Adjusted Observational Study
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DOI：
10.1038/oby.2010.254
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发表时间：
2011-04-01
期刊：
影响因子：
6.9
通讯作者：
Marchesini, Giulio
中科院分区：
文献类型：
--
作者：
Moscatiello, Simona;Di Luzio, Raffaella;Marchesini, Giulio
认知行为治疗（CBT）治疗非酒精性脂肪性肝病（NAFLD）的有效性迄今为止在非常有限的样本中进行了测试，NAFLD主要与超重/肥胖有关，并被认为是代谢综合征（MS）的肝脏表达。在三级转诊中心，连续观察NAFLD受试者在13个小组会议的基础上，提供旨在减肥和增加身体活动的CBT计划；68例患者进入治疗方案，拒绝接受治疗的患者（n = 82）给予饮食和身体活动建议。治疗目标（体重减轻>= 7%的初始体重，肝酶正常化，改善MS参数）在6个月（所有病例）和2年通过logistic回归测试，包括有意治疗和完成治疗的患者（饮食，78；CBT, 65）。根据民事、人体测量学和临床变量，对参加CBT计划的倾向评分进行了调整。在基线时，CBT组有更大的肥胖患病率和更严重的胰岛素抵抗（体内平衡模型评估（HOMA））。在随访中，CBT与更高的体重减轻和正常肝酶相关(6个月：优势比（OR）， 2.56；95%置信区间（CI）， 1.15-5.69；2年意向治疗：OR， 3.57, 95% CI, 1.59-8.00)，校正倾向和体重变化后。在胰岛素抵抗的结局目标和MS评分中也观察到类似的趋势，两者都降低了。综上所述，NAFLD患者参加CBT治疗可显著改善其一般指标和肝脏指标。在与生活方式相关的疾病发病机制保持一致的2年随访中，有益效果在很大程度上保持不变。
The effectiveness of cognitive-behavior treatment (CBT) in nonalcoholic fatty liver disease (NAFLD), largely related to overweight/obesity and considered the hepatic expression of the metabolic syndrome (MS), has so far been tested in very limited samples. In a tertiary referral center, consecutively observed NAFLD subjects were offered a CBT program aimed at weight loss and increased physical activity, based on 13 group sessions; 68 cases entered the treatment protocol, those who refused (n = 82) were given recommendations for diet and physical activity. Treatment goals (weight loss >= 7% initial body weight, normalization of liver enzymes, and improved parameters of MS) were tested by logistic regression at 6 months (all cases) and at 2 years, both on intention-to-treat and in completers (Diet, 78; CBT, 65). The results were adjusted for the propensity score of attending the CBT program, based on civil, anthropometric and clinical variables. At baseline the CBT group had a larger prevalence of obesity and more severe insulin resistance (homeostasis model assessment (HOMA)). At follow-up, CBT was associated with a higher probability of weight loss and normal liver enzymes (6-month: odds ratio (OR), 2.56; 95% confidence interval (CI), 1.15-5.69; 2-year intention-to-treat: OR, 3.57, 95% CI, 1.59-8.00), after adjustment for propensity and changes in body weight. A similar trend was observed in the outcome goals of insulin resistance and the score of MS, which were both reduced. In conclusion, subjects with NAFLD participating in a CBT program significantly improve their general and liver parameters. The beneficial effects are largely maintained at 2-year follow-up, in keeping with the lifestyle-related pathogenesis of disease.