Vitamin E and changes in serum alanine aminotransferase levels in patients with non-alcoholic steatohepatitis.
Vitamin E and changes in serum alanine aminotransferase levels in patients with non-alcoholic steatohepatitis.
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DOI：
10.1111/apt.12352
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发表时间：
2013-07
影响因子：
7.6
通讯作者：
Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN)
中科院分区：
文献类型：
--
作者：
Hoofnagle JH;Van Natta ML;Kleiner DE;Clark JM;Kowdley KV;Loomba R;Neuschwander-Tetri BA;Sanyal AJ;Tonascia J;Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN)
非酒精性脂肪性肝炎（NASH）是血清丙氨酸氨基转移酶（ALT）升高和慢性肝病的常见原因，但目前尚不清楚ALT升高如何反映肝损伤。评估ALT升高的变化如何反映维生素E治疗后肝脏组织学的改善。重新评估了吡格列酮vs.维生素E vs.安慰剂治疗非酒精性脂肪性肝炎（PIVENS）试验的维生素E和安慰剂组ALT水平、体重和肝脏组织学变化之间的相关性。ALT应答定义为降至≤40 U/L且较基线降低≥30%。在治疗前后对肝活检进行非酒精性脂肪肝活动度（NAS）和纤维化评分。维生素E组ALT应答率（48%）高于安慰剂组（16%）（P < 0.001）。在维生素E接受者中，ALT应答与NAS降低相关（P < 0.001），但与纤维化评分无关（P = 0.34），而在安慰剂接受者中，ALT应答与NAS和纤维化评分显著降低相关（P < 0.05）。体重减轻（≥2 kg）也与ALT反应（P < 0.001）、NAS改善（P < 0.001）和纤维化（P < 0.02）相关，但维生素E在体重减轻和不减轻的情况下都有额外的作用。体重增加（≥2 kg）与未服用维生素E的患者的ALT反应缺乏以及NAS和纤维化评分恶化相关。NASH患者ALT水平降至正常通常与组织学活性改善相关。管理人员应强调减肥的价值，并强烈阻止体重增加。维生素E可以改善ALT水平和组织学，无论是否减肥。临床试验编号：NCT 00063622。
Non-alcoholic steatohepatitis (NASH) is a common cause of serum alanine aminotransferase (ALT) elevations and chronic liver disease, but it is unclear how well ALT elevations reflect the liver injury. To assess how well changes in ALT elevations reflect improvements in liver histology in response to vitamin E therapy. The vitamin E and placebo arms of the Pioglitazone vs. Vitamin E vs. Placebo in Non-alcoholic Steatohepatitis (PIVENS) trial were reassessed for associations among changes in ALT levels, body weight and liver histology. An ALT response was defined as a decrease to ≤40 U/L and by ≥30% of baseline. Liver biopsies taken before and after treatment were scored for non-alcoholic fatty liver disease activity (NAS) and fibrosis. ALT responses were more frequent among vitamin E (48%) than placebo (16%) recipients (P < 0.001). Among vitamin E recipients, ALT responses were associated with decreases in NAS (P < 0.001), but not fibrosis scores (P = 0.34), whereas among placebo recipients, ALT responses were associated with significant decreases in both (P < 0.05). Weight loss (≥2 kg) was also associated with ALT response (P < 0.001), improvements in NAS (P < 0.001) and fibrosis (P < 0.02), but vitamin E had an added effect both with and without weight loss. Weight gain (≥2 kg) was associated with lack of ALT response and worsening NAS and fibrosis scores in patients not on vitamin E. Decrease of ALT levels to normal in patients with NASH is usually associated with improved histological activity. Management should stress the value of weight loss and strongly discourage weight gain. Vitamin E can improve both ALT levels and histology with and without weight loss. Clinical Trial Number: NCT00063622.
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DOI：
10.1056/nejmoa0907929
发表时间：
2010-05-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sanyal AJ;Chalasani N;Kowdley KV;McCullough A;Diehl AM;Bass NM;Neuschwander-Tetri BA;Lavine JE;Tonascia J;Unalp A;Van Natta M;Clark J;Brunt EM;Kleiner DE;Hoofnagle JH;Robuck PR;NASH CRN
通讯作者：
NASH CRN
影响因子：
7.4
作者：
Traber, Maret G.;Stevens, Jan F.
通讯作者：
Stevens, Jan F.
影响因子：
2.2
作者：
Chalasani NP;Sanyal AJ;Kowdley KV;Robuck PR;Hoofnagle J;Kleiner DE;Unalp A;Tonascia J;NASH CRN Research Group
通讯作者：
NASH CRN Research Group
影响因子：
12.6
作者：
Sanyal, Arun J.;Mofrad, Pouneh S.;Mills, Alan S.
通讯作者：
Mills, Alan S.
影响因子：
158.5
作者：
Sano, M;Ernesto, C;Thal, LJ
通讯作者：
Thal, LJ