Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study
Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study
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DOI：
10.3945/ajcn.113.068890
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发表时间：
2014-03-01
影响因子：
7.1
通讯作者：
Hekmatdoost, Azita
中科院分区：
文献类型：
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作者：
Eslamparast, Tannaz;Poustchi, Hossein;Hekmatdoost, Azita
背景：非酒精性脂肪性肝病(NAFLD)是世界上最常见的慢性肝病。口服合生素已被认为是一种有效的治疗NAFLD的方法，因为它对肠道菌群有调节作用，可以影响肠-肝轴。目的：评价合生素对NAFLD患者肝纤维化、肝酶和炎症标志物的影响。设计：在一项随机、双盲、安慰剂对照的临床试验中，52例NAFLD患者每天补充两次合生素或安慰剂胶囊，共28周。结果：研究结束时，两组患者的丙氨酸氨基转移酶(ALT)浓度均下降，合生素组下降更明显。在研究结束时，合生素组和安慰剂组之间的显著差异分别是：ALT[-25.1(-26.2，-24)比-7.29(-9.5，-5.1)IU/L；P<；0.0011，天冬氨酸转氨酶[-31.33(-32.1，-30.5)比-7.94(-11.1，-4.8)IU/L；P<；高敏C反应蛋白[-2.3(-3，-1.5)对-1.04(-1.5，-0.6)mol/L；P<；0.001]；P<；0.0011，总核因子kappaB p65[-0.016(-0.022，-0.011)，P<；0.001(-0.004，-0.007)mmoL/L；P<；瞬时弹性成像测定的肝纤维化积分[-2.98(-3.6，-2.37)比-0.77(-1.32，-0.2 2)kPa；P<；0.0011]。结论：在改善生活方式的基础上加用合生素补充剂治疗非酒精性脂肪性肝病优于单纯改变生活方式，至少部分是通过减少体内炎症标志物的作用。随着治疗时间的延长，这些影响是否会持续仍有待确定。
Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world. Oral administration of synbiotic has been proposed as an effective treatment of NAFLD because of its modulating effect on the gut flora, which can influence the gut-liver axis.Objective: The objective was to evaluate the effects of supplementation with synbiotic on hepatic fibrosis, liver enzymes, and inflammatory markers in patients with NAFLD.Design: In a randomized, double-blind, placebo-controlled clinical trial conducted as a pilot study, 52 patients with NAFLD were supplemented twice daily for 28 wk with either a synbiotic or a placebo capsule. Both groups were advised to follow an energy-balanced diet and physical activity recommendations.Results: At the end of the study, the alanine aminotransferase (ALT) concentration decreased in both groups; this reduction was significantly greater in the synbiotic group. At the end of the study, the following significant differences [means (95% CIs)] were seen between the synbiotic and placebo groups, respectively: ALT [-25.1 (-26.2, -24) compared with -7.29 (-9.5, -5.1) IU/L; P < 0.0011, aspartate aminotransferase [-31.33 (-32.1, -30.5) compared with -7.94 (-11.1, -4.8) IU/L; P < 0.001], gamma-glutamyltransferase [-15.08 (-15.5, -14.7) compared with -5.21 (-6.6, -3.9) IU/L; P < 0.001], high-sensitivity C-reactive protein [-2.3 (-3, -1.5) compared with -1.04 (-1.5, -0.6) mmol/L; P < 0.05], tumor necrosis factor-alpha [-1.4 (-1.7, -1.1) compared with -0.59 (-0.8, -0.3) mmol/L; P < 0.0011, total nuclear factor kappa-B p65 [-0.016 (-0.022, -0.011) compared with 0.001 (-0.004, - 0.007) mmol/L; P < 0.0011, and fibrosis score as determined by transient elastography [- 2.98 (-3.6, -2.37) compared with -0.77 (-1.32, -0.22) kPa; P < 0.0011.Conclusions: Synbiotic supplementation in addition to lifestyle modification is superior to lifestyle modification alone for the treatment of NAFLD, at least partially through attenuation of inflammatory markers in the body. Whether these effects will be sustained with longer treatment durations remains to be determined.