Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis
Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis
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DOI：
10.1053/j.gastro.2015.04.005
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发表时间：
2015-08-01
期刊：
影响因子：
29.4
通讯作者：
Romero-Gomez, Manuel
中科院分区：
文献类型：
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作者：
Vilar-Gomez, Eduardo;Martinez-Perez, Yadina;Romero-Gomez, Manuel
背景与目的：体重减轻如何影响非酒精性脂肪性肝炎（NASH）患者的肝脏组织学特征尚不清楚。我们研究了生活方式改变引起的体重减轻幅度与NASH组织学特征变化之间的关系。方法：我们对293例经组织学证实的NASH患者进行了一项前瞻性研究，这些患者被鼓励采取推荐的生活方式改变，以减轻体重超过52周，从2009年6月到2013年5月，在古巴哈瓦那的三级医疗中心。在研究开始时和饮食第52周时收集肝脏活组织检查，并进行组织学分析。结果：从261例患者中获得了配对肝活检。在293名经历52周生活方式改变的患者中，72名（25%）脂肪性肝炎消退，138名（47%）非酒精性脂肪性肝病活动评分（NAS）降低，56名（19%）纤维化消退。在第52周，88名受试者（30%）的体重减轻>= 5%。体重减轻程度与所有NASH相关组织学参数的改善独立相关（优势比= 1.1-2.0; P <0.01）。体重减轻≥ 5%的受试者中NASH消退（51/88 [58%]）和NAS降低2分（72/88 [82%]）的比例高于体重减轻≥ 10%的受试者，NAS降低90%，NASH消退45%，纤维化消退45%。所有体重减轻7%-10%且几乎没有风险因素的患者也降低了NAS。在基线特征包括女性、体重指数>= 35、空腹血糖>5.5 mmol/L和许多气球样细胞的患者中，NAS评分随着体重减轻> 10%而显著降低。结论：生活方式改变引起的更大程度的体重减轻与NASH组织学特征的改善水平相关。体重减轻>= 10%的患者NAS降低、NASH消退和纤维化消退率最高。
BACKGROUND & AIMS: It is not clear how weight loss affects histologic features of liver in patients with nonalcoholic steatohepatitis (NASH). We examined the association between the magnitude of weight loss through lifestyle modifications and changes in histologic features of NASH. METHODS: We conducted a prospective study of 293 patients with histologically proven NASH who were encouraged to adopt recommended lifestyle changes to reduce their weight over 52 weeks, from June 2009 through May 2013, at a tertiary medical center in Havana, Cuba. Liver biopsies were collected when the study began and at week 52 of the diet and were analyzed histologically. RESULTS: Paired liver biopsies were available from 261 patients. Among 293 patients who underwent lifestyle changes for 52 weeks, 72 (25%) achieved resolution of steatohepatitis, 138 (47%) had reductions in nonalcoholic fatty liver disease activity score (NAS), and 56 (19%) had regression of fibrosis. At week fifty-two, 88 subjects (30%) had lost >= 5% of their weight. Degree of weight loss was independently associated with improvements in all NASH-related histologic parameters (odds ratios = 1.1-2.0; P < .01). A higher proportion of subjects with >= 5% weight loss had NASH resolution (51 of 88 [58%]) and a 2-point reduction in NAS (72 of 88 [82%]) than subjects who lost = 10% of their weight had reductions NAS, 90% had resolution of NASH, and 45% had regression of fibrosis. All patients who lost 7%-10% of their weight and had few risk factors also had reduced NAS. In patients with baseline characteristics that included female sex, body mass index >= 35, fasting glucose >5.5 mmol/L, and many ballooned cells, NAS scores decreased significantly with weight reductions >10%. CONCLUSIONS: A greater extent of weight loss, induced by lifestyle changes, is associated with the level of improvement in histologic features of NASH. The highest rates of NAS reduction, NASH resolution, and fibrosis regression occurred in patients with weight losses >= 10%.