肥胖伴非酒精性脂肪性肝病的临床研究  

Clinical study of obesity associated non-alcoholic fatty liver disease

作　　者：范竹萍[1] 邱德凯[1] 谢渭芬[2] 胡和平[3] 陈岳祥[2] 孙媛媛[3] 刘苏[2] 曾民德[1] 

机构地区：[1]上海第二医科大学附属仁济医院消化科,上海市消化疾病研究所200001 [2]第二军医大学附属长征医院消化科 [3]第二军医大学附属东方肝胆病医院消化科

出　　处：《肝脏》2004年第3期155-158,共4页Chinese Hepatology

摘　　要：目的　探讨非酒精性脂肪性肝病 (NAFLD)的发病机制及奥利司他结合低热量饮食治疗对NAFLD的有效性和安全性。方法　将 10 7例病人分为 4组。A组为肥胖伴NAFLD和肝损伤组 (60例 ) ,B组为无脂肪肝肥胖组 (16例 ) ,C组为肥胖伴NAFLD组 (12例 ) ,D组为丙氨酸转氨酶 (ALT)和天冬氨酸转氨酶 (AST)均升高组 (19例 ) ,其中A组给予奥利司他 12 0mg ,每日 3次 ,结合低热卡饮食 ,共治疗 2 4周。分别检测各组相关代谢指标。结果　①各组之间胰岛素 (INS)、瘦素、游离脂肪酸 (FFA)、铁蛋白、胰岛素抵抗指数 (IR)水平差异无显著性 ,而转化生长因子 (TGF) β1在A组与C组和C组与D组间差异有显著性 (P =0 .0 0 0 3 0 )。②TGF β1和FFA与肝 /脾比值 (LSR )呈负相关 ,AST、谷氨酰转肽酶 (GGT)与LSR呈负相关 ,白细胞与LSR呈正相关。③A组病人在治疗 2 4周后体重指数 (BMI)下降达 10 .76%±4.5 2 %。AST、ALT、GGT及总胆红素有显著改善 ,治疗后LSR亦显著增加 (P <0 .0 1)。④不良作用发生率为 96.7% ,均与排便有关。结论　奥利司他结合低热量饮食可改善肝功能和相关代谢综合征 。Objective To study the pathogenesis of non alcoholic fatty liver disease(NAFLD) and the efficacy and safety of Orlistat plus low caroli diet in the treatment of NAFLD.Methods 107 patients were divided into 4 groups. Group A was obese associated NAFLD with abnormal liver test ( n =60),group B was obese without NAFLD( n =16), group C was obese associated NAFLD( n =12),group D was obese with both ALT and AST elevation ( n =19). Patients in group A was given Orlistat plus low caroli diet for 24 weeks. The laboratory parameters were tested for all patients.Results ①There were no significant differences in levels of insulin, leptin, free fatty acid(FFA), ferritin and the index of insulin resistance among 4 groups.The differences of the level of transforming growth factor β1(TGF β1)were significant between group A and C, and group C and D( P = 0.0003 ).②The levels of TGF β1 and FFA were negatively related with the ratio of liver/spleen in CT scan(LSR),AST and GGT were negatively related with LSR,and the white blood cells were positively related with LSR.③ Body mass index decrease to 10.76% ±4.52% in group A after 24 weeks therapy. The levels of AST、ALT、GGT and total bilirubin improved. The LSR also increased ( P < 0.05 ).④The incidence of adverse events was 96.7% , almost manifested by oily stool.Conclusion Orlistat with low caroli diet can be used as a treatment option.

关 键 词：肥胖 治疗 NAFLD 奥利司他 非酒精性脂肪性肝病 AST 低热量饮食 FFA ALT 病人 

分 类 号：R575[医药卫生—消化系统] R589.2[医药卫生—内科学]