Effect of weight reduction on histological activity and fibrosis of lean nonalcoholic steatohepatitis patient
Effect of weight reduction on histological activity and fibrosis of lean nonalcoholic steatohepatitis patient
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DOI：
10.2478/jtim-2019-0023
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发表时间：
2019-09-01
影响因子：
4.9
通讯作者：
Hasan, Nazmul
中科院分区：
文献类型：
--
作者：
Alam, Shahinul;Hasan, Mohammad Jahid;Hasan, Nazmul
背景和目的：体重减轻对非酒精性脂肪性肝炎（NASH）的组织学活性和纤维化的减弱有明显的益处，但缺乏关于瘦型NASH亚组的数据。我们设计了这项研究来比较体重减轻对瘦型和非瘦型NASH的组织学活性和纤维化的影响。方法：我们纳入了20例瘦型和20例非瘦型组织学证实的NASH患者。BMI < 25 kg/m2被定义为非瘦型。获得每例受试者的知情同意书。所有方法均按照赫尔辛基宣言进行。建议两组进行适度运动沿着饮食限制以减轻体重。1年后，16名非瘦型和15名瘦型患者完成了第二次肝活检。结果如下：两组患者年龄、性别、谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转移酶（GGT）、胰岛素抵抗指数（HOMA-IR）、甘油三酯（TG）、高密度脂蛋白（HDL）水平相似。两组的脂肪变性、气球样变、小叶炎症、非酒精性脂肪性肝病活动评分（NAS）和纤维化相似。在瘦/非瘦组中，分别在8/11、5/6和2/6例患者中发现任何量的体重减轻、>= 5%的体重减轻和>= 7%的体重减轻。在瘦和非瘦组中，任何量的体重减轻都与脂肪变性、气球样变和NAS的显著减少相关，小叶炎症和纤维化除外。在两组中，体重减轻>= 5%仅与NAS显著降低相关。然而，仅在非瘦型组中注意到NAS的显著改善，体重减轻>= 7%。结论：较少量的体重减轻具有改善瘦型和非瘦型NASH中所有组织学活性区段的良好益处。
Background and Objective: Weight reduction has evidenced benefit on attenuation of histological activity and fibrosis of nonalcoholic steatohepatitis (NASH), but there is scarcity of data for lean NASH subgroup. We have designed this study to compare the effects of weight reduction on histological activity and fibrosis of lean and non-lean NASH. Methods: We have included 20 lean and 20 non-lean histologically proven NASH patients. BMI < 25 kg/m(2) was defined as non-lean. Informed consent was taken from each subject. All methods were carried out in accordance with the Declaration of Helsinki. Moderate exercise along with dietary restriction was advised for both groups for weight reduction. After 1 year, 16 non-lean and 15 lean had completed second liver biopsy. Results: Age, sex, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltrasferase (GGT), Homeostasis model assessment insulin resistance (HOMA-IR), triglyceride and high density lipoprotein (HDL) was similar in both groups. Steatosis, ballooning, lobular inflammation, nonalcoholic fatty liver disease activity score (NAS) and fibrosis was similar in the two groups. In lean/non-lean group, any amount of weight reduction, >= 5% weight reduction and >= 7% weight reduction was found in respectively 8/11, 5/6 and 2/6 patients. In both lean and non-lean groups, weight reduction of any amount was associated with significant reduction of steatosis, ballooning and NAS, except lobular inflammation and fibrosis. In both groups, weight reduction of >= 5% was associated with significant reduction in NAS only. However, significant improvement in NAS was noted with >= 7% weight reduction in non-lean group only. Conclusion: Smaller amount of weight reduction had the good benefit of improvement in all the segments of histological activity in both lean and non-lean NASH.