Docosahexanoic Acid Plus Vitamin D Treatment Improves Features of NAFLD in Children with Serum Vitamin D Deficiency: Results from a Single Centre Trial.
Docosahexanoic Acid Plus Vitamin D Treatment Improves Features of NAFLD in Children with Serum Vitamin D Deficiency: Results from a Single Centre Trial.
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二十二碳己酸加维生素D治疗可改善血清维生素D缺乏症儿童NAFLD的特征：来自单中心试验的结果
DOI：
10.1371/journal.pone.0168216
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Nobili V
中科院分区：
文献类型：
--
作者：
Della Corte C;Carpino G;De Vito R;De Stefanis C;Alisi A;Cianfarani S;Overi D;Mosca A;Stronati L;Cucchiara S;Raponi M;Gaudio E;Byrne CD;Nobili V
目前还没有针对成人或儿童的非酒精性脂肪性肝病(NAFLD)的许可治疗方法。在NAFLD中，几项研究表明omega-3脂肪酸治疗对血脂、胰岛素敏感性和肝脏脂肪变性有好处，也有研究表明维生素D治疗对肝脏疾病具有潜在的抗纤维化作用。然而，到目前为止，还没有研究测试二十二碳六烯酸(DHA)和维生素D的组合治疗可能有益于NAFLD的所有疾病。因此，我们的目标是在一项随机、双盲的安慰剂对照试验中，测试每日DHA(500毫克)加维生素D(800IU)对经活检证实为NAFLD和维生素D缺乏症的肥胖儿童的治疗效果。43名患者中有41名完成了研究(18名患者接受治疗，23名患者接受安慰剂治疗)。12个月时：i)主要结果是NAS定义的肝脏组织学改善；ii)次要结果是代谢参数的改善。在治疗组中，DHA加维生素D治疗降低了非酒精性脂肪肝活动度评分(5.4v1.92；P<；0.001)。治疗组肝纤维化积分无明显变化，但肝星状细胞活化程度和胶原纤维含量明显降低(3.51±1.66vs1.59±1.37；P=0.003)。此外，治疗后甘油三酯(174.5比102.15 mg/dl)、丙氨酸氨基转移酶(40.25uI/dl比24.5uI/L)和HOMA-IR(4.59比3.42uI/dl)均下降。DHA加维生素D治疗可改善胰岛素抵抗、血脂、ALT和NAS。治疗后HSC活性和胶原含量均降低。
There are no licensed treatments for non alcoholic fatty liver disease (NAFLD) in adults or children. In NAFLD, several studies have shown a benefit of omega-3 fatty acid treatment on lipid profile, insulin-sensitivity and hepatic steatosis and it has also been suggested that Vitamin D treatment has potential antifibrotic properties in liver disease. To date, however, there are no studies that have tested the combination of Docosahexanoic acid (DHA) and vitamin D treatment which may benefit the whole spectrum of disease in NAFLD. Our aim therefore, was to test the effect of daily DHA (500 mg) plus vitamin D (800 IU) treatment, in obese children with biopsy-proven NAFLD and vitamin D deficiency, in a randomized, double-blind placebo-controlled trial. The 41/43 patients completed the study (18-treatment, 23-placebo). At 12 months: i) the main outcome was liver histology improvement, defined by NAS; ii) the secondary outcome was amelioration of metabolic parameters. DHA plus vitamin D treatment reduced the NAFLD Activity Score (NAS), in the treatment group (5.4 v1.92; p<0.001 for baseline versus end of study). There was no change in fibrosis score, but a reduction of the activation of hepatic stellate cells (HSC) and fibrillar collagen content was noted (3.51±1.66 v. 1.59±1.37; p = 0.003) in treatment group. Moreover, the triglycerides (174.5 vs. 102.15 mg/dl), ALT (40.25 vs. 24.5 UI/l) and HOMA-IR (4.59 vs. 3.42) were all decreased with treatment. DHA plus vitamin D treatment improved insulin-resistance, lipid profile, ALT and NAS. There was also decreased HSC activation and collagen content with treatment.